Cerebrovascular disease: Neuroimaging of cerebral small vessel disease

The cerebral microvasculature is exceptionally vulnerable to changes due to aging. Both the radiological and clinical manifestations of cerebral small vessel disease (cSVD) in older age are highly heterogeneous, ranging from no symptomatology to devastating neurocognitive complications, including stroke, dementia, and depression. To date, the exact pathogenesis of cSVD is unknown; neither prevention nor treatments are currently available for this potentially very disabling condition. This chapter reviews recent advances in neuroimaging methodologies that have improved our understanding of the appearance of cSVD and the underlying mechanisms. We will discuss new venues for future research focusing on: (a) methodologies to measure early stages of cSVD, examining damage primarily in small vessels and secondarily in parenchyma; and (b) lifespan study designs to capture the onset and evolution of cSVD over time, as well as the temporality of exposure to risk factors.