Vascular cognitive impairment is more prevalent than vascular dementia, but at present this condition is not recognized adequately. Vascular cognitive impairment does not manifest itself as dementia after stroke, but as gradually commencing cognitive impairment with or without a gait disorder. The clinical picture is caused by white matter damage and multiple lacunar strokes, sometimes called 'silent' strokes. Patients with vascular cognitive impairment have an increased risk of cardiovascular events, falling, and further cognitive decline, eventually evolving into dementia. It is important to recognize these patients and to provide advice and appliances and equipment, treat cardiovascular risk factors and prevent the complications of falling.