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Hippocampal mitochondrial dysfunction is closely related to cognitive deficits in vascular dementia. We reviewed the latest developments in the internal associations of hippocampal mitochondrial dysfunction with cognitive deficits in vascular dementia, which mainly encompass seven aspects: abnormal mitochondrial autophagy, abnormal apoptotic pathway, oxidative damage, abnormal biosynthetic function, dynamic imbalance, imbalance of calcium homeostasis and abnormal respiratory function. According to the evidence, hippocampal mitochondrial dysfunction may be a major cause of cognitive impairment in vascular dementia, which provides insights into the development of new ideas and effective ways for clinical prevention and improvement of cognitive function in vascular dementia.