Jokinen H, Koikkalainen J, Laakso HM, et al. - Researchers quantified multiple types of small vessel disease-related brain changes and studied their individual and combined predictive value on cognitive and functional abilities by analyzing MRI scans of 560 older people from LADIS (Leukoaraiosis and Disability Study). 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. According to results, 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 related to the part of the outcome measures, but their participation 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 linked to vascular cognitive impairment, a combined measure of white matter hyperintensities, lacunar, gray matter, and hippocampal volumes could be used.