A number of neurotransmitters, including acetylcholine, serotonin, noradrenaline, and dopamine, modulate cerebral perfusion. In vascular dementia, reductions in markers of cholinergic innervation are consistently reported, and there are some indications that the serotonergic and dopaminergic systems may also be affected. Limited data indicate that the numbers of nucleus basalis, locus coeruleus, and dorsal raphé neurons and the density of neurotransmitter receptors are not reduced in the majority of cases. These data suggest neurotransmitter systems as a potential therapeutic target in vascular dementia.