Cerebrovascular changes, including small vessel disease (SVD), contribute to more than 80 percent of all autopsy-confirmed cases of dementia and are the most common pathology to co-occur with Alzheimer’s disease. Enlarged perivascular spaces (PVS), a form of SVD, have long been considered a benign neuroimaging feature in older adults. Now, a landmark study published in Neurology has found that PVS may have important associations with cognitive performance, particularly information processing speed and executive function.