GLP-1 Analogue in Preventing Progression of Small Vessel Disease (GAPP-SVD)

Inclusion Criteria:

1. Chinese ethnicity;

2. Age 55 to 80 years old;

3. Age-Related White Matter Change (ARWMC) Scale of 2 or early 3 in FLAIR MRI;

4. Modified Functional Ambulation Classification 5 or above;

5. Montreal Cognitive Assessment (MoCA) score < 25;

6. Both diabetic and non-diabetic patient are eligible;

7. Patient who understands the purpose and requirements of the study, and able toprovide an informed consent;

Exclusion Criteria:

1. Dementia or MoCA score lower than 2nd percentile of the age and education adjustedcutoff ;

2. Cerebral white matter changes unrelated to neurodegenerative, e.g. CADASIL, X-linkedadrenoleukodystrophy, metabolic diseases, multiple sclerosis, etc.;

3. Contraindication to GLP-1R agonist, including thyroid carcinoma, pancreaticpathology, proliferative retinopathy, hypersensitivity to GLP-1R agonist and historyof family history of multiple endocrine neoplasia;

4. BMI <18.5kg/m2;

5. Contraindication to proposed imaging, e.g. chronic kidney disease (KDNIGO) stage 4or above, acute kidney injury, hypersensitivity to gadolinium-based contrast,non-MRI conditional implants or prosthesis;

6. Medical condition that would not allow the patient to adhere to the protocol orcomplete the study.;

7. Patient with established neurodegenerative disorders (e.g. Parkinson's Disease,Alzheimer's Disease, etc.);

8. Pregnancy.