Historically, the approach towards dementia associated with vascular disease has been to manage risk factors. Recent findings also suggest that symptomatic treatment is a realistic option, and cardiologists should be aware of treatments that are, or may soon be, available for their patients. Here, agents that have been evaluated for the symptomatic treatment of vascular dementia (VaD) are reviewed. In particular, the role of cholinesterase inhibitors is discussed. These agents are commonly used worldwide to treat the symptoms of Alzheimer’s disease (AD). Since most patients with VaD have concomitant AD, cholinesterase inhibitors may provide some benefits in these patients. In addition, these agents have demonstrated some efficacy in patients with possible or probable VaD.