Cerebral small vessel disease （CSVD） refers to a group of clinical， imaging， and pathological syndromes， mainly involving intracerebral small arteries， arterioles， capillaries， and small veins. It is commonly observed in the elderly population， and its insidious onset often causes the delay in diagnosis and treatment， which may lead to poor prognosis and progression to cognitive and behavioral impairments. This article elaborates on the pathogenesis， imaging features， diagnosis， and treatment of CSVD and CSVD-induced cognitive impairment， in order to raise the awareness of early diagnosis and treatment of CSVD in clinical practice.

Cerebral small vessel disease （CSVD） is a cerebral microvascular disease and is a common cause of stroke and a major cause of cognitive impairment in the elderly， but its pathogenesis remains unclear. This article reviews the main etiologies and pathogeneses of CSVD， in order to provide a reference for the clinical diagnosis and treatment of the disease.

Cerebral small vessel disease （CSVD） is a series of clinical， imaging， and pathological syndromes mainly caused by small vessel lesions， and it often has an insidious onset， diverse manifestations， and a low rate of early identification， which are the common reasons for gradual progression to cognitive impairment. It is worth noting that CSVD-related cognitive impairment is not limited to vascular cognitive impairment， and it can also involve other neurodegenerative diseases such as Alzheimer disease and Parkinson disease dementia. Therefore， precise identification， early diagnosis， and intervention are of great importance in controlling the development and damage of CSVD-related cognitive impairment. Given the complex pathological mechanisms and classifications of CSVD and the fact that the association between CSVD and the progression of cognitive impairment cannot be neglected， this article provides a comprehensive understanding of the etiology， pathogenesis， pathology， and imaging subtypes of CSVD and reviews the association between CSVD and various cognitive impairment diseases， so as to provide a reference for the clinical multimodal evaluation， prevention， and treatment of CSVD-related cognitive impairment.

Cerebral small vessel disease （CSVD） is a common disease with great impact on the health of the Chinese population. CSVD has insidious progression and is often neglected by both patients and physicians. In recent years， advances have been made in the research on CSVD from the aspects of risk factors， pathogenesis， clinical manifestations， and evaluation systems. In 2013， the international Standards for Reporting Vascular Changes on Neuroimaging （STRIVE） collaborative group standardized the definition and description of CSVD， and subsequently in 2021， our team released Chinese expert consensus on the diagnosis and treatment of cerebral small vessel disease 2021， which summarized the latest research findings in China and globally. In 2023， the international STRIVE collaborative group provided further updates on research advances in the field of CSVD. CSVD has similar clinical manifestations to neurodegenerative diseases， with a lack of significant specificity. Although genetic testing and brain tissue biopsy help to make a confirmed diagnosis to a certain extent， their application in clinical practice has been limited by technical and financial constraints. At present， neuroimaging techniques are mainly used to detect brain tissue lesions induced by CSVD and make a diagnosis. This article discusses the imaging markers for the diagnosis of CSVD and the imaging-based differential diagnosis of CSVD.

Cerebral small vessel disease （CSVD） is one of the major causes of depression in the elderly， and recent studies have shown that CSVD is closely associated with the development and progression of depression and may be an important predictive factor for the onset of depression. Therefore， this article reviews the association between CSVD and depression and the role of its neuroimaging features in the pathogenesis of depression， in order to provides an objective basis for the identification， prevention， and treatment of depression in high-risk populations in early clinical stages.

Cerebral small vessel disease （CSVD） refers to a series of clinical， imaging， and pathological syndromes caused by various factors that affect intracerebral small arteries and their distal branches， arterioles， capillaries， venules， and small veins. CSVD has a complex etiology， an insidious onset， and significant clinical heterogeneity， which can lead to disability and greatly threatens the health and life of people. In recent years， the development of neuroimaging technology has greatly promoted the screening and diagnosis of CSVD， but there are still limited effective therapies for CSVD. This article reviews and summarizes the current treatment status and research advances in CSVD in recent years， including traditional treatment methods and potential therapeutic targets， and analyzes the future development directions in this field， so as to explore the effective treatment strategies for CSVD.

Cerebral autoregulation （CA） is the ability of blood vessels to keep cerebral blood flow （CBF） relatively constant across a wide range of blood pressure or cerebral perfusion pressure. Ischemic cerebrovascular disease has been associated with CA impairment， but the mechanism is unclear. While their association is a focus， research on perioperative CA and neurovascular coupling （NVC） monitoring for carotid artery stenting has also made progress. This paper focuses on research progress on perioperative CA and NVC monitoring in patients undergoing carotid artery stenting， and discusses the value of CA and NVC for monitoring autoregulation of cerebral blood flow in the perioperative period of carotid artery stenting.

Obesity is a risk factor for various neurological diseases， and a comprehensive understanding of its harmful effects on the central nervous system is of great significance for the prevention and treatment of obesity-related neurological diseases. The blood-brain barrier （BBB） is a regulatory interface between blood and the brain tissue， which can prevent harmful substances from entering the brain while eliminating metabolic wastes from the brain tissue. It plays an important role in cerebral microenvironment homeostasis and physiological function. However， a large number of studies have shown that obesity can cause dysfunction of the BBB， directly or indirectly promoting the development and progression of various neurological diseases. This review systematically summarizes the latest research progress on the phenotypes and mechanisms of BBB dysfunction in obesity. From the aspects of altered BBB permeability， transport dysfunction， and neuroinflammation， we present the specific phenotypes of BBB dysfunction caused by obesity and regulatory mechanisms， and discuss the harmful effects of obesity on BBB function，aiming to provide theoretical guidance for relevant basic research and clinical practice.

The human brain has an extremely sophisticated neurovascular system to meet the instant demands of energy metabolism for brain cells. However， existing instruments can only detect single neurovascular functions to provide so fragmented information that many scientific issues related to neurovascular diseases remain unresolved. This paper reviews the role of cerebral autoregulation， cerebrovascular reactivity， neurovascular coupling， and autonomic nervous function in major diseases， and discusses the feasibility of a multi-functional， multi-paradigm， multi-scale， and high-resolution measurement system for human neurovascular function. We hope to provide scientific tools for in-depth investigation into new theories and mechanisms of major neurovascular diseases such as cerebrovascular disease and neurodegenerative disease.

Ischemic stroke （IS） is the most common type of stroke that can lead to severe neurological dysfunction while effective diagnostic and therapeutic methods are currently limited. Exosomes are natural vesicles that can play a key role in intercellular communication by delivering proteins， lipids， and nucleic acids. Notably，IS could cause changes in the level and content of exosome， which can serve as a potential biomarker to assist the diagnosis and treatment of IS. This article reviews the potential diagnostic value of exosomes，discusses their repair effects， and explores the potential application as drug carriers in IS. We also provide a concise summary of the current clinical research status based on exosomes.

Carotid atherosclerosis is an important risk factor leading to ischemic events. Carotid plaque load and carotid artery stenosis are closely related to the occurrence of ischemic events. In addition， the composition of carotid artery plaques is also closely associated with the occurrence of ischemic events. Intraplaque neovascularization （IPN）， as a characteristic component of vulnerable plaques， participates in the formation of carotid atherosclerotic plaques through a variety of mechanisms. This review focuses on the relationship between IPN grading and the degrees of carotid atherosclerosis.

Cerebral small vessel disease is a series of complex and heterogeneous cerebrovascular syndromes caused by various etiological factors that affect small vessels in the brain. Due to a lack of typical symptoms， the diagnosis of cerebral small vessel disease relies mainly on magnetic resonance imaging， and the neuroimaging findings can include recent small subcortical infarcts， lacunes of presumed vascular origin， white matter hyperintensities of presumed vascular origin， perivascular spaces， cerebral microbleeds， cortical superficial siderosis， and brain atrophy. Currently， the pathogenic mechanism of cerebral small vessel disease remains unclear， and specific treatment is also lacking. Given its similarities with stroke in risk factors and histopathological characteristics， stroke prevention and treatment approaches， such as antihypertensive and antiplatelet therapies， can be applied to the treatment of cerebral small vessel disease. However， due to the differences between the two conditions， stroke treatments cannot be fully suitable for cerebral small vessel disease， and an individualized comprehensive assessment is needed. This review presents the management of cerebral small vessel disease and stroke， highlighting their similarities and differences.

脑小血管病（cerebral small vascular disease,CSVD）越来越受到关注，其发病率是大血管病的5~6倍。按欧洲分类［1］脑小血管病分为六大类，其中第一类型最多，约占80%左右，系脑的小动脉粥样硬化、玻璃样变等所致。与年龄、高血压、糖尿病等脑血管病的高危因素有关。MRI常常表现为腔隙性梗死、脑白质损伤（脑白质高信号）、脑的微出血、扩大的血管周围间隙以及脑萎缩。这些影像变化随年龄增长而增加，正如本期董强教授研究所示，年龄每增加10岁，白质高信号、腔隙、脑微出血分别增加126%、35%、51%。 脑小血管病临床最常见的表现为情绪异常、头昏、步态异常、认知功能减退以及腔隙性梗死的表现。腔隙性梗死表现多变，与病灶部位和大小有关，常常为无临床症状。脑小血管病的防治需关注以下几个方面：(1)高危人群的筛查和随访：60岁以上人群，常常伴有高血压，或糖尿病或高脂血症等血管高危因素，都存在不同程度的“脑小血管病的影像改变”。例如一个老年患者，有高血压病史，MRI发现有白质损伤，Fazekas Ⅱ，认知功能正常，也没有腔隙性梗死，很难确定是否存在脑小血管病，是否可能演变成腔隙性梗死和认知功能障碍。国内外同行多数采用MRI包括结构和功能MRI研究早期诊断/预警的标志物。目前的研究提示，对老年高危人群，有条件可定期（6~12 m）MRI常规序列（DWI、T1WI、T2WI、FLAIR、SWI），观察白质高信号、腔隙性梗死、脑微出血、血管周围间隙和脑萎缩改变。如变化速度快［2~4］，警惕脑小血管病发生。当然，期待多中心，纵向队列研究多模态MRI研究，尽早发现预警/早期诊断的影像标志物或预测模型。(2)高危因素的防控：年龄是不可控因素，但其他高危因素是可控的。控制高血压可以减缓或抑制脑小血管病以及脑白质损伤的发生、发展［2］。降压药物建议首选CCB类的，减压疗效好，尤其对老年的波动性血压、晨峰血压有效，同时还具有心脑血管保护作用。调控血糖、血脂、戒烟、戒酒，治疗慢性肾病，治疗房颤等控制高危因素是对减少CSVD的重要措施。对腔隙性梗死患者建议使用一种抗血小板药物，可以减少复发率约20%左右［5］。脑微出血、脑白质损伤以及脑萎缩尚无有效的特异治疗药物。基础研究提示［6］，脑小血管病的最常见病理改变为脑血管内皮的损伤、血脑屏障的损伤以及脑免疫炎症。临床建议，可靶向血管内皮、血脑屏障以及脑免疫炎症，筛选已应用于临床的老药，进行临床研究，发现具有治疗脑小血管病作用，如改善或延缓脑白质损伤、脑微出血、认知功能减退，腔隙性梗死发生发展。即可以发现老药的新功能，如银杏类、前列腺素类药物，从机制上分析可能有效，有待多中心临床研究证实。

Objective　To investigate the risk factors for cerebral microbleeds (CMBs) in patients with white matter hyperintensities (WMH),and to find out the correlation between the severity of cerebral microbleeds and the duration of taking aspirin in patients with white matter hyperintensities.Methods　We collected patients with white matter hyper-intensities confirmed by MRI，who were admitted to the neurology department of Beijing Chaoyang Hospital Affiliated to Capital Medical University from June 2016 to September 2017.All enrolled patients were divided into non-CMBs group,mild CMBs group and moderate to severe CMBs group.All patients’ clinical data were collected for analyzing the risk factors of CMBs.Furthermore,the WMH patients who is taking aspirin were analyzed by subgroup analysis.Results　A total of 357 WMH patients were enrolled in this study,including 189 patients in the non-CMBs group,94 in the mild-CMBs group,and 74 in the moderate to severe CMBs group.There were significant differences among the three groups in gender,acute ischemic stroke,the history of hypertension,the history of ischemic stroke,diastolic blood pressure on admission,taking aspirin for more than two years,homocysteine level and the severity of WMH (P<0.05).Results　From subgroup analysis of 263 patients with WMH patients taking aspirin showed that with the increase of CMBS,the percentage of severe WMH patients increased gradually,and the percentage of patients taking aspirin for more than 2 years increased gradually as well.Conclusions　The severity of WMH is correlated with the severity of CMBs in WMH patients.Male,the history of hypertension and taking aspirin for more than two years are risk factors for CMBs in WMH patients,and the longer duration of taking aspirin in WMH patients,the more severe CMBs are.

Objective　To explore the characteristics of musical cognition in aged Cerebral Small Vessel Disease (CSVD) patients.Methods　Thirty-five aged CSVD individuals as well as 32 elderly subjects were recruited from Jan to Sep 2019 in Department of Neurology,the Seventh Medical Center for PLAGH.Montreal Battery of Evaluation of Amusia (MBEA) was chosen to analyze musical cognition,including pitch,rhythm and memory scores.Meanwhile,demographic data and amount of cognitive assessments were also collected.Student t-test for two independent samples was used to compare the data between groups,Pearson correlations were chosen to analyze the relationship between musical cognition parameters and other variants.Results　Compared to control group,aged CSVD individuals showed significant different ability of musical cognition,reflected by lower scores in pitch,rhythm and memory (P<0.05).Rhythm score correlated with Digital Symbol Substitution Test (DSST) (r=0.374,P=0.002).Memory score correlated with DSST (r=0.278,P=0.023) as well as Choice Reaction Time (CRT) (r=0.323,P=0.008).Total score correlated with DSST (r=0.338,P=0.005) as well as CRT (r=0.247,P=0.044).Conclusion　Significant differences could be found in musical cognition between aged CSVD patients and elderly control,and could be helpful to reveal the executive dysfunctions in aged CSVD subjects.

Objective　To examine the use of Montreal Cognitive Assessment (MoCA) scale for prediction of cognitive outcome.Methods　Data from 286 elderly patients who had performed cognitive assessment twice or more were obtained retrospectively,and divided into Normal Control (NC),Mild Cognitive Impairment (MCI) and dementia groups according to their baseline performance.The correlations between each item scores of MoCA and total score change at follow up were compared within groups.Results　Total score change was significantly correlated to the MMSE,cube,attention and subtraction in NC group;visuospatial/executive,clock-hands and digit-backward in MCI group;and abstraction in dementia group.Conclusion　Cognitive prognosis is influenced by the course of disease,interventions,learning effect and regression to the mean.Executive function decline can be considered as the early sign of Alzheimer’s disease.

Objective　To dissect the clinical and imaging differences between atypical multiple sclerosis and cerebral small vessels diseases.Methods　We presented one case of a hereditary cerebral small vessel disease-autosomal dominant genetic disease combined with subcortical infarction and white matter encephalopathy (CADASIL),which was initially misdiagnosed as multiple sclerosis.Afterwards.We reviewed literature regarding typical images and clinical aspects in multiple sclerosis and cerebral small vessels diseases and discussed the differential diagnosis points.Results　Multiple sclerosis often starts in young adults,with IgG index greater than 0.7,positive oligoclonal band,central venous signs,few microbleeding and asymmetric periventricular white matter lesions on MRI scan.On the contrary,cerebral small vessel diseases often start in old patients with vascular risk factors.MRI scan often shows the lacunar cerebral infarction,microbleeding,brain atrophy and symmetric periventricular white matter hyperintensity.Conclusion　Understanding the differential points between the two diseases may help avoid misdiagnosis and initiate reasonable treatment immediately.

高血压（Hypertension，HTN）是一种最常见的慢性疾病，是导致全球过早死亡或残疾的主要危险因素，其主要影响65岁以上的老年人。目前全球范围内的高血压患者约有11.3亿人，大约每4个成年人中就有1人患有高血压，并呈现出逐年增长的趋势。高血压可导致多种心脑血管病，大脑是高血压早期损伤的靶器官之一，可导致脑小血管病、缺血性脑卒中、出血性脑卒中或高血压脑病或认知功能减退等。实际上，高血压介导的神经系统疾病出现临床表现前，大脑结构或功能已经出现异常的改变，这种改变可被通过结构或功能磁共振成像（magnetic resonance imaging，MRI）技术发现，MRI具有分辨率高、对比性强、无创等优点，已广泛应用于临床。本文将高血压患者大脑磁共振常见变化综述如下。

脑微出血（cerebral microbleeds，CMBs）病理学中常表现为脑内微小血管（＜200 μm）管周病变，致使含铁血黄素沉积［1］，在磁共振梯度回波成像（T2*-weighted gradient-recalled echo，T2*-GRE）及磁敏感加权成像（susceptibility weighted imaging，SWI）常常表现为圆形或椭圆形病灶(非线形)，直径一般为5~10 mm，常规T1WI及T2WI上往往无高信号表现［2］。CMBs作为脑小血管病变的重要影像学标志之一，近年来受到越来越多的重视，尤其与认知功能障碍相关性的研究已逐渐成为热点。我们常按照CMBs所处部位，将CMBs大体上分为深部（deep or infratentorial，DI）CMBs和脑叶（strictly lobar，SL）CMBs两种类型。本文就CMBs与认知功能障碍的相关性、所致认知障碍类型及其发生机制进行综述，以期望进一步加深CMBs的理解，为今后评估认知障碍水平，延缓认知功能障碍进展提供一定依据。