Modern brain imaging methods have shown that vascular brain changes are a frequent finding in elderly individuals. The clinical relevance of subcortical white matter lesions is subject of debate, their impact on the functional status of those affected unclear. We assessed the prevalence of large white matter lesions and stroke, defined by Magnetic Resonance (MRI) criteria and by questionnaire reports, among 268 participants of the Memory and Morbidity in Augsburg Elderly Study, a 1997/98 follow up project of the MONICA survey S2 (1989/90), and evaluated the association of both types of brain changes with limitations in activities of daily living. The prevalence of large white matter lesions was 37 % (n = 69), that of any stroke or TIA 19.4 % (n = 52) and 12 % (n = 32) were affected by both brain changes. The latter group performed significantly worse in geriatric performance tests and had considerable impairments in their daily functioning. Vascular brain changes are very prevalent in older populations and have a measurable and considerable impact on functional capabilities of those affected.