Although periventricular white matter alterations (PWMA) are commonly reported on magnetic resonance imaging (MRI) scans of elderly individuals, a consistent pattern of neuropsychological deficits has yet to be found. However, there are some findings suggesting that executive functions (Luria, 1980) are more impaired than other areas of neuropsychological functioning. We undertook a prospective study of two groups of elderly, demented patients with and without PWMA as measured by MRI. The results demonstrated that subjects with greater white matter alterations performed worse on some executive function tests (e.g., Trail Making Test‐Part B and competing programs/go‐no‐go), whereas there were no differences in other areas of neuropsychological functioning. There were no between‐group differences on the Modified Ischemic Scale (Rosen, Terry, Fuld, Katzman, & Peck, 1980) or on measures of depression. Other pertinent clinical and methodological issues related to the clinical presentation of PWMA, as well as B...