Anil Man Tuladhar, MD, PhD, Radboud University Medical Center, Nijmegen, Netherlands, highlights the importance of investigating why cerebral small vessel disease (SVD) only progresses to cognitive decline in some patients, and the underlying mechanisms behind this progression. Dr Tuladhar explains that additional disruption to white matter tracts, in the presence of existing lesions and risk factors like hypertension, can lead to impairments in cognitive function. This interview took place at the European Stroke Organisation Conference (ESOC), 2021.