Impact of white matter lesions on clinical progression of Alzheimer's disease when accounting for regional neurodegeneration

These results suggest a sex difference, with WMH burden serving as a stronger predictor of baseline cognitive status and AD conversion in men than in women. The findings also indicate that microvascular disease, quantified as WMH, contributes to cognitive variation with lower WMH being associated with greater resilience in MCI-to-AD progression beyond structural integrity. These results highlight the crucial role of vascular health in preserving functional independence in individuals with AD pathology.