discussed in the laymedia. The increased use of imaging technology has heightened awareness of VAD despite disagreement on the criteria for VAD. Cerebrovascular disease is a heterogenous disorder. VAD is second in incidence to Alzheimer’s disease (AD) and is being diagnosed with increasing frequency. Both VAD and AD share the risk factors of hypertension, insulin resistance, diabetes, and dyslipidemia. Purpose: VAD increases steadily with age, particularly with repetitive stroke. The pathophysiology of VAD includes large artery infarctions, usually cortical; small artery infarctions, or lacunes exclusively subcortical affecting the basal ganglia, caudate, thalamus, and internal capsule; and chronic subcortical ischemia occurring in the distribution of small arteries in the periventicular white matter. Mixed dementia or AD plus VAD is increasingly being recognized. Indeed in Japan, VAD ismore common thanAD. In addition, a studywithmagnetic resonance imaging suggested that hallmark findings of VAD and AD have a synergistic effect on cognitive decrease inpatientswithmildAD. Ina studyof thepathologic correlates of late-onset dementia in England, themajority of patients had mixed AD and VAD diseases. Methods: Review of recent literature. Results: Stroke is amajor risk for the occurrence ofVAD, and it is well demonstrated that moderate–to-high intensity of statin therapy, such as in the TNT and other trials, is associated with a reduction of stroke incidence. In fact stroke incidence in the United States, which had decreased during that last 20 years is now reaching a plateau. Despite adequate trials demonstrating the effectiveness of statin therapy in reducing the incidence of stroke, many high risk patients are not currently on statin therapy, or are noncompliant. Amajor clinical trial is underway to determine the role of carotid stenting in reducing stroke. Future trials will include more patient drugs as well. Conclusions: There is enough evidence to use statin and other drugs to reduce the incidence of stroke and VAD. In our aging society, doing less than we can would constitute tragic neglect. We can and must do more for this silent epidemic. We have the diagnostic tools, the therapeutic approaches; we lack only the decision to act.