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The biological mechanisms underlying SCA remain unclear. This systematic review synthesizes current evidence on quantifiable SCA biomarkers to address this critical gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Design and Methods<\/jats:title>\n                    <jats:p>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched PubMed, Scopus, PsycINFO, and Web of Science (up to December 2024). After screening 6,699 records, 62 studies met the inclusion criteria. Data from included studies were extracted, assessed for risk of bias, and synthesized for integrated findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 34 SCA definitions, categorized them into three types, and analyzed biomarkers across six domains: (1) genetic\/epigenetic biomarkers, (2) biofluid biomarkers, (3) histological biomarkers, (4) positron emission tomography biomarkers, (5) structural magnetic resonance imaging biomarkers, and (6) functional neuroimaging biomarkers. Integrated findings suggest that SCA is driven by unique multidomain biological mechanisms (e.g., young DNA methylation age, high von Economo neuron density, and efficient glucose metabolism, etc.), not merely resistance to age-related neuropathology such as amyloid-\u03b2 and tau. Neuroimaging findings highlight the role of brain reserve, maintenance, and compensation on SCA, particularly within a newly defined \u201ccingulate gyrus\u2013medial temporal lobe\u2013frontal cortex\u201d brain signature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Implications<\/jats:title>\n                    <jats:p>This systematic review advances our understanding of SCA\u2019s biological substrates, provides theoretical frameworks for future SCA biomarker research, and offers a foundation for future strategies to promote cognitive health in aging populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/geront\/gnaf277","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T12:35:24Z","timestamp":1763987724000},"source":"Crossref","is-referenced-by-count":1,"title":["What characterizes the exceptional cognition of superagers? A systematic review of multidomain biomarkers of successful cognitive aging"],"prefix":"10.1093","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1190-7540","authenticated-orcid":false,"given":"Yiru","family":"Yang","sequence":"first","affiliation":[{"name":"School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University , Jinan, Shandong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolei","family":"Li","sequence":"additional","affiliation":[{"name":"School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University , Jinan, Shandong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shudan","family":"Gao","sequence":"additional","affiliation":[{"name":"Shandong Provincial Key Laboratory of Brain Science and Mental Health, Faculty of Psychology, Shandong Normal University , Jinan,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanxu","family":"Gao","sequence":"additional","affiliation":[{"name":"Institute for AI in Medicine and Faculty of Medicine, Macau University of Science and Technology , Macau,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"2026050622123624800_gnaf277-B1","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1093\/brain\/awz037","article-title":"The metabolic brain signature of cognitive resilience in the 80+: Beyond Alzheimer pathologies","volume":"142","author":"Arenaza-Urquijo","year":"2019","journal-title":"Brain: A Journal of Neurology"},{"key":"2026050622123624800_gnaf277-B2","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/s11427-023-2305-0","article-title":"Biomarkers of aging","volume":"66","author":"Bao","year":"2023","journal-title":"Science China Life Sciences"},{"key":"2026050622123624800_gnaf277-B3","doi-asserted-by":"publisher","first-page":"307","DOI":"10.3233\/jad-180360","article-title":"Amyloid and FDG PET of successful cognitive aging: Global and cingulate-specific differences","volume":"66","author":"Baran","year":"2018","journal-title":"Journal of Alzheimer\u2019s Disease: JAD"},{"key":"2026050622123624800_gnaf277-B4","doi-asserted-by":"publisher","first-page":"1514","DOI":"10.1001\/jamaneurol.2014.1663","article-title":"Common genetic variants on 6q24 associated with exceptional episodic memory performance in the elderly","volume":"71","author":"Barral","year":"2014","journal-title":"JAMA Neurology"},{"key":"2026050622123624800_gnaf277-B5","doi-asserted-by":"publisher","first-page":"561","DOI":"10.3233\/jad-221062","article-title":"Superior global cognition in oldest-old is associated with resistance to neurodegenerative pathologies: Results from the 90+ study","volume":"93","author":"Biswas","year":"2023","journal-title":"Journal of Alzheimer\u2019s Disease: JAD"},{"key":"2026050622123624800_gnaf277-B6","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.3233\/jad-210063","article-title":"Increased glucose activity in subgenual anterior cingulate and hippocampus of high performing older adults, despite amyloid burden","volume":"81","author":"Borelli","year":"2021","journal-title":"Journal of Alzheimer\u2019s Disease: JAD"},{"key":"2026050622123624800_gnaf277-B7","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1017\/S1041610218000431","article-title":"Neurobiological findings associated with high cognitive performance in older adults: A systematic review","volume":"30","author":"Borelli","year":"2018","journal-title":"International Psychogeriatrics"},{"key":"2026050622123624800_gnaf277-B8","doi-asserted-by":"publisher","first-page":"55","DOI":"10.3389\/fnagi.2017.00055","article-title":"Youthful processing speed in older adults: Genetic, biological, and behavioral predictors of cognitive processing speed trajectories in aging","volume":"9","author":"Bott","year":"2017","journal-title":"Frontiers in Aging Neuroscience"},{"key":"2026050622123624800_gnaf277-B9","doi-asserted-by":"publisher","first-page":"101540","DOI":"10.1016\/j.intell.2021.101540","article-title":"Is there a \u201cg-neuron\u201d? 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