Pathophysiological Divergence Between Vascular and Post-Stroke Dementia: Bridging Human and Experimental Perspectives

Vascular dementia (VaD) and post-stroke dementia (PSD) are two leading subtypes of vascular cognitive impairment (VCI), each arising from distinct cerebrovascular pathologies. VaD typically results from chronic cerebral hypoperfusion and small vessel disease, leading to progressive executive dysfunction and white matter degradation. In contrast, PSD occurs following acute ischemic events and is frequently associated with hippocampal damage and episodic memory deficits. This review delineates the pathophysiological divergence between VaD and PSD by integrating findings from human clinical studies and preclinical animal models. While rodent models of chronic hypoperfusion replicate key features of VaD, such as oligodendrocyte injury and myelin loss, transient ischemia models-particularly middle cerebral artery occlusion-capture hallmark PSD features, including excitotoxic neuronal death, blood-brain barrier disruption, and glial activation. Emerging research also highlights the involvement of neurovascular unit dysfunction, inflammation-driven neurodegeneration, and region-specific synaptic alterations. Recognizing these mechanistic differences is critical for advancing diagnostic precision, identifying therapeutic windows, and improving translational relevance. Furthermore, the review underscores the need for aged and comorbid animal models, integration of human biomarker studies, and implementation of novel therapies targeting endothelial function, glial reactivity, and cognitive plasticity. Through this comparative approach, we propose a unified framework to guide future investigations and interventions across the spectrum of VCI.