Analysis of 247 cognitively healthy Dutch centenarians revealed that accelerated epigenetic aging measured by the GrimAge DNA methylation clock increased mortality risk by 60% (HR=1.60), outperforming traditional predictors like cognitive scores and brain biomarkers. Using advanced PacBio sequencing, researchers found GrimAge acceleration operated independently of neurodegeneration markers including neurofilament light chain levels and showed minimal correlation with Alzheimer's-related pathology. This challenges conventional assumptions that brain health drives survival at extreme ages. The finding suggests peripheral biological aging processes, potentially involving blood cell aging patterns, may be more critical for centenarian survival than previously recognized. GrimAge's effectiveness in this ultra-elderly population is particularly striking since most aging biomarkers lose predictive power at advanced ages. However, this preprint awaits peer review, and the cohort's ethnic homogeneity limits broader applicability. The research represents an incremental but important advance in precision aging assessment, potentially enabling better health monitoring strategies for the growing centenarian population and refining our understanding of what drives survival past 100 years.