Lifetime influences on imaging markers of adverse brain health and vascular disease.

Cerebral small vessel disease (cSVD) is highly prevalent in the general population, increases with age and vascular risk factor exposure, and is a common cause of stroke and dementia. There is great variation in cSVD burden experienced in older age, and maintaining brain health across the life course requires looking beyond an individual's current clinical status and traditional vascular risk factors. Of particular importance are social determinants of health which can be more important than healthcare or lifestyle choices in influencing later life health outcomes, including brain health. In this paper we discuss the social determinants of cerebrovascular disease, focusing on the impact of socioeconomic status on markers of cSVD. We outline the potential mechanisms behind these associations, including early life exposures, health behaviours and brain reserve and maintenance, and we highlight the importance of public health interventions to address the key determinants and risk factors for cSVD from early life stages.