ConditionBrain & nerves
Vascular Dementia
Vascular dementia is a decline in thinking skills caused by conditions that reduce or block blood flow to the brain, such as strokes or long-term damage to small blood vessels. It is the second most common type of dementia after Alzheimer's disease, and the two often occur together. Early problems are typically with planning, organizing, attention and slowed thinking, rather than memory. Symptoms may worsen in sudden steps after strokes or gradually. Controlling blood pressure, diabetes and other risk factors can slow its progression.
Also called: Vascular cognitive impairment, multi-infarct dementia, post-stroke dementia, subcortical vascular dementia, arteriosclerotic dementia (older term)
At a glance
- What it is
- Dementia caused by damage to the brain from impaired blood supply.
- Causes
- Strokes (large or many small ones), small vessel disease, bleeding in the brain.
- Early symptoms
- Slowed thinking, trouble planning and organizing, poor attention, mood changes, walking difficulties.
- Pattern
- Stepwise decline after strokes, or gradual with small vessel disease.
- Diagnosis
- Cognitive testing plus brain MRI or CT showing vascular damage.
- Treatment
- Control vascular risk factors, prevent further strokes, manage symptoms and provide support.
When to get help
Call 911 or go to the ER
- Sudden face drooping, arm or leg weakness, slurred speech, vision loss or loss of balance: call 911 or your local emergency number and note the time (possible stroke)
- Sudden severe confusion, drowsiness or a sharp decline over hours to days (possible stroke or delirium from infection or medicines)
See a doctor within a day or two
- Symptoms that came and went within minutes (possible TIA, a warning sign of stroke)
- New falls, rapid worsening of walking, or new urinary incontinence
- Severe depression, agitation or hallucinations
Book a routine appointment
- Gradual problems with planning, organizing, attention or slowed thinking, especially with high blood pressure, diabetes or past strokes
- Memory or thinking changes noticed by family
- Questions about safety, driving or long-term planning
What causes vascular dementia
Brain cells need a constant supply of oxygen and nutrients. When blood vessels are blocked or damaged, brain tissue is injured. Main mechanisms:
- Large strokes: a single major stroke in a key area can cause dementia (post-stroke dementia).
- Multiple small strokes (multi-infarct dementia): each may go unnoticed, but damage adds up.
- Small vessel disease: long-term narrowing of tiny arteries deep in the brain, mainly from high blood pressure and diabetes, damages white matter connections. This is the most common cause.
- Brain bleeds: including microbleeds and cerebral amyloid angiopathy.
- Rare genetic causes: such as CADASIL.
Mixed dementia, with both Alzheimer's and vascular changes, is very common in older adults.
Risk factors
- high blood pressure, the most important
- diabetes
- high cholesterol
- smoking
- atrial fibrillation
- previous stroke or TIA
- heart disease and peripheral artery disease
- obesity and physical inactivity
- older age
Symptoms
Symptoms depend on which parts of the brain are damaged. Common features:
- slowed thinking and processing
- difficulty planning, organizing, making decisions and following steps
- poor concentration and attention
- confusion
- memory problems, often less prominent early than in Alzheimer's
- depression, apathy and emotional changes, including sudden laughing or crying
- walking problems: slow, shuffling, unsteady gait and falls
- urinary frequency, urgency or incontinence
- symptoms of previous strokes, such as weakness or speech problems
Vascular dementia vs Alzheimer's disease
| Vascular dementia | Alzheimer's disease | |
|---|---|---|
| Cause | Damaged blood supply | Amyloid plaques and tau tangles |
| Early symptoms | Slowed thinking, planning, attention, mood, walking | Short-term memory loss |
| Onset | Can be sudden after a stroke | Gradual |
| Progression | Stepwise or gradual | Steady decline |
| Brain imaging | Strokes, white matter changes | Shrinkage, especially memory areas |
Stages
Vascular dementia does not follow a fixed sequence, but in broad terms:
- Mild: slowed thinking, difficulty with complex tasks, mood changes; largely independent. See mild cognitive impairment for the earliest stage.
- Moderate: more confusion, problems with daily tasks, walking difficulties, incontinence; needs regular help.
- Severe: needs full-time care, with major difficulties in communication, mobility and self-care.
Stepwise decline means people may stay stable for a period, then worsen suddenly after another stroke.
Diagnosis
- History from the person and family, including stroke history and timeline of decline.
- Cognitive tests such as the MoCA, which is sensitive to vascular-type problems.
- Neurological exam for signs of previous strokes and gait changes.
- Brain MRI (or CT) showing strokes, white matter disease or microbleeds.
- Blood tests: cholesterol, blood sugar, B12, thyroid and others to exclude contributing causes.
- Heart tests: ECG and sometimes heart monitoring for atrial fibrillation; carotid ultrasound.
Treatment
There is no cure, but treatment can slow progression and improve quality of life:
- Control blood pressure, often the most important step.
- Manage diabetes and cholesterol with lifestyle and medicines.
- Prevent further strokes: antiplatelet medicines or anticoagulants for atrial fibrillation, as appropriate.
- Stop smoking and limit alcohol.
- Stay physically active and eat a heart-healthy diet such as the Mediterranean diet.
- Treat depression and sleep problems.
- Cholinesterase inhibitors and memantine may help some people, particularly those with mixed dementia, though benefits are modest.
- Rehabilitation: physical, occupational and speech therapy.
- Support and planning: caregiver support, safety measures, legal and financial planning.
Outlook
Vascular dementia shortens life expectancy, with average survival often around 5 years after diagnosis, partly because of heart disease and stroke risk. Outcomes vary widely; good control of risk factors can slow decline.
Frequently asked questions
What are the early signs of vascular dementia?
Early signs often include slowed thinking, difficulty planning and organizing, trouble concentrating, mood changes such as depression or apathy, and walking difficulties. Memory may be less affected at first than in Alzheimer's disease.
What is the difference between vascular dementia and Alzheimer's?
Vascular dementia is caused by damage to the brain's blood supply, often from strokes, and typically affects thinking speed and planning first. Alzheimer's is caused by protein build-up and typically starts with memory loss. Many people have both.
Can vascular dementia be slowed down?
Yes. Controlling blood pressure, diabetes and cholesterol, preventing further strokes, not smoking and staying active can slow progression. There is no cure, but these steps make a real difference.
What is the life expectancy with vascular dementia?
On average, people live about 5 years after diagnosis, though this varies widely. Survival depends on age, overall health, the extent of brain damage and how well heart and stroke risk factors are controlled.
Sources
This guide was written from current patient and clinical guidance, including:
- National Institute on Aging: Vascular dementia
- National Institute of Neurological Disorders and Stroke: Vascular contributions to cognitive impairment and dementia
- Alzheimer's Association: Vascular dementia
- American Heart Association/American Stroke Association: Scientific statement on vascular contributions to cognitive impairment and dementia
- NHS: Vascular dementia