There is growing evidence that vascular health plays a significant role in the etiology of clinical Alzheimer's disease (AD). Understanding the timing of vascular changes in relation to progression from cognitive impairment to AD has become of increasing importance, being both possible pre-clinical markers and potentially modifiable risk factors. White matter hyperintensities (WMH) detected in vivo with magnetic resonance imaging, are commonly used to assess cerebrovascular burden in cognitive impairment and appear to be associated with an increased risk of cognitive decline due to many causes. The present review examines specifically the association between WMH and AD and its related biomarkers. Overall, current findings across the literature suggest that WMH may predict AD at least a decade before the clinical stage of the disease, independently of biomarkers of AD pathology, thus indicating that vascular factors may constitute important targets for pre-clinical detection and intervention.