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 by a partial blockage or completely blocked by a blood clot.
Symptoms of vascular dementia may develop gradually, or may become apparent 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 signs and 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's 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 of impairment. Multi-infarct dementia 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 very small area in a part of the brain that controls memory is affected, for example, you may be "forgetful" but it doesn't necessarily change your ability to carry on normal activities. If a larger area is affected, you may have trouble thinking clearly or solving problems, or greater memory problems that do 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 increasing.
- People are living longer with chronic diseases, such as heart disease and diabetes.
Vascular dementia is caused by a lack of blood flow to a part of the brain. Blood flow may be decreased or interrupted by:
- 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 autoimmune disorder
CADASIL (cerebral autosomal dominant arteriopathy with sub-cortical infarcts and leukoencephalopathy) is a genetic disorder that generally leads to dementia of the vascular type. One parent with the gene for CADASIL passes it on to a child, which makes it an autosomal-dominant inheritance disorder. It affects the blood vessels in the white matter of the brain. Symptoms, such as migraine headaches, seizures, and severe depression, generally start when a person is in his or her mid-30s; but, symptoms may not appear until later in life.
Risk factors for vascular dementia include risk factors for the conditions associated with vascular dementia, such as heart disease, stroke, diabetes, and atherosclerosis:
- Increasing age
- High blood pressure
- Cigarette smoking
- High cholesterol and triglyceride levels
- Atrial fibrillation (fast and irregular rate of the upper 2 heart chambers)
- High level of homocysteine in the blood, which can cause damage to blood vessels, heart disease, and blood clots
- Lack of physical activity
- Overweight or obesity
- Oral birth control pills
- Conditions that cause the blood to "thicken" or clot more easily
- Family history of dementia
- Family history of CADASIL
The symptoms of vascular dementia depend on the location and amount of brain tissue involved. Vascular dementia symptoms may appear suddenly after a stroke, or gradually over time. Symptoms may get worse after another stroke, a heart attack, or major surgery. These are signs and symptoms of vascular dementia
- Increased trouble carrying out normal daily activities because of problems with concentration, communication, or inability to carry out instructions
- Memory problems, although short-term memory may not be affected
- Confusion, which may increase at night (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, shuffling steps
- Problems with movement and/or balance
- Urinary problems, such as urgency or incontinence
In addition to a complete medical history and physical exam, your healthcare provider may order some of the following:
- Computed tomography (CT). This imaging test uses X-rays and a computer to make horizontal, or axial images (often called slices) 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
- Magnetic resonance imaging (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 resemble dementia.
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 following a healthy diet, getting physical activity, quitting smoking, and quitting or decreasing alcohol consumption
- 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 brain
- Medicines, such as cholinesterase inhibitors to treat the symptoms of dementia or antidepressants to help with depression or other symptoms
Vascular dementia is a progressive disease that has no cure, but the rate at which the disease progresses can vary. Some people with vascular dementia may eventually need a high level of care due to 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's, 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.
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 become worse (such as obvious changes in behavior, personality, memory, or speech) or if new symptoms appear, such as sudden weakness or confusion.
- Vascular dementia is a disorder characterized by damaged brain tissue due to lack of blood flow. Causes can include blood clots, ruptured blood vessels, or narrowing or hardening of blood vessels that supply the brain.
- 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 progress over time. Treatments can't cure the disease, but lifestyle changes and medicines to treat underlying causes (such as high blood pressure, high cholesterol, diabetes, or blood clots) might help slow its progress.
- Surgical procedures 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.
January 16, 2018
Textbook of Alzheimer Disease and Other Dementias. Myron F. Weiner, MD and Anne M. Lipton, MD, PhD, Eds. 2009. Chap. 10: Vascular Cognitive Disorder., Vascular Dementia: Cerebrovascular Mechanisms and Clinical Management. Robert H. Paul, PhD; Ronald Cohen, PhD; Brian R. Ott, MD; Stephen Salloway, MD, Eds. 2005.
Shelat, Amit, MD,Dozier, Tennille, RN, BSN, RDMS