Although vascular dementia remains the only form of dementia that is preventable, available treatment is limited to the primary and secondary prevention of cerebrovascular disease. Strokes are highly responsive to different forms of prevention and treatment. The effectiveness of the same measures in the prevention of vascular dementia remains unclear, however, owing mainly to the lack of agreement on the definition and management of cognitive impairment. The successful treatment of "vascular dementia" involves the recognition of this term as obsolete, for it falsely implies that the underlying cognitive impairment has an unknown degenerative cause, is progressive, and responds neither to currently available preventive measures nor to treatments. Although dementia resulting from multiple strokes can be a terminal manifestation of this form of cognitive impairment, most patients have treatable cerebrovascular disease. A rational therapeutic approach to the treatment of this cognitive syndrome necessitates an understanding of its broad clinical spectrum and the diverse causes that may be responsive to currently available treatments, from the clinical asymptomatic "brain-at-risk" stage to full-blown dementia.