Trial of Remote Ischemic Pre-conditioning in Vascular Cognitive Impairment

Inclusion Criteria: * Evidence of cerebral small vessel disease on CT or MRI, defined as either beginning confluent white matter hypodensities/hyperintensities (ARWMC scale) or two or more supratentorial infarcts * Montreal Cognitive Assessment \<25 * Concern on the part of the patient, caregiver, or clinician that there has been a decline from previous level of cognitive functioning * Independent with basic activities of daily living (response (a) to questions 2, 4, 5, 6, 7, 8, 9, and 14 on the Bristol Activities of Daily Living scale). Exclusion Criteria: * Cortical infarcts larger than 10 mm axial diameter * Neuroimaging evidence of mass lesion, intracerebral hemorrhage, vascular malformation, or evidence of non-vascular disease such as hydrocephalus. * Residence in long-term care facility. * Other significant neurological or psychiatric disease (e.g. multiple sclerosis). * Does not have a study partner who can provide corroborative information. * English or French is not sufficiently proficient for clinical assessment and neuropsychological testing * Montreal Cognitive Assessment score \<13 * Unable to undergo MRI due to medical contraindications or inability to tolerate the procedure. * Co-morbid medical illness that in the judgment of the study investigator makes it unlikely that the participant will be able to complete three months of study follow-up. * On therapeutic anticoagulation with doses used for treatment of deep venous thrombosis, pulmonary embolism, or for stroke prevention in atrial fibrillation. * Significant bleeding diathesis. * Any symptomatic or previously known arm soft-tissue disease, vascular injury, or peripheral vascular disease * Hypertension with systolic blood pressure \>=180 mmHg despite medical treatment at the time of enrolment. * Planned revascularization (any angioplasty or vascular surgery) within the next 3 months. * Planned surgical procedure within the next 3 months. * Currently receiving an investigational drug or device by other studies * Blood pressure cuff cannot be sized properly (arm circumference is \<23 cm or \>42 cm)