This chapter talks about a 47-year-old Caucasian man who was referred due to memory problems and depression following surgical treatment of aortic dissection 1 year earlier. After surgery, he was unable to return to work and began receiving disability benefits. Recent laboratory tests included normal complete blood count and chemistry laboratory examinations. Neuropsychological evaluation included a neurobehavioral status examination, face-to-face neurocognitive testing, and computer-administered measures. This patient illustrates the clinical manifestations of hypoperfusive dementia and he fulfilled NINDS-AIREN diagnostic criteria for vascular dementia including: presence of dementia; evidence of stroke; and a temporal relation between the first two conditions. Despite his relatively young age, and the absence of extracranial and intracranial Cerebrovascular Disease (CVD), he had watershed infarction as a result of relentless hypotension following aortic dissection. Heavy smoking could have impaired the effective maintenance of cerebral blood flow (CBF).