Jokinen H, Koikkalainen J, Laakso HM, et al. - Via analyzing magnetic resonance imaging scans of 560 older people from LADIS (Leukoaraiosis and Disability Study), researchers quantified multiple types of small vessel disease-related brain changes and tested their individual and combined predictive value on cognitive and functional abilities. For this investigation, they used automated atlas- and convolutional neural network–based segmentation methods yielding volumetric measures of white matter hyperintensities, lacunes, enlarged perivascular spaces, chronic cortical infarcts, and global and regional brain atrophy. Total volumes of white matter hyperintensities, gray matter, and hippocampi were the strongest predictors of cognitive performance and functional outcome over time. Volumes of lacunes, enlarged perivascular spaces, and cortical infarcts were significantly linked to the part of the outcome measures, but their influence was lower. A powerful predictor of long-term cognitive decline and functional disability is the global burden of small vessel disease-related brain changes as quantified by an image segmentation tool. As an imaging marker associated with vascular cognitive impairment, a combined measure of white matter hyperintensities, lacunar, gray matter, and hippocampal volumes could be used.