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Inside the brains of some cognitively normal adults, firing patterns were able to foretell Alzheimer's disease years before the onset of memory loss or the accumulation of plaques and tangles, according to new Stanford Medicine–led research. For others, different firing patterns indicated the opposite—brains unusually resilient to cognitive decline and on track for "super ager" status.

The findings, published Nov. 4 in Science Advances, suggest a new type of early biomarker—perhaps a modifiable one—for cognitive decline in old age.

In the new study, researchers first analyzed the resting brain activity of adults 75 and older on two ends of the cognitive spectrum: those diagnosed with Alzheimer's disease and so-called super agers, who have the memory capacity of people decades younger. Extrapolating from these two extremes, the researchers developed a scoring system that could place slightly younger adults, ages 55 to 70, who had no signs of cognitive decline, along the spectrum based on their brain activity.

The more Alzheimer's-like someone's brain activity, the more likely they would experience mental decline, develop amyloid-beta plaques and be diagnosed with Alzheimer's within the next 12 years. The more super-ager-like someone's brain activity, the more likely they were to avoid these outcomes.

The new scoring system was better at predicting cognitive decline than demographics, amyloid-beta and tau biomarkers and genetics. It could provide some of the earliest warning signs yet of Alzheimer's disease risk in people with no apparent cognitive impairment.

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