Chronic cerebral hypoperfusion (CCH) is a significant cause and pathogenesis of vascular cognitive impairment (VCI). The neurovascular unit (NVU), as the basic functional unit of the central nervous system, responds to prolonged cerebral hypoperfusion through individual and cross-communication among neurovascular cells. Neuroinflammation is amplified in a cascade, leading to irreversible brain tissue damage and cognitive dysfunction. The screening of early biological and imaging markers of CCH provides the possibility for early identification and intervention of VCI. This article reviews the potential mechanisms by which CCH induces VCI and the expression of early related markers, aiming to provide a theoretical basis for the early screening, diagnosis, and intervention of VCI.