Leukoaraiosis (LA or white matter changes of the brain) is a common finding on brain imaging studies in the elderly people. LA predisposes to dementia, ischemic stroke, intracerebral hemorrhage, and cognitive decline as well as associates with a significant increase in falls and gait disorders. As population ages, the incidence of LA increases and is becoming a major global health problem. Therefore, strategies for its prevention and management are urgently needed. This review includes basic knowledge on the pathophysiology, patterns of clinical presentation, risk factors, and imaging findings of LA. The very last and the most comprehensive part of this review discusses potential therapeutic approaches of the future.