Longitudinal changes in white matter hyperintensity volume accelerate across the Alzheimer’s continuum in adults with Down syndrome.

Cerebrovascular disease is elevated across the Alzheimer’s disease (AD) continuum in adults with Down syndrome (DS), but regional change within individuals is unknown. Participants from the Alzheimer’s Biomarker Consortium-Down Syndrome (ABC-DS) study (n = 187) had magnetic resonance imaging (MRI) scans quantified for white matter hyperintensity (WMH) volume. Annualized WMH change was assessed across cognitive diagnostic groups defined by progression or stability between two visits (78% remained cognitively stable (CS), 6% progressed from CS to mild cognitive impairment [MCI]-DS, 5% remained MCI-DS, 6% progressed from MCI-DS to AD, 4% remained AD). Compared to those who remained CS, WMH changes, particularly in posterior regions, over time were faster in advanced diagnostic groups (i.e., MCI-DS to AD, AD at both timepoints). Monotonic increase across progressive diagnostic groups suggest an acceleration in WMH over time. Posterior WMH accelerates with AD progression in adults with DS beginning at the progression from MCI-DS to AD. White matter hyperintensity (WMH) volume increased and decreased over time in adults with Down syndrome. WMH decreased over time in the cognitively stable group. WMH increased over time in advanced Alzheimer’s disease diagnostic groups. Change in posterior WMH accelerated across progressive Alzheimer’s disease groups.