Objective To explore the application effect of targeted nursing under the guidance of comprehensive geriatric assessment for elderly patients with vascular dementia. Methods A total of 86 elderly patients with vascular dementia admitted to our hospital from January 2024 to December 2024 were selected as the research subjects. They were divided into a control group and an observation group by the random number table method, with 43 cases in each group. Patients in the control group received routine care, while those in the observation group received targeted care under the guidance of comprehensive geriatric assessment. The cognitive function, daily living ability, quality of life before and after the nursing care, sleep quality and nursing satisfaction of the two groups were compared. Results After the nursing care, the scores of the Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), activities of daily living (ADL), and the dimensions of the World Health Organization quality of life-brief (WHOQOL-BREF) in the observation group were all higher than those in the control group (P < 0.05); the scores of each dimension of the Pittsburgh sleep quality index (PSQI) in the observation group were all lower than those in the control group, and the total satisfaction rate of nursing was higher than that in the control group (P < 0.05). Conclusion Implementing targeted nursing under the guidance of comprehensive geriatric assessment for elderly patients with vascular dementia can effectively improve their cognitive ability, enhance their daily living ability, quality of life, sleep quality and nursing satisfaction.