Gut Microbiome in Sporadic Cerebral Small Vessel Disease: MRI-Defined Phenotypes, Mechanistic Evidence, and Nutritional Implications for Brain Aging

Background/objectives

Cerebral small vessel disease (CSVD) is a major vascular component of brain aging, yet potentially modifiable systemic contributors remain incompletely understood. Growing evidence links the gut microbiome to magnetic resonance imaging (MRI)-defined CSVD, but interpretation is complicated by heterogeneity in microbiome profiling, clinical populations, analytical methods, and neuroimaging phenotypes. This review critically integrates the available human evidence with complementary multi-omics, ex vivo, and experimental findings.