Cerebral small vessel disease (CSVD) is one of the most common vascular diseases of the brain, primarily diagnosed using magnetic resonance imaging biomarkers. Advanced brain imaging techniques have enabled the detection of asymptomatic or covert CSVD in individuals without neurological symptoms. CSVD is highly prevalent among the elderly and healthy community-dwelling adults with vascular risk factors. It increases the risk of stroke, cognitive decline, and vascular dementia, and exacerbates the severity of Alzheimer’s disease. Covert CSVD is generally considered incidental, leading to a lack of intervention, especially among non-neurological physicians. The relevance of CSVD in asymptomatic healthy populations remains a contentious issue. Despite identifying covert CSVD, management strategies are poorly established, posing challenges for neurologists and primary care physicians. Key debated issues are: (i) the advantages of screening asymptomatic individuals concerning reduced adverse health events or cost-effectiveness, (ii) effective community screening strategies, including the development of non-imaging biomarkers, and (iii) the clinical and therapeutic implications of covert CSVD. Currently, limited scientific evidence addresses these issues, necessitating more high-quality longitudinal studies. Increased awareness regarding the importance of detecting, treating, and systematically monitoring covert CVDS is essential. Screening procedures should be more active, utilizing more accessible non-imaging biomarkers such as blood tests, retinal assessments, and ambulatory blood pressure monitoring. The early detection of CSVD presents an opportunity to implement more effective preventive strategies.