Cerebral small vessel disease: early life antecedents and long-term implications for the brain, aging, stroke and dementia.

Cerebral small vessel disease (SVD) is common in older adults and increases risk of stroke, cognitive impairment and dementia. While often attributed to midlife vascular risk factors such as hypertension, factors from earlier in life may contribute to later SVD risk. In this review we summarise current evidence for early life effects on SVD, stroke and dementia focusing on prenatal nutrition, and cognitive ability, education and socioeconomic status in childhood. We discuss possible reasons for these associations, including differences in brain resilience and reserve, access to cognitive, social and economic resources, health behaviours, and we consider the extent to which these associations are independent of vascular risk factors. Although early life factors, particularly education are major risk factors for Alzheimer’s disease, they are less established in SVD or vascular cognitive impairment. We discuss current knowledge, gaps in knowledge, targets for future research, clinical practice and policy change.