Abstract 6- 1315-1330
Category: Clinical

At the end of the session,
participants will be able to:

  1. Understand the relationship between clinical manifestations and neuropathology in AD
  2. Describe the characteristics that are associated with cognitive resilience in AD patients



Dr. Narges Ahangari is a researcher at Saint Michael’s Hospital, Toronto. She graduated in Medicine from Tehran University of Medical Sciences in Iran in 2018 and moved to Canada in 2019. She has done research at Dr.Allison McGeer’s lab at Mount Sinai Hospital on Enterobacteriaceae infections in hospitals. She then was able to pursue her field of interest in neuropathology, and has been working with Dr.Munoz and Dr. Woulfe since 2019 on different projects including nuclear IMPDH filaments in gliomas and resilience in Alzheimer’s Disease.


Narges Ahangari1, Corinne E. Fischer2,3,4, Tom A. Schweizer2,4,5, David G. Munoz1,2,6

1 Division of Pathology, St. Michael’s Hospital, Toronto, ON, Canada 

2 Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St.Michael’s Hospital, Toronto, ON, Canada 

3 Department of Psychiatry, Faculty of Medicine, University of Toronto, ON, Canada

4 Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada

5 Division of Neurosurgery, Faculty of Medicine, University of Toronto, ON, Canada  

6 Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada

Target Audience:
Pathologists, Residents, Medical Students

Medical Expert (the integrating role), Communicator, Collaborator, Leader, Health Advocate, Scholar, Professional

Cognitive resilience in individuals with severe Alzheimer’s disease neuropathology


We sought to identify demographic, clinical, genetic, and neuropathological features associated with cognitive resilience in subjects with severe Alzheimer’s disease (AD) neuropathology.  Data for this study was obtained from National Alzheimer’s Coordinating Centre (NACC) dataset. Study inclusion criteria are as follows: severe AD pathology, i.e., frequent neuritic plaques and Braak & Braak stage V/VI pathology, interval between last visit and death ≤ 2 years, and absence of other primary neuropathology diagnoses. Cognition was assessed by the Mini-Mental Status Examination (MMSE) score. A total of 654 cases met our criteria. Of these, 59 (9%) persons had MMSE scores ≥24 at their last visit and were categorized as cognitively resilient. First, bivariate analysis was done to compare resilient with non-resilient groups. Then, variables with significant results were entered in the multivariable model. Based on our binary logistic regression model, resilient subjects were older (odds ratio [OR]=1.03; 95% confidence interval [CI]=1–1.07), had more years of education (OR=1.16; 95% CI=1.04-1.29), had lower BMI (OR=0.91; 95% CI=0.85-0.99), were more likely to be a smoker (OR=2.78; 95% CI=1.45-5.34), and were more likely to use an anticoagulant/antiplatelet at last visit compared with subjects with impaired cognition (OR=1.87; 95% CI=1.01-3.48). In addition to expected protective factors such as higher education and lower BMI, our results showed that more smoking and frequent use of an anticoagu­lant/antiplatelet at last visit could also be possibly associated with resilience to clinical expression of AD severe pathology. Pharmacological approaches that mimic the effects of nicotine may be useful in amelioration of AD symptoms.