Silent brain infarctions (SBI), or silent strokes where symptoms are absent or unrecognized, are subcortical cavities (lacunes) or cortical areas of atrophy and gliosis, which are presumed to be caused by previous infarction.1 White matter hyperintensities (WMHs) are also presumed to be caused by brain ischemia.1 Prior epidemiological studies indicate these vascular brain injuries are associated with cognitive decline, incident stroke, dementia, and death.2–4 The presence of SBI is higher in people with traditional cardiovascular risk factors including hypertension, diabetes mellitus, smoking, and cholesterol.5–8 These risk factors are also associated with increased cognitive decline in older populations.4 However, the results of clinical trials using medications to alter cardiovascular risk factors have not consistently shown reductions in cognitive decline.9–12 We hypothesized that cardiovascular risk factors and silent vascular brain injury, as detected by magnetic resonance imaging (MRI), would be significantly associated with reduced cognitive function. Therefore, we investigated if scores on 2 tests, a cognitive screen and a test of processing speed, are lower in individuals with higher cardiovascular risk and those with subclinical vascular brain injury in a large population-based sample.