Understanding brain resilience in superagers: a systematic review
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DIAGNOSTIC NEURORADIOLOGY
Understanding brain resilience in superagers: a systematic review Laiz Laura de Godoy 1,2 & Cesar Augusto Pinheiro Ferreira Alves 3 & Juan Sebastian Martin Saavedra 3 Adalberto Studart-Neto 2 & Ricardo Nitrini 2 & Claudia da Costa Leite 2 & Sotirios Bisdas 1
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Received: 24 June 2020 / Accepted: 16 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Superagers are older adults presenting excellent memory performance that may reflect resilience to the conventional pathways of aging. Our contribution aims to shape the evidence body of the known distinctive biomarkers of superagers and their connections with the Brain and Cognitive Reserve and Brain Maintenance concepts. Methods We performed a systematic literature search in PubMed and ScienceDirect with no limit on publication date for studies that evaluated potential biomarkers in superagers classified by validated neuropsychological tests. Methodological quality was assessed using the QUADAS-2 tool. Results Twenty-one studies were included, the majority in neuroimaging, followed by histological, genetic, cognition, and a single one on blood plasma analysis. Superagers exhibited specific regions of cortical preservation, rather than global cortical maintenance, standing out the anterior cingulate and hippocampus regions. Both superagers and controls showed similar levels of amyloid deposition. Moreover, the functional oscillation patterns in superagers resembled those described in young adults. Most of the quality assessment for the included studies showed medium risks of bias. Conclusion This systematic review supports selective cortical preservation in superagers, comprehending regions of the default mode, and salience networks, overlapped by stronger functional connectivity. In this context, the anterior cingulate cortex is highlighted as an imaging and histologic signature of these subjects. Besides, the biomarkers included pointed out that the Brain and Cognitive Reserve and Brain Maintenance concepts are independent and complementary in the superagers’ setting. Keywords Superagers . Biomarkers . Memory . Cognition . Neuroimaging
Key Points • Superagers showed selective cortical preservation in some DMN and SN regions, overlapped by stronger functional connectivity akin to young adults (Cognitive Reserve and Brain Maintenance). • The anterior cingulate cortex is a key structure of superagers in different biomarkers' sources (structural and functional MRI and histological studies). • Levels of amyloid deposition were not related to the superager subjects, pointing out that brain resilience may be partially independent of neurodegeneration (Brain and Cognitive Reserve). • Brain and Cognitive Reserve and Brain Maintenance concepts tend to exert independent and complementary roles in the setting of superagers. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00234-020-02562-1) contains supplementary material, which is available to authorized users. *
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