{
  "abstract": "Introduction\n\nIt remains unclear whether medial temporal lobe (MTL) hyperperfusion in cognitively unimpaired apolipoprotein E (APOE) ɛ4 carriers reflects resilience or dysfunction. We examined whether cortical MTL cerebral blood flow (CBF) relates to cognition differently in APOE ɛ4 carriers and noncarriers with and without AD pathophysiological changes.Methods\n\nOne hundred forty-eight cognitively unimpaired older adults underwent pseudo-continuous arterial spin labeling MRI to quantify MTL CBF and assessment of memory and executive function. In a subset (n = 126), AD pathology was indexed using plasma phosphorylated tau 217 (pTau₂₁₇).Results\n\nAPOE ɛ4 carriers showed higher MTL CBF than noncarriers. Higher MTL CBF was associated with better executive function only in pTau₂₁₇-negative APOE ɛ4 carriers. Interactions remained significant after adjusting for MTL cortical volume or white matter hyperintensities.Discussion\n\nHyperperfusion in cognitively unimpaired APOE ɛ4 carriers may reflect a resilience biomarker related to better cognitive function in the absence of detectable AD pathophysiological changes.Highlights\n\nApolipoprotein E (APOE) ɛ4 carriers show elevated medial temporal lobe (MTL) cerebral blood flow (CBF). Higher MTL CBF is linked to better executive function in APOE ɛ4 carriers. This association is only observed in APOE ɛ4 carriers who are pTau₂₁₇-negative. MTL hyperperfusion may mark resilience in APOE ɛ4 carriers at risk for AD.",
  "abstract_shown": true,
  "affiliations": [
    "Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA.",
    "Department of Psychological Science, University of California, Irvine, California, USA.",
    "Keck School of Medicine, University of Southern California, Los Angeles, California, USA.",
    "Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA.",
    "Department of Pathology and Laboratory Medicine, University of California, Irvine, Medical Sciences D, Irvine, California, USA.",
    "Department of Neurology, University of California, Irvine, Irvine, California, USA.",
    "Center for Innovations in Brain Science, Department of Pharmacology, University of Arizona, Tucson, Arizona, USA.",
    "Department of Psychology, University of Southern California, Dornsife College of Arts and Letters, Los Angeles, California, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 17,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Melanie Quiring",
      "orcid": "0000-0002-2997-1105"
    },
    {
      "affs": [
        1
      ],
      "name": "Arunima Kapoor"
    },
    {
      "affs": [
        0
      ],
      "name": "John Paul M Alitin"
    },
    {
      "affs": [
        0
      ],
      "name": "Basant Lashin"
    },
    {
      "affs": [
        0
      ],
      "name": "Jillian L Joyce"
    },
    {
      "affs": [
        1
      ],
      "name": "Allison C Engstrom"
    },
    {
      "affs": [
        2
      ],
      "name": "Trevor Lohman"
    },
    {
      "affs": [
        0
      ],
      "name": "Aimée Gaubert"
    },
    {
      "affs": [
        1
      ],
      "name": "Fatemah Shenasa"
    },
    {
      "affs": [
        0
      ],
      "name": "Kevin W Law"
    },
    {
      "affs": [
        0
      ],
      "name": "Farrah Ferrer"
    },
    {
      "affs": [
        3
      ],
      "name": "Danny J J Wang"
    },
    {
      "affs": [
        4
      ],
      "name": "Elizabeth Head"
    },
    {
      "affs": [
        5
      ],
      "name": "Rond Malhas"
    },
    {
      "affs": [
        6
      ],
      "name": "Kathleen Rodgers"
    },
    {
      "affs": [
        7
      ],
      "name": "S Duke Han"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Daniel A Nation",
      "orcid": "0000-0002-9123-0658"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/79hzwwndejv6f.bib",
  "cited_by": 0,
  "doi": "10.1002/alz.71934",
  "fulltext_url": "https://europepmc.org/articles/PMC13687585",
  "id": "79hzwwndejv6f",
  "issns": [
    "1552-5260",
    "1552-5279"
  ],
  "landing_url": "https://europepmc.org/article/MED/42908099",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2738|Dementia and Cognitive Impairment Research"
    ]
  ],
  "openalex": "W7223182287",
  "pdf_url": "https://europepmc.org/articles/PMC13687585?pdf=render",
  "pmcid": "PMC13687585",
  "pmid": "42908099",
  "published": "2026-10-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/79hzwwndejv6f.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42908099",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42908099"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2738|Dementia and Cognitive Impairment Research",
      "subfield": "psychiatry"
    }
  ],
  "title": "Cerebral blood flow as a biomarker of resilience in cognitively unimpaired APOE ɛ4 carriers.",
  "title_text": "Cerebral blood flow as a biomarker of resilience in cognitively unimpaired APOE ɛ4 carriers.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:57Z",
  "url": "https://research.draconitic.com/paper/79hzwwndejv6f",
  "venue": "Alzheimer's & dementia : the journal of the Alzheimer's Association",
  "versions": []
}