After Alzheimer's disease, vascular dementia is the second most common cause of dementia. Depending on the instrument used in the diagnosis and the age of the study population the prevalence of vascular dementia in the geriatric population ranges from 1-5%. Any patient with cognitive deficit should be investigated to detect a treatable dementia. Basic investigations should include a thyroid function assessment, serum vitamin B12 level, syphilis serology, and computed tomographic scan or magnetic resonance imaging study of the brain. The diagnosis of vascular dementia requires the demonstration of socio-professional handicap and demonstrable causal link to vascular disease of the brain. Patients with vascular dementia are prone to recurrent stroke with further worsening of the cognitive state. In patients with known symptomatic cerebral infarctions, acetylsalicylic acid, ticlopidine and warfarin have been shown to reduce the risk of recurrent stroke. Antidepressants should be prescribed for patients with symptomatic or subclinical depression.