Cerebral Slow Flow: An Emerging Phenomenon in Vascular Dementia Pathogenesis

Dementia poses a major global health burden, currently affecting more than 55 million individuals worldwide, with vascular dementia ranking as the second most prevalent form after Alzheimer's disease.The pathogenesis of vascular cognitive impairment spans a wide continuum of cerebrovascular pathology, ranging from overt largevessel strokes to more subtle microvascular dysfunction. 1 A central feature of this disease process is impaired cerebral perfusion, wherein ischemic insults and chronic hypoperfusion compromise neuronal integrity and survival.Although traditional paradigms have emphasized macrovascular occlusion and white matter injury, accumulating evidence indicates that more subtle perfusion abnormalities may play an equally critical role in driving cognitive decline.We seek to highlight an emerging neurological phenomenon that may represent a substantial yet underrecognized contributor to vascular dementia: cerebral slow flow (CSF).While this concept is increasingly recognized through advanced neuroimaging techniques, it remains insufficiently apppreciated in clinical practice, despite its potential diagnostic and therapeutic implications in the evaluation and management of vascular cognitive impairment.