A - 36 Neuroprotective and Resilience Factors in an Individual with Positive ad Biomarkers.

Abstract

There is conflicting research on risk indicators relating to the diagnosis of early-onset Alzheimer's disease (EOAD). We assessed an individual with numerous factors that are associated with EOAD including the presence of two APOE e4 alleles, family history of EOAD, and positive biomarkers (i.e., Amyloid PET Scan; CSF). Longitudinal neuropsychological data reflect minimal cognitive decline through age 73, suggesting substantial mediating effects of cognitive reserve and neuroprotective measures: aerobic exercise, cognitive stimulation, and psychological health. A 73-year-old man was seen for repeat neuropsychological evaluation in 2022 at an academic medical center following his baseline evaluation in 2019, which did not reveal cognitive deficits. Testing was conducted and interpreted by a clinical neuropsychologist in the context of available neuroimaging and neurodiagnostic information. Results of the neuropsychological assessment were interpreted in the context of High Average to Superior premorbid functioning, a significant family history of EOAD, a positive Amyloid PET scan and two ApoE4 alleles (4/4). Results of his 2022 evaluation remain consistent or improved from 2019 and do not suggest mild cognitive impairment (MCI). Functionally, this individual is fully independent in IADLs and does not report significant subjective cognitive concerns. Phenotypic expression of ad symptoms are delayed in this individual despite his genetic risk and pathologic biomarkers; the reason is likely multifactorial but includes several resilience factors, including good cardiovascular health (i.e., aerobic exercise 5x/week), continued cognitive stimulation, and psychological health. These are areas worthy of further research.