Background <p>The occurrence of worry in subjects with Subjective Cognitive Decline(SCD) confers a greater risk of future AD and cognitive decline. However, it is not known whether these individuals have distinct memory and neuroimaging profiles. Therefore, we aimed to identify brain imaging characteristics associated with episodic memory in elderly adults with subjective cognitive decline and related worry (SCD+) in a population-based cohort.</p> Methods <p>A total of 418 individuals from the BABRI cohort underwent structural MRI (<i>n</i> = 418) and episodic memory-related task-based fMRI (<i>n</i> = 153) scans. The subjects were classified into Mild Cognitive Impairment (MCI), SCD+ , SCD, and Normal Control (NC) groups. A brain structure–function-episodic memory pathway model was constructed to investigate potential compensatory mechanisms.</p> Results <p>Cognitively, SCD+ group did not perform significantly worse than SCD group on episodic memory tasks. For the structural T1-weighted MRI results, gray matter integrity in SCD+ group exhibited altered atrophy patterns compared to SCD, mainly in the posterior hippocampus and parahippocampal cortex. Using PsychoPhysiological Interactions (PPI) to investigate task-based functional connectivity, we found that the SCD+ group exhibited significantly stronger functional connectivity (FC) in the Default Mode Network (DMN) and other networks than SCD. Using moderation model analysis, we found that stronger FC between the DMN and Visual Network (VN) moderated the relationship between gray matter volume (GM) of the posterior hippocampus and episodic memory encoding accuracy within SCD+ group.</p> Conclusions <p>Stronger DMN–VN connectivity may reflect early cognitive reserve processes supporting episodic memory in SCD+ despite structural vulnerability, although such adaptations may vunerable as Alzheimer's disease progresses. Task-based fMRI may serve as a sensitive tool for detecting these processes before clinical decline.</p>