Summary:A neuropsychological screening battery (NSB) and cerebral magnetic resonance imaging (MRI) scan were given to 49 older individuals, 18 with clinically diagnosed Alzheimer's disease (AD) and 31 age-, sex-, and education-matched normal controls. All subjects were given the Mini–Mental State Examination (MMSE) and had an assessment of cerebrovascular risk factors (CVRFs). Computerized measurements of supratentorial brain, ventricle, and extra-axial fluid volumes were made, and detailed analyses of white matter hyperintensities (WMHs) on T2-weighted images were carried out. The NSB was superior to the MMSE in identifying patients with AD, in whom significantly greater brain atrophy was seen. Atrophy was strongly correlated with neuropsychological performance in the combined groups, although not in either group alone. The WMHs were more apparent in the AD group, although they were common in normal subjects as well. The CVRFs were infrequent in both groups. These results suggest that the NSB is useful in the diagnosis of AD and that brain atrophy is reliably demonstrated by MRI. The WMHs are common in the elderly and may not impair cognition; factors other than ischemia may contribute to their origin.