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Oxygen extraction fraction (OEF), which reflects the functional status of cerebral small vessels, is a potential physiological biomarker for VCID. We tested this hypothesis in older adults enriched for small vessel diseases, controlling for Alzheimer's disease (AD) co\u2010pathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Comprehensive cognitive, plasma, and imaging data were collected from 81 older adults with at least one vascular risk factor. OEF in major cerebral veins was quantified using magnetic resonance imaging. Associations between OEF and cognition, vascular, and plasma AD biomarkers were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In this VCID\u2010enriched cohort, poorer global cognition and executive function were associated with elevated OEF, but not with plasma phosphorylated tau 217. Increased OEF correlated with more vascular risk factors and greater white matter hyperintensity volume.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Our findings suggest that elevated OEF in individuals with vascular risks is a physiological biomarker for VCID.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71828","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T02:52:07Z","timestamp":1789354327000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebral oxygen extraction fraction as a physiological biomarker in vascular cognitive impairment: A study in older adults enriched for small vessel diseases"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8533-5893","authenticated-orcid":false,"given":"Jie","family":"Song","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"The Russell H. 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