Defining overlooked structures reveals new associations between cortex and cognition in aging and Alzheimer's disease.

Recent work suggests that indentations of the cerebral cortex, or sulci, may be uniquely vulnerable to atrophy in aging and Alzheimer's disease (AD) and that posteromedial cortex (PMC) is particularly vulnerable to atrophy and pathology accumulation. However, these studies did not consider small, shallow, and variable tertiary sulci that are located in association cortices and are often associated with human-specific aspects of cognition. Here, we first manually defined 4,362 PMC sulci in 432 hemispheres in 216 participants. Tertiary sulci showed more age- and AD-related thinning than non-tertiary sulci, with the strongest effects for two newly uncovered tertiary sulci. A model-based approach relating sulcal morphology to cognition identified that a subset of these sulci were most associated with memory and executive function scores in older adults. These findings support the retrogenesis hypothesis linking brain development and aging, and provide new neuroanatomical targets for future studies of aging and AD.