Subcortical ischemic vascular disease (SIVD) is characterized by extensive white-matter lesions and lacunar infarcts in deep gray matter. The aim of this study was to investigate patterns of cognitive impairment in patients with SIVD. In a retrospective analysis, the authors compared the cognitive performance of 58 patients meeting MRI-defined criteria for SIVD (26 women; 47.3%) with age- and gender-matched control subjects. SIVD patients showed impairments in measures of verbal fluency, verbal memory, speed of cognitive processing, and divided attention. There were no significant differences in constructional praxis, figurative memory, verbal recognition memory, or semantic processing.