Important and common syndromes of old age, such as dementia, parkinsonism, falls, depression, and urinary incontinence, may be associated with vascular pathology affecting subcortical brain structures. The advent of neuroimaging has brought this more to the attention of clinicians and researchers, with increasing evidence that the common findings of white matter change, and small lacunar infarcts are not entirely benign, as previously assumed. Such lesions are common in elderly populations: only 5% of 1077 subjects aged between 60 and 90 from the Rotterdam study were found to be completely free of white matter lesions. Even in otherwise healthy elderly people, such lesions may impact on cognitive and physical abilities.