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Introduction: Several studies have revealed that patients with cerebral amyloid angiopathy (CAA) have cognitive decline relating to MRI changes especially white matter damage (WMD). CAA showing preference for posterior regions was in accordance with visual cortex, however few focused on visuospatial function and its related imaging makers in CAA.Hypothesis: Severity and distribution of WMD correlate to visuospatial function in CAA patients.Methods: We enrolled non-demented probable CAA patients based on modified Boston criteria in a single hospital, and normal elder people from Shanghai Aging Study. CAA-related WMD included WMH volumes and brain network connection changes measured by regional mean fractional anisotropy (FA), and was evaluated from aspects of severity (mean FA and WMH volumes) and distribution pattern (posterior-anterior gradient). CAA patients completed a standard cognitive test battery for visuospatial function and others. The association of WMD and cognitive domains were analyzed by univariate regression model.Results: 28 non-demented CAA patients and 56 normal controls were enrolled. For WMD, CAA patients demonstrated prominently increased WMH volumes (3.89 mm3 versus 28.84mm3, p<0.001) and posterior-anterior gradient (-22% versus 17%, p=0.004), and decreased posterior mean FA (0.365 versus 0.350, p=0.037), without differences in global and anterior mean FA. For cognitive function in CAA patients, there was no association between severity of WMD and any cognitive domain. Only posterior-anterior gradient of regional FA (β=0.538, p=0.015) and WMH volumes (β=-0.599, p=0.005) significantly related to visuospatial function, which was not found in other domains.Conclusions: Posterior predisposition of decreased brain network connections and increased WMH volumes correlated to visuospatial impairment, which might help to understand the possible mechanism of cognitive decline in CAA patients.