Abstract: Objective To investigate the prevalence of the total burden of cerebral small vessel disease (CSVD) and its associated factors in a community-dwelling, middle-aged and elderly population through a cross-sectional study, aiming to elucidate patterns of risk factors and provide evidence for prevention and control strategies. Methods A cross-sectional study was conducted from January to April 2025. Participants were recruited from community residents through random sampling based on health records, supplemented by voluntary participation following health awareness campaigns. Data on demographics and medical history were collected using a standardized questionnaire. Physical activity and dietary metrics were obtained through guided self-administered questionnaires. All participants underwent laboratory examinations and magnetic resonance imaging (MRI). The prevalence of the total CSVD burden was described, and univariate and multivariate analyses were performed to identify associated factors. Results A total of 451 middle-aged and elderly individuals were included in the final analysis. Regarding the total CSVD burden score, 248 participants (54.99%) had a score of 0, 112 (24.83%) had a score of 1, 65 (14.41%) had a score of 2, 24 (5.32%) had a score of 3, and 2 (0.44%) had a score of 4. The overall prevalence of CSVD (total burden score ≥1) was 45.01% (n=203). Among the specific CSVD markers, white matter hyperintensities were present in 142 individuals (31.49%), at least one lacunar infarct was observed in 96 (21.29%), at least one cerebral microbleed was detected in 70 (15.52%), and significant enlargement of perivascular spaces in the basal ganglia was found in 108 (23.95%). Multivariate logistic regression analysis revealed that age (≥60 years, OR=1.933), a history of hypertension (OR=1.617), a history of diabetes mellitus (OR=1.811), a history of migraine (OR=1.994), BMI (24 to <28 kg/m², OR=2.586; ≥28 kg/m², OR=3.127), fasting blood glucose (>6.1 mmol/L, OR=1.887), HbA1c (≥5.7%, OR=1.704), Hcy (>15 μmol/L, OR=1.768), low physical activity level based on the IPAQ (OR=1.887), and a higher Mediterranean Diet (MED) score (OR=0.548) were significantly associated with the prevalence of the total CSVD burden in this community-based population (all P<0.05). Conclusions The findings of this study indicate a substantial prevalence of CSVD in the community-dwelling, middle-aged and elderly population. Multiple common health issues were identified as significant risk factors. Adherence to a Mediterranean dietary pattern may be associated with a reduced risk. These results highlight potential directions for the formulation of targeted prevention and control strategies.

Key words: Cerebral small vessel disease, Middle-aged and elderly, Total burden score, Community, Influencing factors