This systematic review seeks to (1) summarize the pharmacologic effects of pentoxifylline on the cerebrovasculature and (2) review critically the studies evaluating pentoxifylline in the treatment of vascular dementia. To retrieve all relevant published and unpublished studies, we performed with no language restrictions computer keyword searches of MEDLINE, EMBASE, and Cochrane Library databases; reviewed bibliographies; and contacted the pharmaceutical manufacturer. We included pertinent articles if they met three quality criteria: randomized, double-blinded, and placebo-controlled study design; objective diagnostic criteria for vascular dementia; and reported original data. The literature search identified a total of 20 articles; however, only four studies met the quality criteria for inclusion in this systematic review. All four studies suggested a trend toward improved cognitive function in patients treated with pentoxifylline. Three of the studies performed a subgroup analysis using a stricter definition for vascular dementia. In these secondary analyses, the studies noted statistically significant differences in cognitive function between placebo and treatment groups. In conclusion, this systematic review suggested a potential therapeutic role for pentoxifylline in vascular dementia. However, few studies met the quality criteria for inclusion in this systematic review, and most of these studies were small and had methodologic limitations.