Cerebral small vessel disease (CSVD) is a leading cause of disability and cognitive impairment in older adults, second only to Alzheimer dementia. Though the clinical manifestations of CSVD are common, the underlying mechanisms of disease remain unknown. My research is focused on using advanced neuroimaging techniques to understand what causes CSVD and what factors contribute to its progression. With state-of-the-art, non-invasive neuroimaging techniques, we are beginning to understand the impact of unique pathomechanistic pathways underlying CSVD including chronic cerebral ischemia, blood brain barrier leakage, edema and neuroinflammation. With a more complete understanding of disease pathogenesis, we will begin to identify targets for slowing or reversing CSVD, ultimately resulting in improved outcomes for patients with this common disease