When Silent cerebrovascular lesions (SCLs) are detected in brain MRI, they are clinically described as predictors of symptomatic stroke, Dementia and Alzheimer disease (AD). In MRI, the SCLs can be seen as white matter hyperintensity (WMH) or lacunar infarction (LI). Unfortunately, SCLs incidence has been shown to increase with age where older individuals with cognitive impairment are at a greater risk of subsequent strokes. It might be true that mild cognitive impairment is estimated to affect 40% of persons over the age of 65. This book discusses a recent research study performed in Japan and aimed to assess the independent effect of the pathological changes of SCLs on sub-item scores of the Mini-Mental State Examination (MMSE) and the cognitive functions represented by them. Significant associations were observed between the MMSE subitem “Orientation to place” and WMH as well as the subitem “Copy a figure” and LI. By using these two subitems in all routine clinical settings for elderly, may help in early detection of SCLs and hence the treatment of cerebrovascular lesions risk factors.