Healthy and pathological processes in adult development: new evidence from neuroimaging of the aging brain

Purpose of review Recent research has revealed that the population of older adults is composed not only of individuals who are either healthy or have an age-related disease, most commonly Alzheimer's disease, but also individuals with mild cognitive impairment who are at-risk for or already in the prodromal stage of Alzheimer's disease. These variations in cognitive aging can be related to their neural bases via structural and functional neuroimaging methods. Recent findings Healthy aging appears to primarily affect a frontal-striatal system that undergirds executive control of cognition, while minimally affecting medial temporal lobe structures. Functional imaging studies suggest that enhanced prefrontal engagement may offer compensatory plasticity that minimizes age-related cognitive losses. Mild cognitive impairment appears to affect the entorhinal cortex in particular, with functional consequences in other brain regions. Alzheimer's disease is characterized by severe hippocampal injury, although early-stage Alzheimer's disease may relatively spare some cortical regions. Summary Advances in in-vivo imaging methods are providing the tools for identifying different trajectories of neurocognitive aging, and knowledge about these brain changes may promote opportunities for treatment.