ReviewImaging small vessel-associated white matter changes in aging

•Changes in small vessel sufficiency with aging impact neural health and function.•Variation in even the 'normal' vascular range may measurably impact brain tissue.•Future therapeutics may target vascular systems to reduce age-associated decline.

Alterations in cerebrovascular structure and function may underlie the most common age-associated cognitive, psychiatric, and neurological conditions presented by older adults. Although much remains to understand, existing research suggests several age-associated detrimental conditions may be mediated through sometimes subtle small vessel-induced damage to the cerebral white matter. Here we review a selected portion of the vast work that demonstrates links between changes in vascular and neural health as a function of advancing age, and how even changes in low-to-moderate risk individuals, potentially beginning early in the adult age-span, may have an important impact on functional status in late life.