Visit-to-visit blood pressure variability has been shown to be an independent risk factor for stroke and cognitive impairment. However, the underlying mechanisms are not fully understood. Artery remodeling and silent cerebral injury are suggested to be involved in the relationship between visit-to-visit blood pressure variability and cognitive impairment. The present review article summarizes the recent literature on these topics. Here we review visit-to-visit blood pressure variability, artery remodeling, silent cerebral injury and an issue regarding the impact of these components on dementia including Alzheimer's disease. Geriatr Gerontol Int 2015; 15 (Suppl. 1): 26–33.