Recent reports highlighting serious adverse effects of antipsychotic medication in behavioral and psychological symptoms of dementia (BPSD) has led to calls for research on alternative agents. The authors describe the use of low-dose gabapentin to treat seven patients with a diagnosis of ICD-10 vascular or Mixed Vascular/Alzheimer Dementia with serious aggressive behavior. All seven patients had impressive and clinically significant responses to treatment. Treatment was tolerated in each case without adverse reactions. Our findings suggest that gabapentin should be considered for treating aggressive behavior in patients with vascular or mixed dementia and that it is well tolerated in this context.