A significant advance in the clinical characterization of vascular dementia (VaD) occurred in the 1970s when V. Hachinski described the term multi-infarct dementia (MID). A number of factors have contributed to difficulty in the development and implementation of diagnostic criteria for VaD. All diagnostic criteria have focused on the two most important issues in VaD: the presence of dementia, and the presence of vascular disease of sufficient severity to cause cognitive deficits. However, there is a great variability in their approach to these two core issues. The most difficult aspect in the diagnosis of VaD is to separate the presence of an ongoing neurodegenerative disease from true VaD. Constitutional and cerebrovascular risk factors and previous strokes have been associated with the presence of VaD. Therefore, detailed clinical, laboratory, neuroimaging, and neuropsychological assessments are necessary for the accurate diagnosis of VaD.