Vascular Dementia

What is vascular dementia?

Vascular dementia is a type of dementia that happens when blood vessels are damaged and the blood flow to parts of your brain is restricted. Conditions which damage the blood vessels include high blood pressure, diabetes, heart disease, and high cholesterol.

When blood flow is restricted or stopped, oxygen and other nutrients don’t reach your brain and brain tissue becomes damaged. This can lead to a decline in cognitive functions. The decline can be severe enough to affect everyday life. A lack of blood flow to the brain can cause a stroke

Vascular dementia is also sometimes called vascular cognitive impairment (VCI), because of the range of cognitive changes that it can cause. Vascular dementia is a common type of dementia. It commonly presents with Alzheimer’s disease – this is called mixed dementia.

What are the symptoms of vascular dementia?

The symptoms of vascular dementia include memory loss, confusion, sleeping problems, tremors, mood changes and balance issues.

Vascular dementia symptoms can vary according to which parts of the brain have been affected and how extensive the damage is.

Vascular dementia symptoms include:

• Apathy
• Aphasia (problems using or understanding words)
• Balance problems
• Behavior and personality changes
• Confusion
• Incontinence
• Memory loss
• Mood changes
• Tremors
• Trouble concentrating
• Sleeping issues
• Uncontrolled laughing or crying
• Walking problems

Usually, vascular dementia symptoms appear in steps over several years. There are no define stages, and the progression affects everyone differently depending on the severity and areas of the brain that have been affected. The symptoms are usually most obvious after a stroke. Further strokes can cause further decline.

If you have another type of dementia, such as Alzheimer’s disease, this may affect the progress of symptoms.

What causes vascular dementia?

Vascular dementia is caused by conditions which damage your brain’s blood vessels or fully or partially block blood flow. This reduced or stopped blood flow limits oxygen and nutrients reaching the brain, and your brain cells get damaged.

Vascular dementia is commonly caused by:

• A narrowing of the blood vessels (called atherosclerosis) or a blockage of the blood vessels (ischemic stroke) in the brain.
• A bleed from a ruptured blood vessel in the brain (hemorrhagic stroke).

There are certain risk factors that increase the chance of problems with the blood vessel and vascular dementia. These risk factors include:

• Hypertension (high blood pressure)
• Atrial fibrillation
• Diabetes
• Heart disease
• Hyperlipidemia (high cholesterol)
• Increased age (over 60)
• Smoking
• Stroke history

Vascular dementia isn’t genetic (inherited) but the conditions which can contribute to it, such as heart disease and high blood pressure, sometimes run in families.

Are there different types of vascular dementia?

Vascular dementia can be referred to by different names according to the type of and number of blood vessels that are involved and by the way the symptoms progress.

Types of vascular dementia include:

• Post-stroke dementia: If a single stroke causes a blockage that destroys brain tissue which is required for more than one thinking ability (memory and language difficulties are commonly affected), then vascular dementia can happen.
• Multi-infarct dementia: This is when many strokes have affected blood flow in multiple parts of the brain. Symptoms and cognitive changes are noticed as they happen, worsening over time.
• Binswanger disease: Also called subcortical vascular dementia, this happens when the blood vessels in the brain’s white matter are gradually blocked by atherosclerosis.
• Mixed dementia: There is more than one cause of symptoms. Commonly vascular dementia is combined with Alzheimer’s disease.

How is vascular dementia diagnosed?

Vascular dementia is diagnosed following a thorough evaluation by a specialist. They will:

• Discuss your symptoms
• Ask about your medical history
• Ask about your family’s medical history
• Review any medications you are taking (some can cause similar symptoms to dementia)

A number of tests may then be ordered, including:

• Laboratory tests: These aim to rule out other conditions that may be causing dementia-like symptoms.
• A cerebrospinal fluid (CSF) test may be performed to look for neurodegenerative diseases and autoimmune conditions.
• Brain imaging tests: Computed tomography (CT) and magnetic resonance imaging (MRI) scans look for signs of stroke, tumors, bleeding, and fluid in the brain. An amyloid PET scan may be used to look for a buildup of amyloid proteins, which are often present in the brains of people with Alzheimer’s disease.
• Neuropsychological testing: Computerized and written tests are used to evaluate a range of mental abilities, such as learning, memory, judgement, language, reasoning and problem solving.

If neurocognitive testing confirms a dementia or mild cognitive impairment (MCI) diagnosis, along with evidence on brain imaging of a recent stroke or other vascular changes, and there is no evidence of other factors causing cognitive decline, then vascular dementia is diagnosed.

How is vascular dementia treated?

Vascular dementia can’t be reversed as damage to the brain can’t be repaired. The aim of treatment is to slow down or prevent any further damage. This is done by managing risk factors associated with the disease.

Medication: Medications may be prescribed to manage risk factors such as diabetes, high cholesterol and high blood pressure. There are no medications to treat vascular dementia, but cholinesterase inhibitors may result in slight cognitive improvements by increasing blood flow to the brain.

Rehabilitation

Physical and occupational therapy can help you to manage symptoms, improve physical abilities, and find different ways of doing daily tasks. Speech-language pathologists can support you with swallowing, speaking, and communication.

While you can’t control all the risk factors for vascular dementia, such as your age, many can be controlled. By living a healthy lifestyle, keeping blood sugar, blood pressure and cholesterol within a healthy range, and getting regular exercise, you can help to prevent it. Talk to your doctor to learn more.