What Is Vascular Dementia?

Vascular dementia results from impaired blood flow to the brain. After Alzheimer's disease, it's considered the second most common type of dementia. Vascular dementia also often occurs alongside Alzheimer's disease, resulting in mixed dementia.

Between 5% and 10% of people over the age of 65 in developed countries have vascular dementia. The risk of developing it increases dramatically with age. Vascular dementia is estimated to account for between 15% and 30% of all dementia cases.

Learning about vascular dementia can help you know how to reduce your risk as well as know what to expect if you've been diagnosed. This article gives an overview of the symptoms, causes, and outlook of vascular dementia.

Vascular Dementia Symptoms

Symptoms of vascular dementia can appear suddenly or be subtle at first and worsen over time. People with vascular dementia often display multiple cognitive problems including:

• Memory impairment
• Aphasia (trouble with speech)
• Apraxia (problems with muscle movement and coordination)
• Agnosia (inability to recognize people or things)
• Problems with executive functioning

In many cases, symptoms make it difficult to hold a job, carry out household responsibilities, or maintain social relationships. People with vascular dementia also experience neurological symptoms including:

• Exaggerated reflexes
• Problems with walking and balance
• Weakness in the limbs, hands, and feet

Depending on the individual and on the cause of dementia, delusions, confusion, agitation, urinary problems, and/or depression can also accompany vascular dementia.

In vascular dementia, the first symptoms are often the neurological ones, such as problems with reflexes, walking, and muscle weakness. On the other hand, memory problems and behavioral symptoms are commonly the first issues noticed in Alzheimer's.

Additionally, vascular dementia often progresses in a stepwise fashion. For example, the person will seem stable for a period of time, then suddenly get much worse, and continue to alternate between stable periods and sudden drops in functioning. Alzheimer's disease typically progresses in a more gradual, downward fashion.

Causes

Vascular dementia can occur due to either a narrowing or a complete blockage of blood vessels in the brain, which deprives brain cells of nutrients and oxygen they need to function properly.

In addition, vascular dementia often results from several small strokes that occur over time. It can also occur after a single major stroke, which is sometimes referred to as "post-stroke dementia."

Conditions like high blood pressure and diabetes that narrow blood vessels gradually over time can also lead to vascular dementia.

Risk Factors

People who develop vascular dementia often have a history of certain conditions:

• Heart attack
• Stroke
• High blood pressure
• Diabetes
• High cholesterol

In particular, if an individual has a history of multiple strokes, the risk of developing vascular dementia increases with the number of strokes they've experienced.

Other factors that may increase your risk include:

• Smoking
• Male sex
• African-American descent
• Atrial fibrillation
• Family history of vascular dementia.

Diagnosis

As with Alzheimer's disease, a complete diagnostic workup should be performed in order to rule out other possible causes of the person's symptoms.

If you feel you are experiencing symptoms of dementia, talk with a primary care provider first. They'll assess your symptoms, medical history, medications, and cardiovascular risk factors. They'll likely give you tests to assess your memory and thinking skills. They may also order blood tests to look for other conditions that may be responsible for your symptoms.

Based on those results, they may refer you to a specialist for further evaluation.

Vascular dementia is usually identified through imaging procedures, which can reveal strokes and narrowed or blocked arteries.These tests could include:

• CT (computed tomography) scan
• MRI (magnetic resonance imaging) scan
• PET (positron emission tomography) scan

Neuropsychological tests might also be conducted to determine the nature and extent of cognitive impairment.

Treatment

Doctors often prescribe patients with vascular dementia the same medications that are used to treat Alzheimer's. This may include a cholinesterase inhibitor such as Aricept (donepezil), Exelon (rivastigmine), or Razadyne (galantamine), possibly along with the drug Namenda (memantine).

Managing cardiovascular problems through medication and/or lifestyle changes may also help slow the worsening of vascular dementia symptoms. It's critical to control blood pressure, pulse, cholesterol, blood sugar, and weight, all of which impact brain health and the ease of blood flow to the brain.

Behavior management strategies are also useful for handling the challenging behaviors that sometimes accompany vascular dementia.

Prognosis

Currently, there is no cure for vascular dementia, and damage that has already occurred in the brain can't be reversed. The goal of treatment is to prevent further damage, manage symptoms, and support function as much as possible.

If the dementia was caused by multiple strokes, the person may get worse in a step-wise progression as further strokes occur, where stable periods are interrupted by sudden downward episodes.

Life expectancy for someone with vascular dementia is highly individual and depends on the nature of the cardiovascular problems that are causing dementia, along with the person's age and other medical conditions.

Summary

Vascular dementia results from impaired blood flow to the brain and is the second most common type of dementia after Alzheimer's disease. A host of cognitive and neurological impairments accompany vascular dementia, including memory impairment and trouble with coordination such as walking and balancing.

It is best to consult a healthcare provider early if you think you or a loved one are experiencing dementia symptoms. Though there is no cure, there are treatment options and ways to manage.