How Vascular Dementia Is Treated and Why Prevention Matters

Vascular dementia often arrives suddenly. A person who was managing daily life without difficulty may begin struggling at work, acting impulsively, or having trouble with tasks that once felt routine. These changes don’t come from protein buildup in the brain, but from damage to the blood vessels that supply it — sometimes from a single stroke, and sometimes from years of silent injury.

Despite being the second most common form of dementia, affecting an estimated 2.7 million Americans over age 65, vascular dementia has no FDA-approved drugs to slow or stop its progression. Treatment instead focuses on protecting the brain from further damage

Treatment options include managing cardiovascular risk factors like diabetes, high blood pressure and high cholesterol, along with lifestyle changes that support brain health. In some cases, medications approved for Alzheimer’s are also used off-label to help manage cognitive symptoms.

Staving off risk of further damage

Managing chronic vascular health conditions through medications and lifestyle changes may slow vascular dementia and prevent the risk of future strokes and damage. 

“First, we address all the risk factors. Is blood pressure under optimal control? Is diabetes under optimal control? Is cholesterol treatment optimized?”  UCLA vascular neurologist and neuroscientist told Being Patient in a LiveTalk. 

A range of medications are FDA-approved for treating the biggest risk factors, including statins for cholesterol, and GLP-1 drugs for diabetes. Other healthy lifestyle changes including regular exercise, a nutrient-rich MIND diet, and quitting smoking also keep the brain’s blood vessels healthy.

When there is a history of stroke, mini-strokes, or other cardiovascular diseases, doctors might prescribe antiplatelet medications that might reduce the risk of recurrence. However, it isn’t clear yet whether this strategy prevents future decline.

“We don’t right now have anything outside of the risk factor modulation that can fix or repair the injury that’s occurred to the brain,” Hinman said. 

Treating cognitive symptoms

Many medications approved for treating Alzheimer’s cognitive symptoms are used off-label for vascular dementia. 

Cholinesterase inhibitors — like donepezil, galantamine, and rivastigmine —  slow the breakdown of acetylcholine, a neurotransmitter that plays a key role in memory and cognitive function. Across several studies, this class of drugs is effective at treating the cognitive and memory symptoms in vascular dementia. Memantine, a neuroprotective drug that’s used to treat Alzheimer’s symptoms, also offers symptomatic relief. 

These medications mask the symptoms, providing small to modest benefits, but do not treat the underlying vascular damage or prevent future decline. 

New treatments in the pipeline

There are few experimental vascular dementia drugs currently in clinical trials.

Early in 2025, Chinese researchers completed a Phase 3 trial of butylphthalide, a celery seed extract with potential neuroprotective and anti-inflammatory properties. The researchers haven’t shared the results yet. 

In the U.S., a small 20-person trial is using the antibiotic rifaximin to test whether it might treat vascular dementia by remodeling the gut microbiome, the community of beneficial microorganisms that live in the gut. The study will finish in 2026.

Hinman said that many researchers have set their sights on developing new drugs that target inflammation and blood vessel growth to treat the disease but aren’t yet ready for human trials. NLPR3 inhibitors which block the inflammatory cascade in the brain, have shown promise in animal models of the disease.  

In the future, new treatments might treat the underlying damage that causes vascular dementia. For now, preventing and treating vascular dementia means treating chronic conditions that damage the brain’s blood vessels.