Vascular Dementia

What is vascular dementia?

Dementia is a decline in cognitive function (thinking skills), impacting reasoning and judgment in the brain. Cognitive decline in vascular dementia is caused by impaired or blocked blood flow in the brain. When blood flow is blocked, brain cells can’t receive oxygen or nutrients, similar to what happens during a stroke. 

Vascular dementia is the second most common cause of dementia after Alzheimer's disease, accounting for 5% to 10% of cases, according to the Alzheimer’s Association.

Vascular dementia can cause memory loss and deterioration in problem-solving skills—especially in activities such as getting dressed or managing money.

Unlike Alzheimer’s, which gets worse slowly and steadily, vascular dementia often gets worse in episodes. A person could lose some function all at once. There are often long periods where the patient does not get worse until the next episode occurs.

There is no cure but symptoms can be managed with therapy.

Most common symptoms

The small stroke-like events cause a loss of mental ability. Changes can be abrupt and noticeable, or they can be so small that they are not noticed until they build up over time.

There may be some improvement in function after a new episode, but the improvement is usually not complete. The new level of mental ability often stays constant for some time before suddenly getting worse again with the next episode.

This is called a “step-wise” decline in function. It can affect almost any mental function such as memory, language, attention, problem solving, planning, and working through tasks. It can also affect getting dressed or speaking clearly. Apathy, indifference, and inattentiveness are common symptoms early in the disease.

Main symptoms

Sudden loss of some mental abilities, including:

• Problems with memory
• Difficulty speaking
• Problems paying attention
• Confusion
• Difficulty with problem solving or making decisions
• Problems with planning
• Problems with managing money
• Problems with movement, speech, or fine motor skills such as writing
• Apathy, which is a lack of ability or interest in taking action

Other symptoms you may have

• Visual problems
• Incontinence
• Changes in mood
• Changes in behavior

What is the most common cause of vascular dementia?

Vascular dementia occurs when there is damage to the blood vessels in the brain. The damage can occur because of blood clots, hardening of blood vessel walls, build up of cholesterol, or build up of an abnormal protein called amyloid in the blood vessel walls.

The result is small strokes that cause damage to the brain.

Symptoms depend on which part of the brain is damaged. For example, when the part of the brain used for language is damaged, a person will have problems speaking or understanding speech.

Next steps

If you suspect vascular dementia, you should make an appointment with your primary care physician as soon as possible. If there is a sudden change in ability, a person may be having a stroke, which needs immediate medical care. Call 911 immediately. Symptoms of a stroke can be remembered by the acronym FAST:

Face: Is the face drooping on one side?

Arms: Is one arm suddenly weaker than the other?

Speech: Are you having problems speaking?

Time: Time to call 911.

Treatment of vascular dementia

There is no cure for vascular dementia. Once the brain is damaged, it cannot be repaired.  However, new connections can form that can help improve some of the damage. Therapies can help as well.

People can also learn ways of adapting to changes. For example, speech therapy can teach people adaptations for difficulty communicating or swallowing. Physical and occupational therapy can help to improve balance or strength, or teach you how to use adaptive devices.

Medications

Medications may be used to reduce stroke risk or to treat symptoms. Your doctor should do a careful evaluation for underlying blood vessel problems. This will guide which medications they will recommend to prevent future strokes.

These could include anti-platelet medications (to prevent blood clots), blood thinners, and cholesterol lowering agents. High blood pressure may be treated with antihypertensive medications.

Symptoms vary based on the part of the brain that has been affected. Your doctor will target medications to your specific issues. For example, if you have depression, then antidepressant medications may be used to improve quality of life. If symptoms include seizures, then anticonvulsants will be used.

Risk factors

There are a number of risk factors for vascular dementia, which are all tied to heart disease as well.

• Older age
• High blood pressure
• Smoking
• High cholesterol
• Diabetes
• Prior stroke
• Coronary artery disease
• Peripheral arterial disease

Preventative tips

Decreasing or eliminating risk factors is the best option for managing or preventing vascular dementia.

• Smoking is especially bad for blood vessels and should be stopped; your doctor can help if needed.
• Managing and monitoring high blood pressure, diabetes, and high cholesterol is important. This includes using lifestyle modifications and medications.
• Maintaining an active lifestyle, healthy diet, and healthy weight can also help prevent vascular issues and dementia.