Background: Increasing interest in identifying of cerebral hemodynamics alterations as cause of possible onset or worsening of cognitive impairment in elderly patients with vascular risk factors. Introduction: Intracranial ultrasound is a non-invasive, repeatable inexpensive method for recording variation of the cerebral vascular tree in physiological and pathological conditions as well in the diagnosis of vascular dementia (VaD). Methods: PubMed, Embase, Cochrane library and reference lists have been searched for articles published until March 30, 2020. Results: Clinical studies reported different Transcranial Doppler (TCD) parameters and subsequently transcranial duplex with color code (TCCD) in patients affected by vascular dementia. The number of studies using TCCD remains limited and most of available data are still based on TCD. However, the use of transcranial Doppler could better stratify elderly patients with initial signs of cognitive impairment. Conclusion: Intracranial ultrasound employment to detect cerebral hemodynamic changes in VaD patients has been briefly discussed in this review.