Connectivity and morphology of hubs of the cerebral structural connectome are associated with brain resilience in AD- and age-related pathology.

The physiological basis of resilience to age-associated and AD-typical neurodegenerative pathology is still not well understood. So far, the established resilience factor intelligence has been shown to be associated with white matter network global efficiency, a key constituent of which are highly connected hubs. However, hub properties have also been shown to be impaired in AD. Individual predisposition or vulnerability of hub properties may thus modulate the impact of pathology on cognitive outcome and form part of the physiological basis of resilience. 85 cognitively normal elderly subjects and patients with MCI with DWI, MRI and AV45-PET scans were included from ADNI. We reconstructed the global WM networks in each subject and characterized hub-properties of GM regions using graph theory by calculating regional betweenness centrality. Subsequently, we investigated whether regional GM volume (GMV) and structural WM connectivity (WMC) of more hub-like regions was more associated with resilience, quantified as cognitive performance independent of amyloid burden, tau and WM lesions. Subjects with higher resilience showed higher increased regional GMV and WMC in more hub-like compared to less hub-like GM-regions. Additionally, this association was in some instances further increased at elevated amounts of brain pathology. Higher GMV and WMC of more hub-like regions may contribute more to resilience compared to less hub-like regions, reflecting their increased importance to brain network efficiency, and may thus form part of the neurophysiological basis of resilience. Future studies should investigate the factors leading to higher GMV and WMC of hubs in non-demented elderly with higher resilience.