Cerebral Small Vessel Disease and Vascular Cognitive Impairment

The term ‘cerebral small vessel disease’ is used to describe a variety of pathological, neuroradiological and clinical phenotypes that result from processes affecting the small vessels of the brain. The most prevalent pathological type is arteriolosclerosis, a strongly age- and hypertension-related process. In clinical and research practice, we assess cerebral small vessel disease using neuroimaging. The standardised classification system includes recent small subcortical infarcts, white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces and more generalised processes such as brain atrophy. Clinical symptoms can be acute, for example, lacunar stroke, or more chronic and progressive. A syndrome that includes some or all of cognitive decline, depression, gait disorder and urinary incontinence is often seen. Evidence-based interventions are lacking. Prevention is mainly targeted at common vascular risk factors, particularly hypertension. Finding novel modifiable risk factors or potential interventions is a focus of contemporary research.