Vascular Dementia

Overview

Vascular dementia is a decline in thinking, memory, and reasoning caused by reduced blood flow to the brain. Brain cells need a constant supply of oxygen and nutrients carried by the blood. When blood vessels in the brain are damaged or blocked, areas of brain tissue are injured or die, and the abilities controlled by those areas are affected. Vascular dementia is one of the most common forms of dementia, second only to Alzheimer's disease.

It can result from a single major stroke, a series of smaller strokes, or gradual damage to the small blood vessels deep in the brain. Because of this, the way symptoms appear varies: they can begin suddenly after a stroke or develop and worsen gradually, sometimes in a step-like fashion. Vascular dementia often shares risk factors with heart disease and stroke, which means that controlling those risk factors offers a real opportunity to prevent it or slow its progression.

Symptoms

Symptoms depend on which parts of the brain are affected and how much damage has occurred. They can differ from the pattern seen in Alzheimer's disease.

• Slowed thinking and difficulty concentrating or paying attention
• Problems with planning, organizing, and decision-making
• Confusion that may be worse at certain times
• Memory problems, though these may be less prominent early on than in Alzheimer's
• Difficulty finding words or following conversations
• Mood changes, depression, apathy, or irritability
• Trouble with balance and walking, especially when small vessels are affected

When dementia follows a stroke, there may also be physical symptoms such as weakness on one side of the body or difficulty speaking. Symptoms may worsen in noticeable steps after further strokes.

Causes

Vascular dementia is caused by conditions that damage the brain's blood vessels and reduce blood flow to brain tissue.

• Stroke: a major stroke or a series of small strokes can cause brain damage leading to dementia.
• Small vessel disease: narrowing and damage to the tiny blood vessels deep in the brain can gradually injure brain tissue.
• Reduced blood flow: conditions that lower blood flow to the brain over time.

The same processes that cause heart disease and stroke, such as atherosclerosis (artery narrowing from plaque) and high blood pressure, underlie most vascular dementia. Often it coexists with Alzheimer's disease, a combination called mixed dementia.

Risk Factors

The risk factors for vascular dementia largely overlap with those for stroke and heart disease, many of which can be modified.

• High blood pressure
• Diabetes
• High cholesterol
• Smoking
• A history of stroke or mini-strokes (transient ischemic attacks)
• Heart disease and irregular heart rhythms such as atrial fibrillation
• Older age
• Obesity and physical inactivity

Diagnosis

Diagnosing vascular dementia involves assessing thinking abilities and looking for evidence of blood vessel damage in the brain.

• Medical history and cognitive testing: evaluating memory, attention, planning, and other thinking skills.
• Brain imaging: CT or MRI scans to detect strokes, small vessel disease, and other changes.
• Assessment of risk factors: checking blood pressure, blood sugar, cholesterol, and heart health.
• Tests to rule out other causes: blood tests and evaluation to exclude other conditions that affect thinking.

Because vascular dementia and Alzheimer's disease often occur together, doctors may diagnose a mixed picture. Identifying the vascular component is important because its risk factors can be treated.

Treatment

There is no treatment that reverses the brain damage already done, but care focuses on slowing further decline, treating symptoms, and supporting quality of life. The most important step is controlling the underlying vascular risk factors to prevent more strokes and damage.

• Managing risk factors: controlling blood pressure, diabetes, and cholesterol, and treating heart rhythm problems.
• Preventing further strokes: medicines such as blood thinners or antiplatelet drugs when appropriate, and lifestyle changes.
• Stopping smoking and healthy living: exercise, a healthy diet, and weight management.
• Symptom support: treatment for depression, and sometimes medicines used for dementia symptoms.
• Rehabilitation and support: therapy, structured routines, and caregiver support to maintain function and safety.

Early action on risk factors offers the best chance to slow progression.

Prevention

• Keep blood pressure within a healthy range
• Manage diabetes and keep blood sugar controlled
• Lower high cholesterol through diet, activity, and medication if needed
• Do not smoke
• Stay physically and mentally active
• Eat a heart-healthy diet and maintain a healthy weight
• Treat heart conditions, including irregular heart rhythms, to reduce stroke risk

When to See a Doctor

See a clinician if you or a loved one notices increasing problems with memory, thinking, planning, or confusion, so the cause can be evaluated and treatable factors addressed. Because vascular dementia is linked to stroke, know the warning signs of a stroke and act immediately.

Call emergency services right away if you notice sudden face drooping, arm weakness, slurred or difficult speech, sudden confusion, trouble seeing, or loss of balance. A stroke is an emergency, and fast treatment can limit brain damage and may prevent further decline.

Related Topics

Frequently Asked Questions

References

1. National Institute on Aging (NIA). Vascular Dementia.
2. Mayo Clinic. Vascular dementia — Symptoms and causes.
3. Alzheimer's Association. Vascular Dementia.
4. MedlinePlus, U.S. National Library of Medicine. Vascular dementia.