Cerebral small vessel disease (CSVD), which notably increases the risk of stroke and cognitive disorders, is estimated to affect more than 5 million people in France alone. In the absence of a curative treatment, the prevention of cardiovascular risk factors remains the most effective strategy today. However, promising new therapeutic avenues are being explored.

Cerebral small vessel disease is a chronic condition that affects the smallest arteries of the brain, those that continuously supply the deep regions essential for memory, attention, and coordination.

Over time, these vessels become stiffer, thicken, or become more fragile and permeable. The consequences of this situation are far from insignificant, since cerebral small vessel disease promotes strokes, cognitive disorders, walking difficulties, as well as loss of independence.

In France, cerebral small vessel disease is estimated to affect more than 5 million people aged 65 and over. To date, no treatment is available to cure it.

In Bordeaux at the Laboratory of Cardiovascular Disease Biology, directed by Thierry Couffinhal, and the Vascular Brain Health Institute (founded by Stéphanie Debette, now Director of the Brain and Spine Institute), we are trying to gain a better understanding of the origin of the disease. Here is what we currently know about it.

A disease that is difficult to detect

When the small arteries supplying the brain are affected by cerebral small vessel disease, the brain receives less oxygen and fewer nutrients than it needs.

In addition, the cells lining these blood vessels contribute to the formation of the blood-brain barrier (BBB), a structure that is essential for brain health. This barrier normally acts as a highly selective filter between the blood and the brain. When it becomes more permeable, unwanted substances can enter the brain tissue and contribute to its gradual deterioration.

Cerebral small vessel disease is often silent in its early stages. It is not uncommon for it to progress for years without any striking signs, and the first indications of its presence may be subtle: slowed thinking and balance disorders, cognitive fatigue, or unusual forgetfulness. It can also lead to strokes.

To detect it, brain magnetic resonance imaging (MRI) remains the reference tool today. It makes it possible to observe characteristic lesions, sometimes present even before the first symptoms, such as microbleeds, lacunes (small cavities indicating previous small vessel damage), and above all white........

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