Vascular dementia

Vascular dementia is cognitive impairment severe enough to disrupt daily function that is attributable to cerebrovascular disease, and is the second most common dementia subtype after Alzheimer disease. Pathological substrates include large-vessel territorial infarcts, lacunes, white-matter hyperintensities, microbleeds and microinfarcts, perivascular space dilation and chronic blood-brain barrier dysfunction, often grouped under the umbrella of small vessel disease. Mixed pathology with Alzheimer-type amyloid and tau is common in older adults and increases cognitive risk for any given burden of either pathology. The VICCCS-2 consensus criteria (2018) operationalise diagnosis across mild and major vascular cognitive impairment, and recognise post-stroke, subcortical ischaemic, multi-infarct and mixed subtypes. Management targets vascular risk factors; no disease-modifying therapy is approved. The Lancet Commission on Dementia Prevention 2024 update (Livingston et al.) raised the modifiable-risk-factor set to 14, adding untreated vision loss and high LDL cholesterol — both directly relevant to vascular cognitive risk.