 The prevalence of both Alzheimers Disease AD and stroke doubles each decade over 65 years old. Both are major causes of dementia, currently estimated to affect 46 million people worldwide. The current costs globally are 818 billion. Additionally, in population studies elders over 65 years, covert cerebral small vessel disease appears on MRI scans as silent lacunar infarcts in 25 as Microbleeds in 10, and as focal or diffuse incidental white matter disease WMD in 95. WMD is extensive in 20, with a clinical threshold effect around 10cc2. Small vessel disease is even more common in dementia, often coexisting with AD and independently contributing to cognitive decline and progression to dementia. Longitudinal imaging using cerebral amyloid labeling opens a new opportunity to understand the additiveinteractive effects of small vessel disease and AD. 