Introduction: Accounting for common co-pathologies such as white matter hyperintensities (WMH) of presumed vascular origin may improve the prognostic performance of imaging and blood-based biomarkers for cognitive decline in Alzheimers disease (AD). Methods: We analyzed longitudinal cognitive data from 216 (median age: 67.2 years; median follow up: 5.3 years) community-dwelling older adults who underwent MRI, amyloid PET, and plasma p-tau217, neurofilament light chain, and glial fibrillary acidic protein assessment. Results: WMHs predicted declines in executive function, processing speed, and global cognition, and amplified the effects of imaging and plasma biomarkers, especially on episodic memory. The interaction between amyloid-PET and WMH volume was the primary interaction associated with faster memory decline. Discussion: Coexisting AD pathology and WMHs shorten the preclinical stage of AD. Consideration of amyloid-PET and blood-based biomarkers in the context of an individual s WMH burden may improve the prognostic value of these biomarkers.
Bachmann et al. (Tue,) studied this question.
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