Gender differences are a common phenomenon and manifest in many ways, including cognitive, psychiatric, and behavioral characteristics. Studies on gender differences in dementia are still insufficient, especially for vascular dementia (VaD). Given that the female predominance in depression and anxiety following stroke, the main cause of VaD, has been identified, the authors of this study hypothesized that there would be gender-specific presentations in neuropsychiatric symptoms of VaD as long as gender differences in cognitive impairment. All 467 participants underwent cognitive and neuropsychiatric assessments and the results showed that there were gender differences in the presentation of VaD, which mainly exist in neuropsychiatric symptoms, especially pronounced in mild stage. Female patients were more likely to exhibit delusions, hallucinations, and depression than male patients in mild VaD. Male patients were only more likely to exhibit apathy in moderate-to-severe VaD. Male and female patients had similar verbal and visuospatial functions. The results are of value in gender-specific analysis and treatment of VaD.