Lee WJ, et al. - In this longitudinal follow-up cohort study, researchers investigated how the progression of Alzheimer disease (AD) was influenced by the summative influences of vascular risk factors (VRFs). Participants were 330 AD patients (mean age was 80.7 years) from 2 teaching hospitals in Taiwan who were observed over a period of 3 years. The correlations between the VRFs and longitudinal Mini-Mental State Examination and Clinical Dementia Rating Sum of Boxes alterations were assessed using the generalized estimating equation method. More rapid cognitive decline was seen among patients with more than three VRFs vs those without VRFs as well as those with three or fewer VRFs. Overall, the summative impacts of multiple VRFs on the progression of AD were evident in this study, particularly in apolipoprotein E ε4 carriers.