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Emerging diffusion MRI (dMRI) biomarkers are sensitive to early SVD but the lack of validated approaches for defining dMRI abnormality has limited their clinical utility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>In 3934 participants (8749 observations) from a population\u2010based sample, we classified 9% as vascular cognitive impairment versus not (VCI+\/VCI\u2212) using abnormal FLAIR\u2010MRI and cognitive testing. We evaluated four distinct dMRI positivity criteria and assessed performance in an independent clinical sample.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The young referent criterion performed best and yielded an estimated prevalence of dMRI positivity aligned with pathology literature. About 40% of the population were dMRI positive, and these individuals had lower baseline cognition and faster longitudinal decline. Cutpoints were validated in an independent clinical sample.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>The proposed dMRI abnormality framework can detect VCID and aid in identification of individuals at risk of VCI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71438","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T11:01:28Z","timestamp":1781262088000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Operationalizing diffusion magnetic resonance imaging positivity for detection of vascular contributions to impairment and dementia"],"prefix":"10.1002","volume":"22","author":[{"given":"Mingzhao","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Quantitative Health Sciences Division of Clinical Trials and Biostatistics Mayo 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