Egle M, Loubiere L, Maceski A, et al. - In a longitudinal study of patients with lacunar stroke and confluent white matter hyperintensities, researchers ascertained if both baseline, and change, in neurofilament light chain (NfL) levels were associated with changes in MRI markers, cognitive decline and dementia risk. At baseline and annually for 3 years, patients underwent MRI, cognitive testing and had their blood drawn. Clinical and cognitive follow-up lasted for 5 years. For 113 individuals for the baseline analysis and 90 patients for the longitudinal analysis, NfL data were available. Over a 5 years follow-up period in cerebral small vessel disease (SVD), baseline NfL predicts changes in MRI markers, cognitive decline, and dementia rate, indicating NfL can be a useful prognostic marker. However, there was no identification of changes in NfL values, so NfL might not be a useful surrogate marker in SVD clinical trials.