〔Abstract〕 Objective To compare the magnetic resonance imaging (MRI) features of vascular dementia (VD) and Alzheimer's disease (AD). Methods The data of VD and AD patients admitted to Henan General Hospital from January 2020 to March 2022 were retrospectively selected, and 39 cases of each group were included in the study. The MRI features of the two groups were compared. Results The volume of hippocampal formation and leukoaraiosis in AD patients were smaller than those in VD patients, the height of hippocampu was lower than that in VD patients, the width of temporal angle, lateral fissure width and three ventricle width were greater than those in VD patients, the severity of leukoaraiosis was lighter than that in VD patients, and the incidence of hippocampal atrophy and ventricular changes was higher than that in VD patients, the differences were statistically significant (P < 0.05). Conclusion AD patients mainly showed hippocampal atrophy, and VD patients mainly showed leukoaraiosis, the two diseases showed different features on MRI.