Neurobiology of Aging

Age-related hearing loss is a leading modifiable risk factor for dementia and is increasingly recognized as a non-motor feature of Parkinson's disease (PD). The apolipoprotein E (APOE) E4 allele is the strongest genetic risk factor for Alzheimer's disease and is associated with cognitive decline in PD, yet its relationship to hearing loss remains unclear. Therefore, we examined the independent and interactive effects of PD status and APOE E4 carrier status on age-related hearing loss using a validated web-based speech-in-noise (SIN) assessment in 239,620 23andMe Research Institute participants without PD and 4,361 PD cases. Generalized additive models for location, scale, and shape (GAMLSS) showed that both PD and APOE E4 independently exacerbated age-related hearing decline, with speech reception thresholds (SRTs) worsening non-linearly with advancing age, but without evidence of synergistic interaction. However, longitudinal analyses in a subcohort completing at least two assessments (1,434 PD cases; 36,242 controls) using GAMLSS mixed models showed a significant three-way interaction between PD status, APOE E4, and age2, such that SIN hearing loss accelerated more steeply with age in APOE E4 carriers with PD. Males and individuals with lower educational attainment also exhibited worse SIN hearing loss. These results identify APOE E4 carriers with PD as a priority population for hearing screening and intervention, and support the integration of SIN assessments into routine PD care to detect hearing decline that may compound cognitive and communicative burden in aging.

PurposeSimilar vocal impairments occur in normative aging and Parkinsons disease (PD), making differential diagnosis challenging in early stages. The brains role in age and PD-related vocal dysfunction is unclear. This motivated our use of the zebra finch songbird model. We applied human acoustic analysis to evaluate aging and parkinsonian-like birdsong for shared and distinct features. MethodTwo open-access datasets of zebra finch song were analyzed using an expanded set of parameters that, in the case of humans, can detect subtle changes in voice. The aging dataset included younger, middle-aged, and older birds. The PD dataset included birds receiving viral injections into Area X to induce -synuclein overexpression or control treatment, recorded pre- and post-injection. Songs were automatically segmented into motifs using cross-correlation. Acoustic measures were extracted from harmonic, noisy, and mixed syllables. ResultsMiddle-aged birds differed from younger and older birds, showing non-linear trajectories in fundamental frequency measures and age-related increases in spectral slope, spectral emphasis, and intensity variability, whereas temporal parameters remained stable. In PD, pre-post changes occurred in both ASYN and controls, with ASYN birds exhibiting larger effects for fundamental frequency variability, decreasing frequency modulation, and vocal intensity measures. ConclusionsVocal aging in zebra finches was characterized by non-linear trajectories and prominent spectral and intensity-related changes. In a gene-driven PD state there were greater alterations in fundamental frequency variability and intensity regulation, features that may distinguish aging-from disease-related vocal variability. These findings further support the zebra finch as a translational model for vocal biomarker research.

Pattern separation is widely regarded as a hippocampally mediated process that reduces interference between memories of similar experiences. Performance on the Mnemonic Similarity Task (MST), where the requirement is to discriminate between studied items (targets) and perceptually similar lures, is commonly held to depend on pattern separation. Specifically, it has been proposed that similar lure identification is supported by a recall-to-reject strategy, whereby lures are identified as a result of the retrieval of the corresponding studied item. According to this proposal, therefore, the encoding operations that support successful target recollection and successful lure identification should be closely similar, since both mnemonic judgments depend upon subsequent recollection of the study item. Here, using fMRI, we examined this prediction. In samples of cognitively healthy young and older adults, we employed a three-choice MST (target/lure/new) with scene and object images as test items. Using ROI-based univariate and multivoxel analyses, we assessed whether encoding-related activity was predictive of the identification of target and similar lure items on the subsequent memory test. The activity elicited by scene images predicted memory performance for subsequently presented targets but not for corresponding similar lures, contrary to the recall-to-reject hypothesis. No effects could be identified for either class of object test items. The magnitude of the encoding effects for the scene targets was age-invariant, and, moreover, the univariate scene SMEs demonstrated a robust, age-invariant association with the target-lure discriminability metric. HighlightsO_LIEncoding fMRI activity predicted scene recognition but not lure discrimination. C_LIO_LIEncoding-related fMRI effects showed no age-related differences. C_LIO_LIEncoding fMRI effects for scenes predicted mnemonic discrimination performance. C_LIO_LINo encoding-related fMRI effects were detected for objects. C_LI

Alzheimer's disease (AD) is clinically marked by difficulty retaining newly learned information, yet routine memory scores often conflate poor initial encoding with failure to stabilise information after encoding. This ambiguity limits the mechanistic interpretability of cognitive assessment during the transition from mild cognitive impairment to AD. Here we propose a Hippocampal Cortical Consolidation Bottleneck (HCCB) model to computationally separate these two components of new memory failure. The model represents newly presented information as a rapidly formed hippocampal trace and a slowly stabilised cortical trace, predicting a residual bottleneck when delayed recall falls below the level expected from immediate recall. We operationalised this prediction as Consolidation Bottleneck Index*(CBI*), a cognitively normal reference normalised residual index, and evaluated it using Alzheimer's Disease Neuroimaging Initiative (ADNI) cognitive and MRI data, with independent dynamical support from OpenNeuro EEG. Simulations showed recent memory vulnerability when hippocampal vulnerability exceeded cortical vulnerability. In ADNI, CBI* increased from cognitively normal participants to mild cognitive impairment nonconverters, reached Alzheimer like levels in mild cognitive impairment converters, and was associated with hippocampal atrophy. CBI* added minimal discrimination beyond established clinical and structural predictors, supporting its role as a mechanistic phenotype rather than a replacement prognostic model. OpenNeuro EEG further showed increased neurodynamic rigidity in AD. Our findings provide a computational framework for quantifying failed stabilisation of newly encoded information in AD progression.

The APOE gene is a critical determinant of human healthspan and longevity, with the rare{varepsilon} 2 allele traditionally viewed as a universal protective factor against Alzheimer s disease (AD) and a driver of exceptional lifespan. However, this protective paradigm is predominantly derived from European-centric cohorts, leaving the evolutionary and clinical impacts of{varepsilon} 2 across diverse, highly admixed populations largely unknown due to a lack of local ancestry (LA) resolution. To investigate how local genomic backgrounds modulate APOE survival dynamics we analyzed two Brazilian sample collection of older adults from Sao Paulo city: the Biobank for Aging Studies (BAS, n = 716), a post-mortem autopsy study of naturally deceased individuals; and the Health, Well-being and Aging Study (SABE, n = 952), a census-based elderly sample collection. We evaluated deviations from Hardy-Weinberg equilibrium (HWE) using robust permutation-based models to capture ongoing selective and mortality pressures at the APOE locus. While global APOE frequencies adhered to HWE, integrating LA unveiled striking, mirrored ancestral deviations. Our findings reveal that APOE {varepsilon}2 homozygotes with African ancestry significantly contribute to deviations from HWE in the BAS, with an excess of {varepsilon}2AFR/{varepsilon}2AFR homozygotes observed (p = 0.0196). These distinct HWE deviations demonstrate that an African LA background acts as a genetic buffer, attenuating the phenotypic extreme effects of APOE alleles. Furthermore, we observed an excess of the{varepsilon} 4 European haplotypes in the BAS, which is consistent with a mortality pressure allelic effect in the European LA context. Conversely, the{varepsilon} 4AFR/{varepsilon}4AFR combination was overrepresented in the SABE. While this buffering mechanism mitigates{varepsilon} 4 toxicity, it simultaneously dampens the exceptional longevity advantage typically conferred by the{varepsilon} 2 allele, leading to its neutral accumulation in the post-mortem cohort. Our study challenges the "one-size-fits-all" assumption of APOE biomarkers, demonstrating that{varepsilon} 2 protective mechanisms are context-dependent and modulated by local genomic backgrounds in admixed populations.

Many nonhuman primate species recapitulate the neuropathological features of sporadic Alzheimer's disease (AD) to varying degrees. As with humans, the assessment of AD-related pathology in nonhuman primates has historically relied on the use of postmortem brain tissues. In vivo alternatives, such as PET imaging tracers and fluid biomarkers, have been developed for use in humans but require further validation in nonhuman primates before replacing postmortem analyses. Here we employed the Nucleic Acid-Linked Immuno-Sandwich Assay (NULISATM) CNS Disease panel to compare age-related changes in plasma biomarkers in two nonhuman primate species (rhesus monkeys and baboons). In addition, we examined whether amyloid and tau biomarkers were associated with brain atrophy, as measured by gray matter volume. We found significant associations between age and multiple biomarkers of neurodegeneration for both species, as well as significant differences in the patterns of these associations between the two species. For the phosphorylated tau measures, though rhesus monkeys had higher values, baboons showed significant and stronger associations with age. By contrast, rhesus monkeys exhibited an earlier age-related decline in A{beta}42/A{beta}40 ratio than baboons. Finally, in both species, lower A{beta}42/A{beta}40 ratios were associated with lower gray matter volumes. This is the first systematic comparative study of age-related changes in neurodegeneration biomarkers in two closely related nonhuman primates using comparable age ranges and sample sizes, and the same multiplex assay. Future studies should examine longitudinal changes in these biomarkers as well as validate the plasma findings using cerebral spinal fluid.

By utilizing a targeted genetic assay within a Fox Insight cohort (N = 1,987), this research establishes a hybrid, transparent, and interpretable predictive framework. Initial modeling via Firth penalized logistic regression discovered enrichment regarding the GBA N370S locus (OR = 0.01, FDR < .001), highlighting the critical role of epidemiological evaluation in enriched, human study populations. Advanced ensemble learning methods, refined through a meta-learner gradient boosting machine, attained an out-of-sample AUC of 0.929 on 15% of the analysis dataset partitioned via random sampling and strictly held-out from model training. Both global, visual machine learning explanations and local-Shapley interpretations provide transparency into the models and individual predictions representative of practical, collaborative human-artificial intelligence efforts, offering a solution that supports classification while remaining accessible and economical.

Motivation: Linkage disequilibrium score (LDSC) regression is a popular method to estimate heritability for complex traits using summary statistics and linkage disequilibrium (LD) reference panels, offering a practical alternative to methods requiring individual-level data. Despite its widespread use, LDSC regression can produce biased heritability estimates. The properties of LDSC regression were investigated using summary statistics from several large-scale Alzheimer's disease (AD) studies and a variety of LD reference panels. These heritability estimates were compared with those obtained from individual-level data. Results: When LDSC regression was applied to summary statistics obtained from meta-analysis, it led to an underestimation of heritability. This can occur if meta-analysis is used to combine studies of different ancestries leading to the caveat of the lack of an appropriate LD reference panel. Additionally meta-analyses often include studies with different phenotype definitions, that not only impacts heritability estimates but also makes them uninterpretable. Summary statistics generated from imputed variants, even those with high imputation accuracy, can lead to underestimation of heritability. For example, the heritability estimates for AD were reduced from 0.265 (se 0.148) to 0.160 (se 0.041) when imputed variants (INFO>0.9) were included compared to analyzing only genotype array variants. A decrease in heritability estimates was also observed when individual-level imputed variant data were analyzed using GCTA-GREML. Our findings highlight the caveats of estimating heritability using meta-analysis summary statistics or imputed data instead of genotyped or sequence data.

Post-encoding sleep plays an essential role in episodic memory consolidation. Much of the existing literature on sleep and memory relies on deprivation paradigms or laboratory-controlled sleep. Relatively few studies have examined how naturalistic post-encoding sleep relates to memory retrieval and its supporting neural activity, or whether age-related impairments in this sleep are linked to those in episodic memory. In the present study, we used actigraphy and electroencephalography to examine how post-encoding sleep quality relates to context memory performance and retrieval-related ERPs supporting performance in younger and older adults. Participants encoded object-scene pairs and were tested on matching and mismatching pairs after a 96-hour sleep-filled delay. We found that greater post-encoding sleep continuity predicted better delayed context memory performance for mismatching pairs across age groups. Post-encoding sleep continuity was also associated with larger ERP differences between context hits and misses for context-matching pairs, for ERP effects associated with post-retrieval monitoring operations across age groups. Together, these findings suggest that more continuous, naturalistic post-encoding sleep facilitates episodic memory performance and neural mechanisms supporting episodic memory retrieval across adult age.

Neuroticism, a personality trait characterized by the predisposition to experience intense and frequent negative emotions, has been associated with an increased risk of Alzheimer's disease (AD). However, the mechanisms underlying this association remain unclear. Our study investigated two potential pathways: (1) whether the relationship between neuroticism and AD is causal, and (2) whether it is mediated by health and behavioral factors associated with both neuroticism and AD risk. To assess causality, a two-sample Mendelian randomization (MR) was employed using publicly available genome-wide association studies (GWAS) for neuroticism (Nagel et al., 2018) and AD (Bellenguez et al., 2022). Mediation analysis was conducted in a subset of UK Biobank participants aged 60 and older, including 121,825 controls (mean age = 63.9 {+/-} 2.81; 61,993 females or 50.9%) and 1,277 individuals with AD (mean age = 65.6 {+/-} 2.71; 628 females or 49.2%). All participants had complete data on neuroticism and the potential mediators. MR analysis suggested that the neuroticism-AD relationship is unlikely to be causal. However, depression ({beta}=0.048, p=3x10-4), hypertension ({beta}=0.005, p=2x10-4), and alcohol consumption ({beta}=0.001, p=1x10-5) were identified as significant mediators of the relationship between higher neuroticism and increased AD risk. Overall, the association between neuroticism and AD may be largely explained by modifiable health and behavioral factors rather than a direct causal effect. A better understanding of these mediating pathways may inform targeted prevention and therapeutic strategies to reduce AD risk.

Age-related speech-in-noise difficulties have been associated with increased activity in prefrontal regions. Whether this upregulation reflects adaptive compensation, neural inefficiency, or changes in task engagement as listening demands increase remains unresolved. Most studies have relied on linear contrasts of task difficulty, limiting our understanding of how the role of prefrontal recruitment evolves with listening demand. The present study examined these competing accounts within a non-linear framework. Using functional near-infrared spectroscopy, we measured activity in the dorsolateral prefrontal cortex (DLPFC) while 36 young and 34 older adults performed a sentence-in-noise task across five signal-to-noise ratio conditions. We tested whether DLPFC recruitment followed a quadratic trajectory across listening demands and whether its relationship with performance changed accordingly. Dorsomedial and ventrolateral prefrontal activity was also recorded to assess regional specificity. Bilateral DLPFC responses followed an inverted U-shaped pattern, increasing from easier to intermediate conditions before declining at the most difficult levels. Greater left DLPFC activation was associated with poorer performance in older adults across the ascending and peak portions of the demand-response function. High-performing older adults showed more youth-like recruitment profiles characterized by lower overall activation. Within the older adult group, higher left DLPFC activation was associated with greater age but not with hearing or global cognition. These results clarify the neural mechanisms underlying age-related speech-in-noise difficulties, suggesting that the shape of DLPFC recruitment reflects a demand-sensitive trajectory broadly preserved across age groups, while the level of activation in older adults may reflect neural processing efficiency, with greater upregulation associated with poorer performance.

Healthy older adults are more susceptible to false memories than young adults. Traditional false memory paradigms leverage semantic overlap, shared meaning, to induce false memories, but experiences can also overlap temporally whereby they occur close together in time. Prior work shows that older adults have impaired episodic memory, memory for events within a spatiotemporal context, corresponding to an overall shift toward semantic memory and away from episodic memory across the lifespan. We hypothesize that compared to young adults, older adults rely more heavily on semantic versus episodic information, which promotes false memory. We collected behavioral data in young and older adults performing an old/new recognition memory task in which we manipulated the degree of semantic and temporal overlap between study words and included critical lures, unstudied words that semantically overlap with study words. We find that whereas young and older adults are similarly reliant on semantic relative to episodic information to support false memory, the two age groups differ in their reliance on semantic relative to episodic information to support true memory. These results suggest that differences in the orientation of attention -- toward semantic vs. episodic information -- may underlie age-related memory changes.

Structured AbstractO_ST_ABSBackgroundC_ST_ABSAlzheimers disease (AD) neuropathology emerges decades before symptoms, requiring sensitive, non-invasive markers for early diagnosis. We investigated behavioural and EEG markers of episodic memory in cognitively normal older adults at-risk for AD. MethodsForty-five INSIGHT-preAD cohort participants (15 progressors to prodromal AD, 15 stable {beta}-amyloid positive [A{beta}+] participants, 15 controls [A{beta}-]) completed an Old/New word recognition task during high-density EEG. Behavioural performance and memory-related evoked-related potentials (ERPs; P3, FN400, P600, post-retrieval monitoring) were analysed longitudinally over 5 years. ResultsProgressors showed significantly reduced accuracy, sensitivity, and slower responses. They showed attenuated FN400, P600, and monitoring amplitudes over left parieto-occipital regions. Source analysis revealed hypoactivation in the left inferior frontal and right posterior cingulate cortex, across components with additional disruption during P600. Stable A{beta}+ individuals showed milder P600 hypoactivations. DiscussionBehavioural and ERP alterations preceded clinical decline, supporting EEG-based markers of episodic memory decline for preclinical AD risk stratification.

Parkinsons disease (PD) is strongly age-associated, yet how aging reshapes PD-related transcriptional changes remains unclear. We performed an age-stratified meta-analysis of 16 bulk RNA-seq datasets (646 samples: 314 PD, 332 controls) to distinguish early-onset (<60 years) from late-onset ([&ge;]60 years) signatures. In the full dataset, 131 significantly (padj<0.05, |log2FC|>1) differentially expressed genes (DEGs) were observed, spanning neuronal activity-dependent genes (NPAS4, PVALB, ARC, FOSB) and immune/stress-related transcripts (IL3RA, SLC25A6, HSPA1A/B). Age-specific analyses revealed 31 DEGs in <60, dominated by large-effect changes in uncharacterized lncRNA LINC02188, pseudogene loci (MUC20P1, RPS28P7), calcium-modulating gene CALML6, lipid{square}associated gene TLCD3B, and cytoskeletal regulators (TIAM2, KCTD8). In contrast, the [&ge;]60 group showed 181 DEGs enriched for neuronal markers (NPAS4, PVALB) and immune-metabolic genes (FGA, NPC1L1, UPK1A, HSPA1A/B). GO/KEGG analyses indicated that the <60 signature centers on actin remodeling, filopodia, axonogenesis, and Rap1-mediated adhesion/signaling, consistent with early neurite and structural reorganization. The [&ge;]60 signature was enriched for blood microparticles, chemokine activity, infection-related pathways, ER protein processing, and arachidonic/ether lipid and cytokine signaling, pointing to broad immune-metabolic and proteostasis dysregulation. Cross-age comparison showed that classical PD neuronal immediate-early gene changes are largely [&ge;]60-driven, whereas early-onset PD involves novel lncRNA-calcium-lipid and cytoskeletal modules. These findings highlight LINC02188, TLCD3B and related cytoskeletal/lncRNA genes as novel early-onset PD-associated candidates, and NPC1L1, IL3RA and PVALB as age-amplified markers within the broader PD transcriptomic signature.

Background: While genetic factors strongly influence brain aging trajectories, variants conferring cognitive resilience remain poorly characterized. The neurokinin-3 receptor (NK3-R), encoded by Tachykinin Receptor 3 (TACR3), modulates cholinergic signaling in memory circuits vulnerable to aging. Previous studies linked the non-WT expression of the TACR3 variant rs2765 with cognitive decline and reduced volume of the hippocampus and basal forebrain, but systematic replication and mechanistic validation were lacking. Methods: We investigated rs2765 in the preregistered AgeGain cohort of cognitively healthy older adults (n=188) with independent validation in the ADNI cohort (n=809) which includes persons with and without Alzheimers Disease (AD) that show healthy cognition, mild cognitive impairment or dementia. Analyses integrated structural neuroimaging, longitudinal cognitive assessments, epigenetic aging (PhenoAge), genome-wide methylation profiling, and mechanistic validation through luciferase assays and cross-species protein expression studies. Results: The infrequent protective rs2765 WT variant, found in 12.8% of Europeans, conferred 49% slower cognitive decline (p = 0.002) for amyloid-positive individuals of the ADNI cohort and 3.7 years younger epigenetic age (p = 0.013, 95% CI: 0.79-6.67 years) in the cognitively healthy AgeGain cohort. WT carriers showed larger hippocampal and basal forebrain volumes across cohorts, with Allen Brain Atlas integration revealing these outcomes to occur exclusively in regions where TACR3 expression positively correlated with gray matter volume. Mechanistically, the non-WT variant ameliorated RBMX-mediated post-transcriptional regulation, reducing NK3-R protein expression by 25-40% in vitro and ex vivo murine brain slice models. Senescence-accelerated mice exhibited reduced endogenous NK3-R expression, phenocopying the predicted functional consequences of the variant. In AgeGain participants, genome-wide methylation profiling identified 2,313 differentially methylated CpGs affecting 228 pathways spanning glutamatergic signaling, acetylcholine receptor pathways, chromatin remodeling, and angiogenesis, suggesting coordinated molecular reprogramming from synaptic function to systemic aging. Conclusions: rs2765 WT confers resilience to age- and AD-related cognitive decline through RBMX-dependent regulation of NK3-R expression, with effects of remarkable size cascading from memory to systemic aging. rs2765 genotyping could stratify individuals for NK3-R modulator therapy (e.g., fezolinetant or senktides) and identify those maintaining function despite pathological burden, complementing APOE-based risk assessment in precision geromedicine.

While loss of NMDA receptors (NMDARs) is associated with Alzheimers disease (AD) severity, the effect of sex or the relationship between regional NMDAR density and antemortem cognitive status across the AD spectrum has not been examined. We performed quantitative in vitro autoradiography of hippocampus, entorhinal cortex (EC), and parietal cortex using NMDAR and tau radioligands. Relationships between regional NMDAR density and cognitive status assessed by the Mini Mental State Exam (MMSE), and between NMDAR and tau density, were examined by bivariate correlations. In both sexes, the largest AD-related decreases in NMDAR density were observed in the CA1 field. However, there was a significant diagnosis by sex interaction driven by sex-specific changes in the mild cognitive impairment (MCI) stage, with lower NMDAR density in MCI women, but not MCI men relative to same-sex controls. Within diagnosis analyses revealed positive correlations between NMDAR density and MMSE scores and significant negative correlations between EC NMDAR and tau density, which was significant only in AD men. Our data show that changes in hippocampal NMDAR density across the AD continuum are modulated by sex and may contribute to the known sex differences in the clinical trajectory of the disease.

Background & Methods: The multifaceted physical nature of heritable cognitive impairment in dementia presents significant challenges for traditional linear frameworks attempting to model synergistic risk. While various loci are identified as contributing to neurocognitive disparities, the emergent phenotypic expression and associated predictive value relative to standard clinical baselines require further investigation. To facilitate dimensional reduction of complex genetic data into identifiable phenotypes, Generalized Low Rank Modeling (GLRM) and K-means clustering are applied to participant data from the Alzheimer's Disease Neuroimaging Initiative (ADNI). The utility of these derived archetypes and clusters is assessed, stratifying variance for Mini-Mental State Examination (MMSE) performance. Utilizing generalized additive modeling (GAM) and partial eta squared (p2) effect size, the derived genetic features are compared with other predictors including age, educational attainment, gender, and raw, genetic variant carriage dimensions. Results & Conclusion: In accordance with the hypothesized empirical regularity, age and education persist as primary predictors of MMSE performance. The unsupervised machine learning pipeline successfully identified a composite genetic cluster that emerged as an influential predictor in terms of relative magnitude (p2). Centroid analysis of the GLRM subspace indicated that a particular sub-population (Cluster 2) - defined by a substantial weighting on the EPHA1 target - demonstrated a statistically significant association with MMSE scores, relative to cluster 3. These results suggest that data-driven genetic feature engineering provides an interpretable basis for inference regarding variance in global cognition. By discovering multivariate genetic architecture, this modeling approach captures complexity often missed by individual clinical variable modeling. Such findings implicate the utility of interpretable machine learning for translational dementia research and predictive clinical stratification.

Background: The ability to remember object locations in real life is a fundamental cognitive process that supports goal-directed behavior and is particularly vulnerable to aging and neurodegenerative disease. Despite a growing body of functional magnetic resonance imaging (fMRI) research on object-location memory (OLM), the neural substrates of establishing and retrieving location information are largely unknown. Objective: This systematic review and coordinate-based meta-analysis aimed to identify brain regions consistently activated during OLM in healthy adults, primarily for encoding and - on an exploratory basis - for retrieval, and to characterize age-related differences in OLM-related neural activity. Methods: A systematic search was conducted across three databases (PubMed, PsycInfo, Cochrane Library) up to February 2026. Studies employing task-based fMRI during the encoding and retrieval of object-location associations in healthy adults were eligible. Age-related differences in OLM-related brain activity were examined via narrative synthesis. An activation likelihood estimation (ALE) meta-analysis was performed on studies reporting stereotactic peak coordinates. The review was pre-registered on PROSPERO (CRD420251023695). Results: Twenty-one studies comprising 637 participants were included in the systematic review, with 12 studies being eligible for the encoding ALE meta-analysis. The retrieval ALE meta-analysis was not possible due to the limited number of included studies and reported foci. The systematic review indicated that OLM encoding consistently recruited bilateral fusiform gyri and parahippocampal cortices, with additional engagement of parietal and prefrontal regions across individual studies, whereas OLM retrieval recruited mainly the hippocampus and precuneus. The coordinate-based ALE meta-analysis revealed two significant clusters of activation during OLM encoding: a left-lateralized cluster encompassing the fusiform gyrus, parahippocampal gyrus, and inferior temporal gyrus (peak MNI: -28, -38, -16), and a right-hemisphere cluster spanning the parahippocampal gyrus and fusiform gyrus (peak MNI: 30, -46, -16). Age-related differences, based on a small number of studies with direct age comparison, pointed toward reduced activity in posterior cortical regions coupled with increased activity in prefrontal and midline regions. Additionally, younger adults showed greater hippocampal activation for successful than unsuccessful spatial retrieval, whereas older adults showed the opposite pattern. Conclusion: The systematic review and meta-analysis identify the fusiform gyri and parahippocampal cortices as the most reliably activated regions during OLM encoding, locating OLM formation primarily within the ventral visual-to-medial-temporal processing stream. Retrieval additionally engaged the hippocampus and precuneus, consistent with their established roles in episodic memory. Age-related differences included reduced posterior cortical encoding activity in older adults, a reversal of the hippocampal activation pattern during retrieval, and weaker suppression of midline regions during task performance. The identified encoding pathway may inform targeted network-level interventions such as non-invasive brain stimulation to counteract cognitive decline in aging and neurodegenerative disease.

Background: Speech-in-noise (SIN) perception is a difficult everyday listening task that becomes more difficult with age. Neural tracking of target speech is associated with successful speech perception in clean and noise-degraded listening environments. How aging impacts neural tracking of speech and relates to behavioral decrements in older adults' SIN perception remains unclear. To address these questions, we measured neural speech tracking during a continuous SIN perception task in younger and older adults via multichannel EEG. Method: Participants (n=83) monitored a continuous stream of syllables (~4.5 Hz) presented in quiet and noise conditions during EEG recordings. We assessed neural phase-locking value (PLV) to the acoustic speech envelope to investigate interactions between aging, hearing loss, and stimulus noise on neural synchronization to speech. Results: Compared to younger adults, older adults demonstrated less behavioral sensitivity to noise effects than young adults and had higher overall PLV to target speech. Older adults also showed greater noise-related degradations in neural speech processing relative to younger listeners. Age remained a strong predictor of behavioral responses to speech even after controlling for hearing loss. Covarying for hearing loss removed most age-related effects on neural PLV. Conclusion: Older adults demonstrate overexaggerated neural tracking to ongoing speech presented in quiet and greater noise-related reductions in neurobehavioral speech processing than young adults. Our results support the decline-compensation hypothesis, corroborate unusually large speech envelope encoding in older listeners, and suggest more robust neural synchronization to the speech signal is not always perceptually advantageous.

Despite extensive knowledge of the progressive sequence of cognitive and functional deficits in Alzheimer's Disease (AD), the impact of neurodegeneration on the conscious experience of patients remains largely unexplored. Understanding how the content of consciousness, particularly perceptual awareness, changes with the progression of AD is crucial to enable meaningful person-centred care. This is especially important in severe AD when impairments in language and other cognitive domains mean people are unable to report their experiences. We investigated whether electrophysiological (EEG) and fMRI signatures of perceptual awareness described in healthy older people are present in people with mild-moderate and severe AD using two "no-report" paradigms. Firstly, a visual masking paradigm examined visual awareness negativity (VAN) and late positive (LP) electrophysiological responses and activation in visual cortex and fronto-parietal regions that are characteristically associated with conscious perception of faces; and second, a complex audio-visual (movie) task examined activation in fronto-parietal networks previously associated with perceptual awareness. In healthy older controls we found cortical responses characteristic of awareness in both EEG and fMRI modalities, with VAN and LP markers and widespread occipital, fusiform face area and fronto-parietal activation. In people with mild-moderate AD, there were significant reductions in VAN and LP markers and reduced fronto-parietal activation. In participants with severe AD, who were behaviourally minimally responsive, there was only limited evidence of presence of frontoparietal markers of perceptual awareness, however this may reflect attentional and task insensitivity in people with advanced dementia. These results demonstrate that the brain mechanisms associated with perceptual awareness become increasingly impaired with progression of AD. Specifically, involvement of frontoparietal networks is reduced in AD, which may reflect reduced higher-level awareness. This suggests AD should be considered a disorder of consciousness and should motivate further investigation into the dimensions of awareness affected by the disorder with implications for treatment and management of people with dementia.