Cerebral small vessel disease (SVD) is manifested as age-related white matter lesions (WML) and lacunar infarcts and on brain imaging. SVD is prevalent in the elderly population. In community dwelling persons ≥ 60 years of age, up to a quarter had lacunar infarcts and 96% had varying degree of WML. Significant SVD, namely early confluent or confluent WML and multiple lacunar infarcts, are found in up to 1 in every 5 elderly persons. In a previous study we found that Chinese are more prone to develop significant SVD than Caucasians. SVD is associated with a plethora of age-related disabilities such as dementia, falls, depression, impaired daily functioning and death Cognition - SVD is the most common cause of vascular cognitive impairment (VCI) and vascular dementia, which is the second most prevalent type of dementia. Community elderly persons with SVD had two-fold increased risk of developing dementia when compared to those without. SVD may direct damage neural structures, disrupt connectivity or cause atrophy in brain regions important for cognitive functioning. Depression - Disconnection of frontosubcortical pathways by SVD contributes to late-life depression, and increased comorbidity of depression and SVD has been observed in the older populations. Depression contributes to poor quality of life and death in older persons.