Objective To investigate the efficacy of the combined treatment of Nao"an Dropping Pills and idebenone in patients with vascular dementia (VD) after cerebral infarction, and to analyze its impact on cognitive function and oxidative stress levels. Methods From August 2021 to August 2024, 104 patients with vascular dementia (VD) after cerebral infarction were prospectively selected and divided into a control group and an observation group, with 52 patients in each group. The control group was treated with idebenone, while the observation group was treated with Nao"an Dropping Pills combined with idebenone, both for a continuous period of 3 months. The clinical efficacy of the two groups was observed, as well as changes in the Brief Self-Assessment of Memory Scale (BSSD), Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL) scale, neurological injury indicators, hemorheology [hematocrit (PCV), blood viscosity at medium shear (BVM), blood viscosity at high shear (BVH), blood viscosity at low shear (BVL)], vascular endothelial function [matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF), nitric oxide (NO), endothelin-1 (ET-1), thromboxane B2 (TXB2)], and oxidative stress indicators [malondialdehyde (MDA), superoxide dismutase (SOD), cystatin C (CysC), advanced oxidation protein products (AOPP), glutathione peroxidase (GSH-Px)]. Results The total effective rate in the observation group was higher than that in the control group (P<0.05). After treatment, compared with the control group, the observation group showed increased BSSD and MMSE scores and decreased ADL scores (P<0.05). After treatment, compared with the control group, the observation group had lower serum levels of NSE and Hcy and higher levels of BDNF and NGF (P<0.05). After treatment, compared with the control group, the observation group had lower PCV, BVM, BVH, and BVL levels (P<0.05). After treatment, compared with the control group, the observation group had lower serum levels of MMP-9, ET-1, TXB2, MDA, CysC, and AOPP, and higher levels of VEGF, NO, SOD, and GSH-Px (P<0.05). Conclusion The combination of Nao"an Dropping Pills and idebenone in the treatment of patients with vascular dementia (VD) after cerebral infarction can enhance clinical efficacy, improve dementia severity and cognitive function, enhance daily living ability, alleviate neural damage, and improve hemorheology and vascular endothelial function, while inhibiting oxidative stress response.