@pkh3381 From what you’ve shared this seems like something to talk with your doctor about. You wrote that you haven’t seen a neurologist for awhile. Was it a neurologist who first diagnosed you with the Small Vessel Ischemic White Matter Disease? We aren’t medical professionals on Mayo Clinic Connect but I can share what I know about treatment for this. High blood pressure and high cholesterol can contribute to ischemia and so many patients are advised to take medications. These include medications to lower blood pressure and to bring cholesterol under better control. In addition, lifestyle changes are recommended such as changes in diet and exercise. Are you taking any medications for blood pressure or cholesterol?