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The roles of Alzheimer's disease (AD) pathology and vascular\u2010related white matter injury in this association were merely studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We included 617 dementia\u2010free participants from the Shanghai Aging Study with up to 10 years of follow\u2010up. At baseline, EDS was assessed with the Epworth Sleepiness Scale (ESS) and plasma phosphorylated tau (p\u2010tau)217 was measured using a single\u2010molecule immune\u2010array assay. Cognitive decline was evaluated using the Mini\u2010Mental State Examination (MMSE), and incident dementia was determined by expert consensus during follow\u2010up. A magnetic resonance imaging marker of white matter injury (peak width of skeletonized mean diffusivity [PSMD]) was derived from diffusion tensor imaging, and gray matter volume was assessed from T1\u2010weighted imaging in a subcohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>At baseline, 66 participants (10.7%) had EDS and showed lower MMSE scores. EDS was associated with a higher risk of incident dementia (hazard ratio [HR] 2.06, 95% confidence interval [CI] 1.09\u20133.92), especially among individuals with low p\u2010tau217 (HR 4.94, 95% CI 1.75\u201313.93) independent of sleep disturbance after adjusting for\u00a0age, sex, and education. Higher ESS was related to AD pathology\u2013dependent patterns of brain atrophy and to higher PSMD. PSMD modified the associations between EDS and cognitive decline, and incident dementia. Participants with both high PSMD and EDS showed the highest dementia risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>EDS may help identify older adults with low AD biomarker burden who are at increased risk of dementia, independent of nocturnal sleep disturbance. White matter injury may contribute to this risk, supporting a vascular vulnerability pathway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/trc2.70272","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T03:06:34Z","timestamp":1780455994000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of Excessive Daytime Sleepiness With Long\u2010Term Incident Dementia: The Role of \u03b2\u2010Amyloid and White Matter Injury"],"prefix":"10.1002","volume":"12","author":[{"given":"Xiaowen","family":"Zhou","sequence":"first","affiliation":[{"name":"Institute of Neurology, Huashan Hospital Fudan University  Shanghai China"},{"name":"National Clinical Research Center for Aging and Medicine, Huashan Hospital Fudan University  Shanghai China"},{"name":"National Center for Neurological Disorders, Huashan Hospital Fudan University  Shanghai 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Chrissy Chen Institute TCCI  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Yang","sequence":"additional","affiliation":[{"name":"Tianqiao and Chrissy Chen Institute TCCI  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute of Neurology, Huashan Hospital Fudan University  Shanghai China"},{"name":"National Clinical Research Center for Aging and Medicine, Huashan Hospital Fudan University  Shanghai China"},{"name":"National Center for Neurological Disorders, Huashan Hospital Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoniu","family":"Liang","sequence":"additional","affiliation":[{"name":"Institute of Neurology, Huashan Hospital Fudan University  Shanghai China"},{"name":"National Clinical Research Center for Aging and Medicine, Huashan Hospital Fudan University  Shanghai 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