Аннотация:Age-related cerebral small vessel disease (CSVD) is a common heterogeneous pathology, occupying a lead-ing place in the structure of disability and mortality in elderly and old patients due to the development of strokes and intracerebral hemorrhages, vascular cognitive impairment, gait disorders, and the induction of neurodegeneration. This review presents advances in the role of neuroimaging in the diagnosis of different forms of this disease and standardization of clinical and experimental studies; it analyzes the potentials and prospects of using in vivo magnetic resonance imaging of cerebral microstructure and the pathophysiolog-ical mechanisms of its damage associated with dysfunction of neurovascular units; it provides evidence of pathomorphosis of the pathology resulting from, among other things, the control of vascular risk factors; it outlines the need to seek new risk factors and to determine individual sensitivities to them; the need for the use of experimental models of CSVD which take account of its pathomorphosis is demonstrated and attention is drawn to the promise of models of endothelial dysfunction; prospects for developing pathoge-netic treatments are assessed from the point of view of seeking molecular targets using omics technologies.