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We wanted to quantify early cerebrovascular health\u2013related magnetic resonance imaging brain measures (structure, perfusion, microstructural integrity) and evaluate their utility as a biomarker for cerebrovascular health.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used 2 independent samples (discovery, n\u2009=\u2009390; validation, n\u2009=\u20091,035) of individuals, aged\u2009\u2265\u200960 years, along the cognitive continuum with imaging from the population\u2010based sample of Mayo Clinic Study of Aging. We ascertained vascular health by summing up recently existing cardiovascular and metabolic conditions (CMC) from health care records (hypertension, hyperlipidemia, cardiac arrhythmias, coronary artery disease, congestive heart failure, diabetes mellitus, and stroke). Using multiple regression models, we quantified associations between CMC and brain health after accounting for age, sex, education\/occupation, and AD burden (from amyloid and tau PET).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Systemic vascular health was associated with medial temporal lobe thinning, widespread cerebral hypoperfusion, and loss of microstructural integrity in several white matter tracts including the corpus callosum and fornix. Further investigations suggested that microstructural integrity of the genu of the corpus callosum was suitable for assessing prodromal cerebrovascular health, had similar distributions in the discovery and independent validation datasets, and predicted cognitive performance above and beyond amyloid deposition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Systemic vascular health has significant impact on brain structure and function. Quantifying prodromal cerebrovascular health\u2013related brain measures that are independent of AD pathology\u2013related changes has great utility for cognitive aging. Ann Neurol 2018;84:713\u2013724<\/jats:p><\/jats:sec>","DOI":"10.1002\/ana.25346","type":"journal-article","created":{"date-parts":[[2018,9,28]],"date-time":"2018-09-28T08:33:53Z","timestamp":1538123633000},"page":"705-716","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":73,"title":["Development of a cerebrovascular magnetic resonance imaging biomarker for cognitive aging"],"prefix":"10.1002","volume":"84","author":[{"given":"Prashanthi","family":"Vemuri","sequence":"first","affiliation":[{"name":"Department of Radiology Mayo Clinic  Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy G.","family":"Lesnick","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research Mayo Clinic  Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Przybelski","sequence":"additional","affiliation":[{"name":"Department of Health Sciences 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