Our findings indicate that Alzheimer's Disease pathology and vascular changes are common in the brains of 90+ people with excellent cognitive abilities, meaning they are resilient to such changes. However, these individuals are less susceptible i.e., resistant to other types of neurodegenerative changes (such as Lewy body disease and hippocampal sclerosis) and have a lower burden of co-existing neurodegenerative changes. Over the past 30 years, the number of people aged 90 and older in the U.S. has nearly tripled, and this number is projected to quadruple in the next four decades. With this rise in age, many people see increased problems with memory and brain function. Further research into the factors that enable these individuals to maintain their cognitive function could provide insights into how to preserve cognitive health despite advanced age.