Objective: Cognitive impairment is a main symptom of chronic vascular encephalopathy (CVE) that impact the severity of illness. Symptomatic treatment is needed for the improvement of cognitive functions and quality of life. We studied the efficacy of  piribedyl in patients with severe CVE. Material and methods: Thirty-six patients with mild cognitive impairment who met diagnostic criteria for CVE were enrolled. Patients were stratified into 3 groups: two groups received piribedyl in dose 50 mg per day during 3 months as monotherapy (group 1) or in the combination with ginkgo biloba in dose 240 mg per day (group 2). Results and conclusion: Piribedyl reduced cognitive impairment and improved quality of life. Comorbid affective disorders can predict the effect of piribedyl on cognitive impairment in CVE. The similar efficacy of piribedyl was noted for monotherapy and in combination with ginkgo biloba.