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INTRODUCTION Tau pathology, a hallmark of Alzheimer’s disease, is observed in the brains of virtually all individuals over 70. METHODS Using 18F-AV-1451 (18F-flortaucipir) PET, we evaluated tau pathology in 54 cognitively normal participants (mean age 77.5, SD 8.9) from the Baltimore Longitudinal Study of Aging. We assessed associations between PET signal and age, sex, race, and amyloid positivity. We investigated relationships between regional signal and retrospective rates of change in regional volumes and cognitive function adjusting for age, sex, and amyloid status. RESULTS Greater age, male sex, black race, and amyloid positivity were associated with higher 18F-AV-1451 retention in distinct brain regions. Retention in the entorhinal cortex was associated with lower entorhinal volume ( β = −1.124, SE = 0.485, p = 0.025) and a steeper decline in memory performance ( β = −0.086, SE = 0.039, p = 0.029). DISCUSSION Assessment of medial temporal tau pathology will provide insights into early structural brain changes associated with later cognitive impairment and Alzheimer’s disease. * AD : Alzheimer’s disease; APOE : apolipoprotein E; BA : Brodmann area; BLSA : Baltimore Longitudinal Study of Aging; CN : cognitively normal; CSF : cerebrospinal fluid; CVLT : California Verbal Learning Test; DVR : distribution volume ratio; FWHM : full-width at half-maximum; HRRT : High Resolution Research Tomograph; ICV : intracranial volume; ITG : inferior temporal gyrus; MCI : mild cognitive impairment; MPRAGE : magnetization-prepared rapid gradient echo; MRI : magnetic resonance imaging; MUSE : multi-atlas region segmentation using ensembles of registration algorithms and parameters; NFT : neurofibrillary tangle; PART : primary age-related tauopathy; PET : positron emission tomography; PiB : Pittsburgh compound B; RBV : region-based voxel-wise partial volume correction; ROI : region of interest; SD : standard deviation; SE : standard error; SUVR : standardized uptake value ratio

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