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We examined whether cortical MTL cerebral blood flow (CBF) relates to cognition differently in\n                      <jats:italic>APOE<\/jats:italic>\n                      \u025b4 carriers and noncarriers with and without AD pathophysiological changes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      One hundred forty\u2010eight cognitively unimpaired older adults underwent pseudo\u2010continuous arterial spin labeling MRI to quantify MTL CBF and assessment of memory and executive function. In a subset (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0126), AD pathology was indexed using plasma phosphorylated tau 217 (pTau\n                      <jats:sub>217<\/jats:sub>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      <jats:italic>APOE<\/jats:italic>\n                      \u025b4 carriers showed higher MTL CBF than noncarriers. Higher MTL CBF was associated with better executive function only in pTau\n                      <jats:sub>217<\/jats:sub>\n                      \u2010negative\n                      <jats:italic>APOE<\/jats:italic>\n                      \u025b4 carriers. Interactions remained significant after adjusting for MTL cortical volume or white matter hyperintensities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>\n                      Hyperperfusion in cognitively unimpaired\n                      <jats:italic>APOE<\/jats:italic>\n                      \u025b4 carriers may reflect a resilience biomarker related to better cognitive function in the absence of detectable AD pathophysiological changes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>\n                            Apolipoprotein E (\n                            <jats:italic>APOE)<\/jats:italic>\n                            \u025b4 carriers show elevated medial temporal lobe (MTL) cerebral blood flow (CBF).\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            Higher MTL CBF is linked to better executive function in\n                            <jats:italic>APOE<\/jats:italic>\n                            \u025b4 carriers.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            This association is only observed in\n                            <jats:italic>APOE<\/jats:italic>\n                            \u025b4 carriers who are pTau\n                            <jats:sub>217<\/jats:sub>\n                            \u2010negative.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            MTL hyperperfusion may mark resilience in\n                            <jats:italic>APOE<\/jats:italic>\n                            \u025b4 carriers at risk for AD.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71934","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:16:07Z","timestamp":1792642567000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebral blood flow as a biomarker of resilience in cognitively unimpaired\n                    <i>APOE \u025b<\/i>\n                    4 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