Background: Cerebrovascular pathologies and hypertension could play a vital role in Alzheimer
disease (AD) progression. However, whether cerebrovascular pathologies and hypertension accelerate
the AD progression through an independent or interaction effect is unknown.
Objective: To investigate the effect of the interactions of cerebrovascular pathologies and hypertension
on AD progression.
Method: A retrospective longitudinal study was conducted to compare AD courses in patients with different
severities of cerebral White Matter Changes (WMCs) in relation to hypertension. Annual comprehensive
psychometrics were performed. WMCs were rated using a rating scale for Age-related WMCs
Results: In total, 278 patients with sporadic AD were enrolled in this study. The mean age of the patients
was 76.6 ± 7.4 years, and 166 patients had hypertension. Among AD patients with hypertension,
those with deterioration in clinical dementia rating-sum of box (CDR-SB) and CDR had significantly
severe baseline ARWMC scales in total (CDR-SB: 5.8 vs. 3.6, adjusted P = 0.04; CDR: 6.4 vs. 4.4, adjusted
P = 0.04) and frontal area (CDR-SB: 2.4 vs. 1.2, adjusted P = 0.01; CDR: 2.4 vs. 1.7, adjusted P <
0.01) compared with those with no deterioration in psychometrics after adjustment for confounders. By
contrast, among AD patients without hypertension, no significant differences in ARWMC scales were
observed between patients with and without deterioration.
Conclusion: The effect of cerebrovascular pathologies on AD progression between those with and without
hypertension might differ. An interaction but not independent effect of hypertension and WMCs on
the progression of AD is possible.