The therapy for vascular dementia has known several changes and updates since the use of niacin in the first years of the 20th century. These modifications were due to the parallel evolution of the concept of vascular dementia. Initially, treatments in this area were proposed because they were considered vasoactive and able to increase the blood flow of the brain. After these, other drugs were introduced because they were also able to ameliorate the oxygen usage by the suffering neurons. The more recent therapeutic proposals were made for drugs active on the metabolic activities of the brain, or with hemorrheological or antioxidant properties. As a consequence, a large array of different pharmacological properties were considered in proposing the several different kinds of drugs as useful in vascular dementia patients. The most recent attempt in this field consists of evaluating the usefulness of traditional antidementia drugs (those with anticholinesterase action) in patients with a prevalence of cerebrovascular disorders.