Physical resilience in the brain: The effect of white matter disease on brain networks in cognitively normal older adults

ABSTRACT BACKGROUND Physical resilience with age is considered a key feature of healthy aging, but current understanding of the neural contributions to resilience is limited. Additionally, few methods exist to identify physical resilience and observe the mechanisms through which resilience manifests. METHODS To address these gaps, we used data from 189 participants from the Brain Networks and Mobility (B-NET) study who completed the short physical performance battery (SPPB) as well as its expanded version (eSPPB), magnetic resonance imaging (MRI), and functional MRI (fMRI). Functional brain networks were generated using graph theory methods. We grouped participants based on SPPB scores (<10=unhealthy & 10-12=healthy) and median splits of white matter hyperintensity volumes: Expected Healthy (EH: low WMH, healthy SPPB, n=81), Expected Impaired (EI: high WMH, unhealthy SPPB, n=42), Unexpected Healthy (UH: high WMH, healthy SPPB, n=53), and Unexpected Impaired (UI: low WMH, unhealthy SPPB, n=13). UH is considered the “resilient” group due to their maintained function despite elevated WMH burden. Continuous analyses assessed the relationships between network properties, mobility, and cognition. RESULTS Higher SPPB scores were associated (p<0.01) with greater sensorimotor cortex community structure (SMN-CS) consistency. While no main effect of the resilience interaction term (SPPB*WMH) was found on SMN-CS, UH showed higher numbers of second-order connections between the SMN and anterior cingulate cortex (ACC) than EI (p<0.01). CONCLUSIONS Increased connectivity between SMN and ACC may be a marker of physical resilience within the brain.