Chronic cerebral circulatory insufficiency (CCCI) is a result of cerebral microangiopathy, most commonly due to uncontrolled hypertension. In this case, the brain is affected due to recurrent silent infarcts and/or microbleedings without clinical manifestations of stroke and chronic brain ischemia. Progressive cognitive impairments with a preponderance of inadequate attention and lower rates of cognitive performance, with impaired planning and control abilities in relative preservation of memory serve as the main manifestation of chronic progressive non-stroke vascular lesion in the brain. The above impairments are generally associated with emotional changes as affective lability and depression. The paper gives an account of a characteristic clinical case of CCCI, analyzes the mechanisms for the development of neurological symptoms, and sets forth current approaches to managing these patients.