•AI-driven tools and multimodal biomarkers emerged as key for early VCID detection.•Novel neuroimaging, fluid, and retinal markers show promise for precision diagnostics.•BBB leakage and inflammation could early drive small vessel disease and VCID.•Clinical trials explore drug repurposing and hybrid lifestyle-pharmacological interventions.•Genetic insights into CADASIL reveal shared pathways with sporadic SVD.
Keywords: Early career investigators; Epidemiology; Fluid, Retinal, Cardiac biomarkers; Hereditary SVD; Neuroimaging; Pathophysiology; Small vessel disease; Treatment; Vascular cognitive impairment and dementia.
© 2025 The Authors.