Cerebral microangiopathy is the second leading cause of dementia after Alzheimer's disease and is a co-factor in the majority of dementias. Its clinical manifestations are multiple and include in addition to cognitive and neuropsychiatric manifestations, also problems of gait, urinary continence, and lacunar-ischaemic and haemorrhagic strokes. Patients with similar radiologic images can present very variable clinical pictures, partially resulting from damage to the neurovascular unit, not visible on conventional MRI, and affecting different neural networks. Management and prevention are possible and effective with well-known, readily available and affordable treatments, through aggressive management of cerebrovascular risk factors.