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We examined aging trajectories of cortical thickness (CTh) and surface area in <jats:italic>C9orf72<\/jats:italic> expansion adult carriers compared to healthy controls to characterize preclinical cerebral changes leading to symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were obtained from the Genetic Frontotemporal Dementia Initiative. T1\u2010weighted magnetic resonance imaging scans were processed with CIVET 2.1 to extract vertex\u2010wide CTh and cortical surface area (CSA). Symptomatic and presymptomatic subjects were compared to age\u2010matched controls using mixed\u2010effects models, controlling for demographic variables. Aging trajectories were compared between carriers and noncarriers by testing the \u201cage by genetic status\u201d interaction. False discovery rate corrections were applied to all vertex\u2010wide analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The sample included 640 scans from 386 subjects, including 54 symptomatic <jats:italic>C9orf72<\/jats:italic> carriers (72.2% behavioral variant FTD), 83 asymptomatic carriers, and 249 controls (age range = 18\u201386\u2009years). Symptomatic carriers showed fairly symmetric reduction in CTh\/CSA in most of the frontal lobes, in addition to large temporoparietal areas. Presymptomatic subjects had reduced CTh\/CSA in more restricted areas of the medial frontoparietal lobes, in addition to scattered lateral frontal, parietal, and temporal areas. These differences were explained by faster cortical thinning linearly throughout adulthood in a similar anatomical distribution, with differences emerging in the early 30s. CSA reduction was also faster in mutation carriers predominantly in the ventrofrontal regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p><jats:italic>C9orf72<\/jats:italic> mutation carriers have faster cortical thinning and surface loss throughout adulthood in regions that show atrophy in symptomatic subjects. This suggests that the pathogenic effects of the mutation lead to structural cerebral changes decades prior to symptoms. ANN NEUROL 2020 <jats:bold>ANN NEUROL 2020;88:113\u2013122<\/jats:bold><\/jats:p><\/jats:sec>","DOI":"10.1002\/ana.25748","type":"journal-article","created":{"date-parts":[[2020,4,14]],"date-time":"2020-04-14T09:10:21Z","timestamp":1586855421000},"page":"113-122","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Faster Cortical Thinning and Surface Area Loss in Presymptomatic and Symptomatic <i>C9orf72<\/i> Repeat Expansion Adult Carriers"],"prefix":"10.1002","volume":"88","author":[{"given":"Gabriella","family":"Le Blanc","sequence":"first","affiliation":[{"name":"Faculty of Medicine McGill University  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Jett\u00e9 Pomerleau","sequence":"additional","affiliation":[{"name":"Department of Psychiatry McGill University Health Centre, McGill University  Montreal Quebec 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IRCCS Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Sanchez\u2010Valle","sequence":"additional","affiliation":[{"name":"Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Department Hospital Clinic, Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer, University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Robert","family":"LaForce","sequence":"additional","affiliation":[{"name":"Clinique Interdisciplinaire de M\u00e9moire, D\u00e9partement des Sciences Neurologiques, CHU de Qu\u00e9bec, and Facult\u00e9 de M\u00e9decine Laval University  Quebec City Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fermin","family":"Moreno","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital Universitario Donostia  San Sebastian 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