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In this review, we discuss the contribution of cerebral amyloid angiopathy and non\u2010amyloid small vessel disease in AD, and the accompanying changes to the density, maintenance and remodelling of vessels (including alterations to the composition and function of the cerebrovascular basement membrane). We consider how abnormalities of the constituent cells of the neurovascular unit \u2013 particularly of endothelial cells and pericytes \u2013 and impairment of the blood\u2010brain barrier (BBB) impact on the pathogenesis of AD. We also discuss how changes to the cerebral vasculature are likely to impair A\u03b2 clearance \u2013 both intra\u2010periarteriolar drainage (IPAD) and transport of A\u03b2 peptides across the BBB, and how impaired neurovascular coupling and reduced blood flow in relation to metabolic demand increase amyloidogenic processing of APP and the production of A\u03b2. We review the vasoactive properties of A\u03b2 peptides themselves, and the probable bi\u2010directional relationship between vascular dysfunction and A\u03b2 accumulation in AD. Lastly, we discuss recent methodological advances in transcriptomics and imaging that have provided novel insights into vascular changes in AD, and recent advances in assessment of the retina that allow in vivo detection of vascular changes in the early stages of AD.<\/jats:p>","DOI":"10.1111\/bpa.13061","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T02:07:24Z","timestamp":1647310044000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":128,"title":["Pathological changes within the cerebral vasculature in Alzheimer\u2019s disease: New perspectives"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0387-290X","authenticated-orcid":false,"given":"Robert A.","family":"Fisher","sequence":"first","affiliation":[{"name":"Dementia Research Group University of Bristol Medical School Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8594-1640","authenticated-orcid":false,"given":"J. 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