The word dementia describes a range of symptoms that include memory loss and difficulties with thinking, problem solving or language. In vascular dementia, these symptoms occur when the brain is damaged due to problems with the blood supply to the brain. You can find more information below.
What is vascular dementia?
Vascular dementia is a group of conditions that cause decreased cognitive abilities. People with vascular dementia have problems with reasoning, reasoning, and memory. These changes may occur suddenly or be mild and may not be noticed at first.
Vascular dementia is caused by a blockage or lack of blood flow to the brain. The reduced blood flow to the brain deprives it of much-needed oxygen. Lack of oxygen and blood can damage the brain even in a short time.
Vascular dementia, sometimes called vascular cognitive impairment , is the second most common cause of dementia after Alzheimer’s disease.
What causes vascular dementia?
Vascular dementia is caused by reduced blood flow to the brain due to diseased blood vessels.
To be healthy and your body to function properly, brain cells need a constant blood supply to use oxygen and nutrients. Blood is delivered to the brain through a network of vessels called the vascular system. If the vascular system inside the brain is damaged – so blood vessels leak or become blocked – then blood cannot reach the brain cells and eventually the brain cells die.
This death of brain cells can cause problems with memory, thinking, or reasoning. These three elements together are known as cognition. When these cognitive problems are bad enough to have a significant impact on daily life, it is known as vascular dementia.
Who is at risk?
Some of the following risk factors (eg lifestyle) can be controlled, but others (eg age and genes) cannot.
Age is the strongest risk factor for this type of dementia. A person’s risk of developing the condition doubles approximately every five years over age 65. Vascular dementia under 65 is rare and affects less than 8,000 people in the UK, for example. Men are at a slightly higher risk of developing vascular dementia than women.
Vascular dementia and stroke
A person who has had a stroke or has conditions such as diabetes and heart disease is about twice as likely to develop vascular dementia. Sleep apnea , in which breathing stops for a few seconds or minutes during sleep , is also a possible risk factor. The person concerned can reduce the risk of dementia by keeping these conditions under control, taking the medications prescribed by the doctor (even if they are feeling well), and getting professional advice about their lifestyle.
Other risk factors
There is some evidence that a history of depression increases the risk of vascular dementia. Anyone who thinks they may be depressed should consult their doctor early.
Cardiovascular disease – and thus vascular dementia – is linked to high blood pressure, high cholesterol, and overweight in middle age. You can reduce the risk of developing them by having regular checkups (over 40), not smoking, and staying physically active. Eating a healthy balanced diet and drinking alcohol only in moderation will also help.
Besides these cardiovascular risk factors, there is good evidence that staying mentally active reduces the risk of dementia. There is also some evidence of the benefits of being socially active.
Types of avascular dementia
Different types of vascular dementia have some common signs and some different symptoms. Its symptoms tend to progress in different ways.
A stroke occurs when blood flow to part of the brain is suddenly cut off. In most strokes, a blood vessel in the brain narrows and becomes blocked by a clot. The clot may have formed in the brain or the heart and may have moved to the brain. A stroke varies in how severe it is, depending on where the blocked artery is and whether the interruption in blood flow is permanent or temporary.
dementia after stroke
A major stroke occurs when blood flow to a large vessel in the brain is suddenly and permanently cut off. Most often this happens when the vein is blocked by a clot. Much less often the vessel bursts and bleeds into the brain. This sudden interruption in the blood supply deprives the brain of oxygen and leads to the death of a large amount of brain tissue.
Not everyone who has had a stroke develops this type of dementia, but about 20 percent of people who have had a stroke develop post-stroke dementia within the next six months. A person who has had a stroke is at risk for further strokes later on. If this happens, there is a higher risk of developing dementia.
Single-infarct and multi-infarct dementia
This type of vascular dementia may be due to one or more strokes. These occur when a large or medium-sized blood vessel is blocked by a clot. The stroke can be so small that the person does not show any symptoms.
Alternatively, the symptoms may be only temporary – perhaps lasting a few minutes – because the blockage clears itself. (If symptoms last less than 24 hours, it’s called a ‘ mini-stroke ‘ or transient ischemic attack .)
If the blood flow is interrupted for more than a few minutes, the stroke will lead to the death of a small area of tissue in the brain. This dying area is known as the infarct. Sometimes only one infarct occurs in a significant part of the brain, causing dementia (known as single-infarct dementia).
More often, the occasional interruption of blood flow over weeks or months causes a series of infarcts to spread around the brain. In this case, dementia (known as multi-infarct dementia) results from the combined damage of all infarcts.
Subcortical vascular dementia is caused by diseases of the very small blood vessels that lie deep in the brain. These small vessels develop thick walls, become stiff and twisted, meaning the blood flow through them is reduced.
Small vessel disease damages nerve fiber bundles that carry signals around the brain. It can also cause small infarcts near the base of the brain.
Small vessel disease develops much deeper in the brain than many stroke-related injuries. This means that many of the symptoms of subcortical vascular dementia are different from the symptoms of stroke-related dementia.
Subcortical dementia is thought to be the most common type of vascular dementia.
Mixed dementia (vascular dementia and Alzheimer’s disease)
At least 10 percent of people with dementia are diagnosed with mixed dementia. In this case, it is generally thought that both Alzheimer’s disease and vascular disease cause dementia. Mixed dementia symptoms may be similar to those of Alzheimer’s disease or vascular dementia, or a combination of the two.
What are the symptoms of vascular dementia?
How vascular dementia affects people depends on different underlying causes and varies from person to person. Symptoms may develop suddenly, for example after a stroke or more gradually, as in small vessel disease.
Early and middle stages
Some symptoms may be similar to other types of dementia. Memory loss is common in the early stages of Alzheimer’s, but it is not usually the main early sign of vascular dementia. The most common cognitive symptoms in the early stages of vascular dementia are:
- Problems with planning, organizing, making decisions, or solving problems
- Difficulty doing things he used to do regularly (for example, cooking)
- Slower speed of thought
- Problems concentrating, including sudden periods of confusion
A person in the early stages of vascular dementia may also have difficulties with:
- Memory – problems remembering recent events (usually mild)
- Language – for example, speech may become less fluent
- visuospatial skills – can develop problems perceiving objects in three dimensions
Along with these cognitive symptoms, it is common for a person with early vascular dementia to experience mood changes such as apathy, depression, or anxiety . Depression is common because people with vascular dementia may be aware of the difficulties the condition causes. A person with vascular dementia can often be more emotional. They may be prone to rapid mood swings and being unusually tearful or happy.
Other symptoms that someone with vascular dementia may experience vary between the different types. Post-stroke dementia will often be accompanied by the obvious physical symptoms of stroke. Depending on which part of the brain is affected, they may have paralysis/weakness in a limb, or they may have problems with vision or speech if a different part of the brain is damaged. Rehabilitation-related symptoms may improve slightly or stabilize for a time, especially within the first six months after a stroke.
Subcortical vascular dementia symptoms are less variable. Early loss of bladder control is common. The person may also have mild weakness on one side of their body or may have a less steady gait and be more prone to falls. Other symptoms of subcortical vascular dementia may include clumsiness, lack of facial expression, and problems pronouncing words.
Progression and next stages
Vascular dementia usually gets worse over time, but the pace and pattern of this condition is variable.
Stroke-related dementia often progresses ‘gradually’, with long periods of stable symptoms and periods of rapid worsening of symptoms. This is because each additional stroke causes more damage to the brain. Subcortical vascular dementia may at times follow this gradual progression, with symptoms gradually worsening as the affected brain area slowly enlarges.
Over time, a person with vascular dementia is likely to develop more severe confusion, disorientation, and more problems with reasoning and communication. The memory loss will also worsen for recent events or names. The person is likely to need more support for daily activities such as cooking or cleaning.
As vascular dementia progresses, many people develop behaviors that seem unusual or out of character. The most common are irritability, agitation, aggressive behavior, and a disturbed sleep pattern. They may also act in socially inappropriate ways.
Sometimes a person with vascular dementia believes things that aren’t true (delusions) or see things that aren’t really there (hallucinations). These behaviors can be irritating and difficult for everyone involved.
In the later stages of vascular dementia, the person concerned may be much less aware of what is going on around them. They may have difficulty walking or eating without assistance and become increasingly weak. Eventually, the person will need help with all their daily activities.
How long a person will live with vascular dementia varies greatly from person to person. Vascular dementia death will occur, on average, about five years after the onset of symptoms. The person is also likely to die from a stroke or heart attack.
How is vascular dementia diagnosed?
There is no single test for these types of dementia. The doctor must first rule out conditions that cause similar symptoms, especially conditions related to depression . Symptoms can also be caused by infections, vitamin and thyroid deficiencies (diagnosed from a blood test), and medication side effects.
Anyone who is concerned that they may have any type of dementia should seek help from their doctor. If you have dementia, early detection has many benefits. Provides an explanation for the person’s symptoms; provides access to treatment, advice and support; It allows them to prepare for the future and plan ahead. For vascular dementia, treatments and lifestyle changes can also slow the progression of the underlying disease.
The doctor will also talk to the person about their medical history . These include questions about dementia or cardiovascular disease in close family members. The doctor will likely do a physical exam and ask how the person’s symptoms are currently affecting their life. The family doctor or a nurse may ask the person to do some mental ability tests . It is often helpful to have a close friend or family member accompany you to medical appointments because they can identify subtle changes that the person may not have noticed.
A person suspected of having dementia will usually have a brain scan to detect changes in the brain. A scan such as a computed tomography or magnetic resonance imaging can show if there is a tumor or fluid buildup inside the brain.
These can have symptoms similar to those of vascular dementia. A computed tomography scan may also show a stroke, or a magnetic resonance imaging scan may show changes such as infarcts or damage to the brain. In this case, the brain scan is used both to rule out other causes and to diagnose the type of dementia.
If the person has dementia and the circumstances mean that this is best explained by vascular disease in the brain, they will be diagnosed with vascular dementia. For example, dementia may have developed within a few months after a stroke, or a brain scan may show a disease pattern that explains dementia symptoms.
The diagnosis should be communicated clearly to the person and often to those closest to them, with a discussion about next steps.
How is vascular dementia treated?
The goal of vascular dementia treatment is to repair any underlying conditions that may be causing it. Your doctor will work with you to lower your blood pressure and cholesterol. They can also encourage you to adopt a healthier lifestyle with a better diet and more exercise to prevent clogged arteries, heart attack, and stroke.
Some medications have been found to be beneficial in boosting memory and cognitive skills. These drugs change how brain cells communicate, process, store and retrieve memories. However, there are no approved treatments to stop or reverse the changes caused by vascular dementia.
cardiovascular disease control
If the underlying cardiovascular diseases that cause vascular dementia can be controlled, it may be possible to slow the progression of dementia. For example, after a person has had a stroke, treatment for high blood pressure can reduce the risk of further stroke and dementia. Especially for stroke-related dementia, there may be long periods of time during which symptoms do not worsen significantly with treatment.
In most cases, a person with vascular dementia will use medication to treat the underlying disease. These include tablets to lower blood pressure, prevent blood clots and lower cholesterol. If the person has been diagnosed with heart disease or diabetes, they will also receive medication for these. It is important that a person continues to take the medication prescribed by the doctor and attends regular checkups recommended by a doctor.
A person with vascular dementia will be advised to take up regular physical exercise, especially if he smokes, and adopt a healthy lifestyle to quit. He should try to eat a diet that includes plenty of fruit, vegetables, and fatty fish, but not too much fat or salt. Maintaining a healthy weight will also help.
Supporting a person with vascular dementia to live well includes treating symptoms, supporting coping with lost abilities, and helping to maintain enjoyable activities. For someone who has had a stroke or has physical difficulties, treatment will include rehabilitation.
Medications routinely prescribed for Alzheimer’s disease have no benefits for vascular dementia and are not recommended for it. However, these drugs may be prescribed to treat mixed dementia (Alzheimer’s disease and vascular dementia).
Talking therapies (such as cognitive behavioral therapy) or medication may also be tried if someone is depressed or anxious. Counseling can also help the person adjust to the diagnosis.
There are many ways to help the person involved remain independent and cope with the cognitive symptoms of vascular dementia. For example, breaking down complex tasks into smaller steps makes things easier for them. For example, an environment that is not too busy or noisy makes it easier to concentrate.
It’s important for a person with any form of dementia to stay active and continue doing things they enjoy. Being mentally active is known to aid memory and communication. Life story work, in which someone shares their life experiences and makes a personal record, can help with memory, mood, and well-being.
If the person has physical difficulties, they will usually benefit from rehabilitation. This may mean working with a physical therapist (especially for help with weakness, coordination, movement and balance), occupational therapist (for everyday activities), or speech and language therapist (for all aspects of communication).
Treatment for behavioral changes in people with vascular dementia
Over time, changes in the person’s behavior such as agitation or aggression become more likely. These are often a sign that the person is in distress. There are many possible reasons for this. For example, the person may be in pain, may have misunderstood something or someone, or may be disappointed.
General non-drug approaches (eg, social interaction) often help with this condition. In some cases, psychiatric medications (such as antipsychotics) may be prescribed by the doctor.