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Do I need to be appointed legal guardian? Medical POA? What about our finances? I am so afraid he will spend all our savings!

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You need to be Guardian NOW. Start the petition by seeing a lawyer.
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You'll get a lot of answers to this question.

You'll need to get powers of attorney for financial and legal as well as medical decisions.. a DPOA, Living Will/Advanced Directive, and of course a Last Will and Testament if your assets warrant it. If you have these prepared by a competent elder law or estate planning attorney, I'm not sure you'll need guardianship, but I also don't know that much about vascular dementia and its progression and what might occur as a result of that.

Start taking charge of the finances now, offering to handle them to relieve him of the responsibility, but try to find something to substitute so he doesn't feel (or recognize) that he's losing control.

You might want to clean out the accounts and leave only enough to pay the bills in the checking accounts while transferring the other funds to a savings account (a) to which he doesn't have access or (b) to which you don't provide the numbers.
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