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 to provide an informed consent; Exclusion Criteria: 1. Dementia or MoCA score lower than 2nd percentile of the age and education adjusted cutoff ; 2. Cerebral white matter changes unrelated to neurodegenerative, e.g. CADASIL, X-linked adrenoleukodystrophy, metabolic diseases, multiple sclerosis, etc.; 3. Contraindication to GLP-1R agonist, including thyroid carcinoma, pancreatic pathology, proliferative retinopathy, hypersensitivity to GLP-1R agonist and history of family history of multiple endocrine neoplasia; 4. BMI \<18.5kg/m2; 5. Contraindication to proposed imaging, e.g. chronic kidney disease (KDNIGO) stage 4 or 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 or complete the study.; 7. Patient with established neurodegenerative disorders (e.g. Parkinson's Disease, Alzheimer's Disease, etc.); 8. Pregnancy.