What is vascular dementia?
Vascular dementia is the second
most common form of dementia after Alzheimer disease. It's caused when decreased blood
flow damages brain tissue. Blood flow to brain tissue may be reduced. Or it may be
completely blocked by a blood clot.
Symptoms of vascular dementia may
develop slowly. Or they may develop after a stroke or major surgery, such as heart
bypass surgery or abdominal surgery.
Dementia and other related diseases
and conditions are hard to tell apart because they share similar symptoms. Although
vascular dementia is caused by problems with blood flow to the brain, this blood flow
problem can develop in different ways. Examples of vascular dementia include:
Mixed dementia. This type occurs when
symptoms of both vascular dementia and Alzheimer exist.
Multi-infarct dementia. This occurs
after repeated small, often "silent," blockages affect blood flow to a certain
part of the brain. The changes that occur after each blockage may not be apparent,
but over time, the combined effect starts to cause symptoms. This is also called
vascular cognitive impairment.
The effect of decreased or no blood
flow on the brain depends on the size and location of the area affected. If a small
area in a part of the brain that controls memory is affected you may be "forgetful." But
this doesn't always change your ability to carry on normal activities. If a larger area
is affected, you may have trouble thinking clearly or solving problems. These problems
may change your ability to function normally.
Researchers think that vascular
dementia will become more common in the next few decades because:
- Vascular dementia is generally caused
by conditions that occur most often in older people, such as atherosclerosis
(hardening of the arteries), heart disease, and stroke.
- The number of people older than 65
years is growing.
- People are living longer with chronic
diseases, such as heart disease and diabetes.
What causes vascular dementia?
Vascular dementia is caused by a
lack of blood flow to a part of the brain. Blood flow may be decreased or interrupted
- Blood clots
- Bleeding because of a ruptured blood
vessel (such as from a stroke)
- Damage to a blood vessel from
atherosclerosis, infection, high blood pressure, or other causes, such as an
Who is at risk for vascular dementia?
Risk factors for vascular dementia
include risk factors for the conditions linked to it, heart disease, stroke, diabetes,
- Increasing age
- High blood pressure
- High cholesterol and triglyceride
- Metabolic syndrome
- Atrial fibrillation. This is fast and
irregular heart rate of the upper 2 heart chambers.
- High level of homocysteine in the
blood. This can cause damage to blood vessels, heart disease, and blood clots.
- Lack of physical activity
- Birth control pills
- Conditions that cause the blood to
"thicken" (clot) more easily
- Family history of dementia
What are the symptoms of vascular dementia?
The symptoms of vascular dementia
depend on the location and amount of brain tissue involved. They may appear suddenly
after a stroke, or slowly over time. Symptoms may get worse after another stroke, a
heart attack, or major surgery. These are symptoms of vascular dementia
- Increased trouble doing normal daily
activities because of problems with concentration, communication, or inability to
carry out instructions
- Memory problems. Short-term memory may
not be affected.
- Confusion, which may get worse at
night. This is known as "sundown syndrome."
- Stroke symptoms, such as sudden weakness and trouble with speech
- Personality changes
- Mood changes, such as depression or irritability
- Stride changes when walking too fast
or shuffling steps
- Problems with movement, balance. or
- Urinary problems, such as urgency or incontinence
How is vascular dementia diagnosed?
Your healthcare provider will ask about your health history and do a physical exam. He or she may also order some of these tests:
Blood tests to look for other conditions causing your symptoms, such as vitamin deficiencies
CT scan.. This imaging test uses X-rays and a computer to make images of the brain. CT scans are more detailed than general X-rays.
FDG-PET scan. This is a PET scan of the brain that uses a special tracer to light up regions of the brain.
Electroencephalogram (EEG). This test measures electrical activity in the brain
MRI. This test uses large magnets, radiofrequencies, and a computer to make detailed images of the brain.
Neuropsychological assessments. These tests can help sort out vascular dementia from other types of dementia and Alzheimer's.
Neuropsychiatric evaluation. This may be done to rule out a psychiatric condition that may look like dementia.
How is vascular dementia treated?
Vascular dementia can't be cured. The main goal is to treat the underlying conditions that affect the blood flow to the brain. This can help cut the risk for further damage to brain tissue.
Such treatments may include:
- Medicines to manage blood pressure, cholesterol, triglycerides, diabetes, and problems with blood clotting
- Lifestyle changes, such as a healthy
diet, physical activity, quitting smoking, and stopping or decreasing alcohol
- Procedures to improve blood flow to
the brain, such as carotid endarterectomy, angioplasty, and stenting. The carotid
arteries are located in the neck and provide blood flow from the heart to the
- Medicines, such as cholinesterase inhibitors to treat the symptoms of dementia or antidepressants to help with depression or other symptoms
Living with vascular dementia
Vascular dementia gets worse over
time and has no cure. But the rate at which the disease gets worse can vary. The disease
can be stable for long periods of time. Some people with vascular dementia may
eventually need a high level of care because of the loss of mental and physical
abilities. Family members may be able to care for a person with vascular dementia early
on. But if the disease progresses, the person may need more specialized care.
Respite programs, adult daycare programs, and other resources can help the caregiver get some time away from the demands of caring for a loved one with vascular dementia.
Long-term care facilities that
specialize in the care of people with dementias, Alzheimer, and other related conditions
are often available if a person affected by vascular dementia can no longer be cared for
at home. Your healthcare provider can recommend caregiver resources.
When should I call my healthcare provider?
People with vascular dementia and
their caregivers should talk with their healthcare providers about when to call them.
They will likely advise you to call if symptoms get worse. This can be obvious changes
in behavior, personality, memory, or speech. You should also call if new symptoms
appear, such as sudden weakness or confusion.
Key points about vascular dementia
- Vascular dementia is a disorder that
damages brain tissue because of a lack of blood flow. Causes can include blood clots,
ruptured blood vessels, or narrowing or hardening of blood vessels that supply the
- Symptoms can include problems with memory and concentration, confusion, changes in personality and behavior, loss of speech and language skills, and sometimes physical symptoms such as weakness or tremors.
- Vascular dementia tends to get worse
over time. Treatments can't cure the disease, but lifestyle changes and medicines to
treat underlying causes might help slow its progress.
- Surgery to improve blood flow to the
brain can also be helpful. Other medicines might slow the progression of dementia or
help with some of the symptoms it can cause.
- A person with vascular dementia may eventually need full-time nursing care or to stay in a long-term care facility.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.