Early-life vascular risk factors, especially elevated systolic blood pressure and smoking before age 40, strongly predict cognitive decline by midlife.
Longitudinal neuroimaging reveals accelerated white matter hyperintensity accumulation and gray matter volume changes in frontal, temporal, occipital, and thalamic regions linked to cognitive trajectories.
Network-level brain reorganization centers on the basal forebrain, potentially reflecting cholinergic and glial responses to early vascular stress, serving as an early biomarker.
Findings underscore the critical window before age 40 for vascular risk management to preserve midlife cognition and delay neurodegenerative processes.
