We found significant cerebral atrophy and abnormal cerebral glucose metabolism in well-treated hypertensive people. These findings suggest that longstanding hypertension can result in structural and metabolic brain changes that predate the clinical evidence of vascular dementia or stroke, and good blood pressure control with a conventional antihypertensive regime fails to protect against hypertension-induced brain damage. White matter abnormalities such as periventricular hyperintensity on magnetic resonance imaging (MRI) occur in up to 13% of patients who had first MRI. This chang is associated with advancing age and hypertension, but the clinical significance of white matter abnormalities in healthy people and in patient with Alzheimer's disease (AD) is unknown. Extensive white matter change can be found in dementia patients clinically indistinguishable from AD. These patients differ from AD patients without white matter change in the pattern of cerebral glucose metabolism. Three such patients who came to autopsy showed AD neuropathology and severe cerebral amyloid angiopathy. White matter hyperintensity volumes in older healthy subjects were predictive of increased lateral ventricular volume, reduced brain volume, and reduced cognitive scores, and lower whole brain and frontal lobe glucose metabolism
