Patient description: A 62-year-old African-American man presented with left upper and lower extremity weakness, associated with dark visual spot in right eye, right facial numbness, facial drop and slurred speech. He denied dyspnea, headache, palpitations, chest pain, fever, dizziness, bowel or urinary incontinence, loss of consciousness. His medical history was significant for hypertension, hyperlipidemia and hypothyroidism. He smokes cigarette 1 pack per day for 40 years and alcohol consumption of 5 to 6 beers per week. He is not aware about his family history. He is using Levothyroxine, Atorvastatin and HTCZ. His vital signs were stable in the primary evaluation. Left-sided facial droop, dysarthria, and left-sided hemiplegia were seen in the physical exam. His National Institutes of Health Stroke Scale (NIHSS) score was calculated as 7. Initial CT angiogram of head and neck reported no acute intracranial findings. Intravenous recombinant tissue plasminogen activator (t-PA) was administered as well as high-dose statin therapy. The patient was admitted to the intensive care unit to be monitored for 24 hours. MRI of the head revealed an acute 1.7-cm infarct of the right periventricular white matter and posterior right basal ganglia.

Clinical trial eligibility criteria: eligible ages (years): 60.0-999.0,  Alzheimer's Disease Small Vessel Disease White Matter Hyperintensities Subtype Vascular Cognitive Impairment Eligible subjects must meet the following before they are enrolled into the study: 1. Patients with early AD or amnestic, non-amnestic single or multi-domain MCI who have confluent pvWMH; recruited from memory clinics. Or Patients who have had a minor stroke (e.g. subcortical lacunar infarct ≤1.5cm) or a TIA with confluent pvWMH; recruited from stroke prevention clinics. 2. Age ≥ 60 3. Patients who have provided written informed consent 4. Patients with greater than 8 years of education 5. Patients with an expected survival of greater than 2 years 6. Patients that are sufficient fluency in French or English for cognitive testing 7. Patients with a Mini-Mental State Exam score of (MMSE) ≥ 20 8. Patients with pvWMH score on CT or MRI of ≥2 on the periventricular Fazekas scale 31 NOTE: Fazekas 2 patients can be included if they have bilateral posterior or anterior periventricular caps extending only 10mm from the ventricle (i.e. halfway into the surrounding white matter vs extending out to most of the surrounding white matter required for Fazekas 3)  Subject meeting any one of the following are not eligible for the the study: 2. Patients with cortical or non-lacunar infarct on imaging 3. Patients with persisting hemiparesis after a motor stroke, leg strength <4/5 on the Medical Research Council (MRC) scale; significant cerebellar ataxia 4. Patients with contraindications to 3T MRI 5. Patients with major psychiatric disorder during the preceding 5 years 6. History of substance abuse within the past 2 years 7. Serious/chronic systemic or neurological illness (other than AD) such as Parkinson's disease, multi-infarct dementia, Huntington's disease, normal pressure hydrocephalus, brain tumor, progressive supranuclear palsy, seizure disorder, subdural hematoma, multiple sclerosis, or history of significant head trauma followed by persistent neurologic deficits or known structural brain abnormalities 8. Pain or sleep disorder that could interfere with testing 9. Claustrophobia 10. Patients that have received radiation therapy to the head or neck or have been in another research study involving radiation 11. Patients who are unable or unwilling to comply with protocol requirements or deemed by the investigator to be unfit for the study