OBJECTIVE : This study aimed to assess the association between neuroimaging signatures of cerebral small vessel disease (cSVD) and the risk of falls in stroke-free older adults living in rural Ecuador. METHODS : Risk of falls was evaluated by the Downton Fall Risk Index (DFRI). MRI readings focused on white matter hyperintensities (WMH) of presumed vascular origin, deep cerebral microbleeds (CMB), silent lacunar infarcts (LI), and > 10 enlarged basal ganglia-perivascular spaces (BG-PVS). Logistic regression models were fitted to evaluate whether these neuroimaging signatures were associated with the DFRI, after adjusting for relevant confounders. RESULTS : We included 288 participants. The DFRI was positive in 69 (24%). Moderate-to-severe WMH were noticed in 55 individuals (19%), deep CMB in 18 (6%), LI in 23 (8%), and > 10 BG-PVS in 65 (23%). Multivariate models showed a significant association between moderate-to-severe WMH and the DFRI (p = .016). There were no associations between other neuroimaging signatures of cSVD and the DFRI. Age was the single covariable remaining significant in all models. CONCLUSIONS : WMH is associated with the DFRI in stroke-free older adults living in a remote rural setting. A target for fall prevention should include the control of factors favoring the development of diffuse subcortical damage of vascular origin.