Atherosclerosis is an important cause of stroke and accumulating evidence suggests the existence of a possible shared pathophysiological process that may drive aging-related disease such as cardiovascular disease, stroke and dementia. The increased intimal permeability represents the substrate on which initial intimal thickening can promote the development of advanced atherosclerotic lesion. Traditional risk factors of cardiovascular disease (hypertension, diabetes mellitus, dyslipidemia, obesity, smoking and atrial fibrillation) have been associated with increased risk of development of vascular dementia and Alzheimer’s disease. Atherosclerotic plaques are composed of different elements including collagen, necrotic core, inflammatory cells and calcification. Recent advancement of imaging modalities, such as ultrasound, computed tomography and magnetic resonance imaging (MRI), can identify atherosclerosis at different stages of its development and differentiate plaque composition. Calcium can be easily identified using different imaging techniques and its amount is increased with advancing age. Atherosclerotic calcification in the coronary, carotid and intracranial arteries have been strongly associated with microstructural brain changes on brain MRI, dementia and Alzheimer’s disease. Subclinical arterial calcification in carotid and cerebral vessels could be present in asymptomatic patients and its presence could be used as a clue to initiate neuropsychological testing for dementia and also to initiate preventative and therapeutic strategies, because mid-life vascular risk factors control can prevent late-life dementia and stroke.