Cerebrovascular disease is the second leading cause of cognitive impairment in late life, either alone or in combination with Alzheimer's disease. Vascular cognitive impairment (VCI) is a heterogeneous phenotype that may result from a large spectrum of risk factors, blood vessel pathologies, types of vascular brain injury, and regional distribution of infarcts and hemorrhages. Recommendations to harmonize clinical, imaging, pathology, and neuropsychology data have recently been made. No single neuropsychological profile is characteristic of VCI, although dysexecutive function is common and verbal memory tends to be better preserved than in Alzheimer's disease. Compared with Alzheimer's disease, rate of mortality is higher and rate of cognitive decline slower. Silent hyperintensities on MRI, including silent incomplete infarcts and white matter changes, are associated with subtle cognitive impairment and increased risk for stroke, warranting a search for modifiable risk factors. To varying degrees, VCI is potentially preventable by vigilant identification and treatment of vascular risk factors.