The protective factors that influence amyloid and Alzheimer disease (AD)-pattern neurodegeneration are different, according to a recent cohort study. Researchers conducted a prospective analysis of 942 elderly individuals ( aged 70-≥90 years) with magnetic resonance imaging and Pittsburgh compound B-positron emission tomography scans enrolled in the Mayo Clinic Study of Aging. They operationalized “exceptional aging” without Alzheimer disease pathophysiology (ADP) by considering individuals aged ≥85 years to be without significant evidence of ADP. Participants included 423 (45%) women and the average age of participants was 79.7 (5.9) years. They found:

• Apart from demographics and the APOE genotype, only midlife dyslipidemia was associated with amyloid deposition.
• Obesity, smoking, diabetes, hypertension, and cardiac and metabolic conditions, but not intellectual enrichment, were associated with greater AD-pattern neurodegeneration.
• In the ≥85 years cohort, results showed small to moderate effects of several variables except job score and midlife hypertension in predicting exceptional aging without ADP.