This article provides a diagnostic framework for vascular cognitive impairment, discusses prevalence and relationships to other neurodegenerative pathologies, and provides advice on diagnostic workup and management.Vascular cognitive impairment is the second most common cause of cognitive impairment and frequently coexists with other neurodegenerative neuropathologies. Three new diagnostic criteria have been published recently; common diagnostic elements include the need to classify cognitive impairment as mild cognitive impairment or dementia and to link the cognitive impairment to evidence of clinically significant cerebrovascular disease. Vascular cognitive impairment may be further subclassified into poststroke vascular cognitive impairment and nonstroke vascular cognitive impairment, most commonly caused by cerebral small vessel disease, which may only be recognized on neuroimaging.Vascular cognitive impairment is a potentially treatable common cause of cognitive impairment, progression of which may be slowed or halted by secondary prevention of vascular disease.