Chronic cerebral hypoperfusion (CCH) is a potential important pathological factor leading to cognitive impairment in vascular dementia (VaD). The pathological mechanisms are complex and diverse,with cerebral white matter lesions being the main pathological feature,which is present throughout the entire progression of cognitive impairment caused by CCH. Dysfunction of the blood-brain barrier and neuroinflammatory responses caused by chronic cerebral hypoperfusion are important causes of cerebral white matter lesions. This article discusses the relationship between cerebral white matter lesions and VaD and the improvement of cerebral white matter lesions in VaD to slow down its development and progression,and explores the mechanism and therapeutic methods for VaD,aiming to find therapeutic targets of VaD to prevent its occurrence and improve symptoms.