Longevity and cognitive resilience in a Colombian family carrying the APOE ε2 variant.

APOE is the strongest genetic risk factor for late-onset Alzheimer's disease. Despite global efforts to promote resilience, delay cognitive decline, and slow aging, APOE ε2, one of the most robust resilience-associated variants, remains relatively underexplored in translational research. Exceptional longevity offers a window into cognitive trajectories. We present clinical, cognitive and neuroimaging data from five APOE ε2/ε3 siblings aged 94-105. Cognition ranged from normal to mild dementia. MRI showed less atrophy than expected for advanced age, and FDG-PET revealed preserved metabolism. Findings demonstrate APOE ε2-associated resilience in the oldest-old and offer insight into mechanisms of exceptional cognitive aging with potential translational relevance.