Abstract
INTRODUCTION: Coping strategies are potentially modifiable factors that may contribute to cognitive resilience. We examined whether adaptive coping modifies the association between Alzheimer's disease (AD) pathology and cognitive decline. METHODS: We included 99 cognitively unimpaired older adults (mean age = 75.2, 59% females) from two observational cohorts who completed coping strategy assessments. Participants underwent yearly longitudinal cognitive assessments (extended PACC) over 5.3 years on average and cross-sectional Aβ (PiB-PET) and tau (F(18)-Flortaucipir) neuroimaging. We used linear mixed-effects models. RESULTS: More frequent use of adaptive coping was associated with better cognitive trajectories, independent of AD pathology. Further, three-way interactions between tau, adaptive coping, and time indicated that individuals with elevated tau and less adaptive coping showed accelerated cognitive decline, while those with more adaptive coping maintained cognitive function. DISCUSSION: Adaptive coping strategies may confer resilience against cognitive decline. Interventions targeting coping skills could represent promising approaches for maintaining cognition in individuals at risk for AD. HIGHLIGHTS: Adaptive coping associates with better cognition independent of Alzheimer's disease (AD) pathology. Adaptive coping buffers tau-related effects on cognitive trajectories. Coping strategies may be modifiable targets for cognitive decline.