Objective To analyze the expressions and significance of serum hypoxia-inducible factor (HIF-1α), soluble Fas (sFas) and livin in elderly patients with vascular dementia(VaD). Methods Fifty-seven elderly patients with vascular dementia admitted to the hospital from August 2019 to October 2020 were selected as observation group. The 57 patients were scored according to clinical dementia rating (CDR), including 16 mild cases, 19 moderate cases and 22 severe cases. Another 20 healthy people who underwent physical examination in the hospital during the same period were selected as control group. Double antibody sandwich enzyme-linked immunosorbent assay(ELISA) was used to monitor the levels of serum HIF-1α, sFas and Livin, and their relationships with elderly vascular dementia were analyzed. Results The levels of HIF-1α and sFas in observation group were higher than those in control group while the level of Livin was lower than that in control group (P<0.01), there was no significant difference in HIF-1α among the patients (P>0.05). The levels of sFas and Livin in patients with severe dementia were lower than those in patients with mild or moderate dementia (P<0.01), and the levels of sFas and Livin in patients with moderate dementia were lower than those in patients with mild dementia (P<0.05). HIF-1α level was not significantly correlated with VaD grading (r=0.159, P>0.05). sFas and Livin were negatively correlated with VaD grading (r=-0.482, -0.481, all P<0.05). Serum HIF-1α, sFas and Livin had high efficiency on VaD grading. When the cut-off value of Livin was 7.46 nmol/mL, the diagnostic efficiency was the highest, and its Youden index, area under the curve (AUC), sensitivity and specificity were 0.821, 0.821, 83.33% and 90.91% respectively. Conclusions erum HIF-1α level has a certain degree of increase in elderly patients with VaD, but it has no obvious correlation with the severity of dementia. sFas and Livin levels decrease with the aggravation of dementia, and are negatively correlated with the severity of disease. Livin is more obvious in grading guidance for CDR.