Open Access Journal of Clinical Pathology Research

Cognitive Reserve (CR) represents the brain’s ability to maintain function despite neurodegenerative pathology, with synaptic plasticity playing a crucial role in this adaptability. While high CR individuals often experience delayed onset of Alzheimer’s disease (AD) symptoms, they tend to exhibit rapid cognitive decline once pathology surpasses compensatory mechanisms. This paradox underscores the importance of understanding the relationship between CR and synaptic plasticity. In this review, we explore the biological underpinnings of CR, the role of synaptic plasticity in cognitive resilience, and the adaptive versus maladaptive consequences of neuroplasticity in AD. Additionally, we highlight challenges in CR research, such as its measurement and the need for longitudinal studies, and propose future research directions to enhance therapeutic strategies aimed at strengthening CR mechanisms.