Cerebral small vessel disease (CSVD) is a common disease in older people, characterized by damage to intracranial microvessels, leading to cognitive decline, increased risk of stroke, and dementia. This review reviews the current therapeutic approaches for CSVD and the latest research advances, encompassing traditional pharmacological therapies, emerging targeted interventions grounded in pathophysiology, exploratory immune-related treatments, and advances in genetic research. In addition, the role of lifestyle modifications in disease management is discussed. The review emphasizes the importance of a holistic, personalized treatment strategy to improve outcomes. More clinical trials are needed to validate these treatments and optimize individualized treatment options for CSVD patients.