Age-dependent cerebral microangiopathy (also known as cerebral small vessel disease) is a common heterogeneous condition that ranks high as a cause of disability and mortality of elderly patients due to strokes and intracerebral hemorrhages, vascular cognitive disorders, walking disorders, and the induction of neurodegeneration. In this review, we 1) describe the achievements of neuroimaging in the diagnosis of the age-dependent cerebral microangiopathy forms and the standardization of clinical and experimental studies; 2) analyze the possibilities and prospects of using a lifetime MRI assessment of the brain microstructure and pathophysiological mechanisms of its damage associated with neurovascular unit dysfunction; 3) provide evidence of pathomorphosis of the disease, due to, among other things, the control of vascular risk factors, and indicate the need to search for new risk factors with the determination of individual susceptibility to them; 4) indicate the need to use experimental models of CMA that consider its pathomorphosis, and pay attention to the prospects of endothelial dysfunction models; 5) assess the prospects for the development of pathogenetic treatment in terms of finding molecular targets using omics technologies. The complexity of the condition and the limited approaches to its prevention indicate the need for consortium discussion and collaboration of various specialists in the field of neuroscience for advancements in the management of this disease.