Discover the causes, symptoms, and management of vascular dementia, a type of dementia caused by reduced blood flow to the brain. Learn more at Meri Sehat.

Vascular Dementia

Online Consultation

Iqra Mazhar

Overview

Vascular dementia is a type of dementia that causes a decline in cognitive skills, including reasoning, planning, memory, language, and judgment as a result of reduced blood flow to the brain. 
&nbsp;

Vascular dementia is the second most common type of dementia after <a href="https://merisehat.pk/disease/alzheimers-disease">Alzheimer&rsquo;s disease</a><a href="#accordion">[1]</a>. It affects 1.5% of the population in Western nations and 2.2% of the population in Japan. In Japan, vascular dementia makes up 50% of all dementia affecting people over 65. Men are more likely than women to have vascular dementia<a href="#accordion">[2]</a>.

Vascular dementia, which is a permanent decline in thinking skills, results from any condition that damages blood vessels and reduces circulation i.e., the brain stops receiving nutrients and oxygen. While insufficient blood supply eventually damages and kills cells in the body, the brain is particularly vulnerable, especially if a stroke blocks an artery in the brain.

These cognitive abilities are initially mildly affected but worsen over time due to multiple minor strokes or widespread damage to the smaller blood vessels. Vascular dementia can develop over time as &quot;silent&quot; strokes accumulate, and the combined effect of numerous strokes results in significant&nbsp;disability.

A person is diagnosed with vascular dementia if they have a decline in at least two types of cognitive abilities, such as language and memory, that are linked to a blood artery blockage in their brain and affect their ability to carry out daily tasks. If&nbsp;fewer than two abilities are compromised or if changes in cognition do not affect daily function, this disorder is known as vascular cognitive impairment.

A person with vascular dementia often has a reduced life expectancy due to an increased risk of having another <a href="https://merisehat.pk/disease/myocardial-infarction">heart attack</a> or <a href="https://merisehat.pk/disease/stroke">stroke</a>. Additionally, researchers believe that vascular dementia will become more common in the future as it is caused mostly by conditions occurring in the elderly, such as <a href="https://merisehat.pk/disease/atherosclerosis">atherosclerosis</a>, heart disease, and stroke<a href="#accordion">[1]</a>.

Also, vascular dementia can occur alongside other types of dementia which is often known as mixed dementia. 
&nbsp;

Types of vascular dementia are: 
&nbsp;

Multiple Lacunar Infarcts: Multiple small blood vessels are affected within the hemispheric gray and white matter.

Multi-Infarct Dementia: Multi-infarct refers to a number of strokes that impair the blood flow to various parts of the brain. Since these strokes frequently leave aftereffects, cognitive alterations follow a step-by-step pattern<a href="#accordion">[5]</a>.

Strategic Single-Infarct Dementia: A single large stroke can occur in a crucial part of the brain, destroying tissue needed for more than one thinking ability.

Binswanger Dementia (Subcortical Arteriosclerotic Encephalopathy): This unusual form of small-vessel dementia is linked to systemic vascular disease and severe, poorly managed hypertension. It results in tissue death from an infarction, loss of blood supply to the brain&#39;s white matter, diffuse and erratic loss of axons and myelin, and extensive gliosis.

Hereditary Vascular Dementia: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a cerebral small vessel disease caused by mutations in the NOTCH receptor 3 gene, which codes for a transmembrane receptor located on vascular smooth muscle cells. Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is also a small vessel disease that is caused by mutations in the HTRA1 gene.<a href="#accordion">[3]</a> 
&nbsp;

Signs and Symptoms

The symptoms of vascular dementia depend on the involvement of brain tissue that was damaged due to lack of blood supply. Symptoms can appear suddenly following a stroke or even gradually over time.

If reduced blood flow continues over long periods of time or more episodes of stroke occur, then it means that more tissue will be damaged and, consequently, more abilities will be affected.

The signs and symptoms of vascular dementia are: 
&nbsp;

<ul>
	<li>Memory problems, like being forgetful about current events, forgetting one&rsquo;s own life history, trouble concentrating or paying attention, misplacing items, or&nbsp; getting lost on familiar routes</li>
	<li>Confusion, which increases at night (also known as sundown syndrome)</li>
	<li>Stroke symptoms, like trouble with speech or sudden weakness</li>
	<li>Changes in speech</li>
	<li>Mood variation, such as irritability, <a href="https://merisehat.pk/disease/depression">depression</a>, or anger</li>
	<li>Movement and balance problems</li>
	<li>Stride changes when walking fast</li>
	<li>Problems with urination, such as incontinence or urgency</li>
	<li>Tremors</li>
	<li>Difficulty organizing</li>
	<li>Agitation and restlessness</li>
	<li>Changes in sleep pattern, often waking up at night</li>
	<li>Difficulty making decisions</li>
	<li>Inability to organize thoughts or actions</li>
	<li>Difficulty writing or reading</li>
	<li>Losing interest in things or not being able to learn new things<a href="#accordion">[1]</a> 
	&nbsp;</li>
</ul>

Causes

As already mentioned, vascular dementia results from conditions that deplete blood flow to the brain. Common conditions that may result in vascular dementia are: 
&nbsp;

<ul>
	<li>Stroke (Infarction) Blocking An Artery In The Brain: Vascular dementia is typically one of a number of symptoms brought on by strokes that block a brain artery. However, not all strokes result in any obvious symptoms. Nevertheless, the risk of dementia increases with time and the number of strokes, whether silent or obvious.</li>
</ul>

Up to one-third of stroke survivors experience dementia within six months, which can be caused by either a succession of little strokes over time or a single large stroke. This is why vascular dementia is also known as post-stroke dementia<a href="#accordion">[7]</a>.

<ul>
	<li>Brain Hemorrhage: A common reason is high blood pressure as it weakens blood vessels and induces bleeding into the brain. Another reason is aging because it can lead to cerebral amyloid angiopathy, i.e., protein buildup in small blood capillaries cause them to weaken over time.</li>
	<li>Narrowed Or Chronically Damaged Blood Vessels Of The Brain: Vascular dementia can also be brought on by illnesses that constrict the brain&#39;s blood vessels or harm them permanently. These problems include the deterioration brought on by aging, high blood pressure, atherosclerosis, abnormal blood vessel aging, and diabetes.<a href="#accordion">[4]</a> 
	&nbsp;</li>
</ul>

Diagnosis

A diagnosis is made based on the symptoms, medical history, and lab test results of the patient.<a href="#accordion">[4]</a> <a href="#accordion">[5]</a> 
&nbsp;

<h5>Lab Tests</h5>

The doctor will order lab tests to determine:

<ul>
	<li>Blood pressure</li>
	<li>Cholesterol</li>
	<li>Blood sugar</li>
	<li>Thyroid disorders</li>
	<li>Vitamin deficiencies</li>
	<li>Liver and kidney function 
	&nbsp;</li>
</ul>

<h5>Neurological Exam</h5>

The doctor will check the patient&rsquo;s neurological health by testing:

<ul>
	<li>Reflexes</li>
	<li>Muscle strength and tone (comparing both sides of the body)</li>
	<li>Ability to stand up from a chair and travel across the room</li>
	<li>Sense of sight and touch</li>
	<li>Coordination</li>
	<li>Balance 
	&nbsp;</li>
</ul>

<h5>Brain Imaging</h5>

Images of the brain help identify observable defects brought on by strokes, blood vessel conditions, tumors, or trauma that can affect how you think and reason. In other words, the doctor can use the images to narrow down the causes of the symptoms.

The recommended procedures are:

<ul>
	<li>Magnetic Resonance Imaging (MRI): MRI provides precise scans of the brain. It is especially useful when looking for signs of stroke, hemorrhage, tumors, and fluid in the brain.</li>
	<li>Computerized Tomography (CT) Scan: X-rays from a variety of angles help produce precise cross-sectional images or slices of the brain. A CT scan can reveal information about the anatomy of the brain, so the doctor can determine which areas are shrinking or look for other signs of a stroke, ministroke (transient ischemic episodes), blood vessel alteration, or tumor.</li>
	<li>FDG PET Scan: This particular brain scan helps identify the type of dementia by analyzing the pattern of how a certain type of glucose is absorbed by brain tissue. 
	&nbsp;</li>
</ul>

<h5>Neuropsychological Tests</h5>

The following abilities of the patient are tested:

<ul>
	<li>Speaking, writing, and understanding language</li>
	<li>Working with numbers</li>
	<li>Learning and remembering information</li>
	<li>Developing a plan of attack and solving a problem</li>
	<li>Responding effectively to hypothetical situations</li>
</ul>

Sometimes, neuropsychological testing can indicate the various types of dementia. People who have vascular dementia find it extremely difficult to analyze a situation and come up with a workable solution. The exam results for those with vascular dementia and those who have Alzheimer&#39;s disease-related brain abnormalities frequently overlap. 
&nbsp;

<h5>Psychological/Psychiatric Evaluation</h5>

A mental health specialist examines the patient to look for indications of depression, mood swings, or other mental health conditions that can lead to memory loss. 
&nbsp;

<ul>
</ul>

Contrary to other forms of dementia, vascular dementia can start slowly or quickly, and it doesn&#39;t necessarily advance in the same way. However, generally speaking, it tends to go in steps, with periods of decline, followed by times of stability, and then periods of decline once more.

However, it can be loosely divided into: 
&nbsp;

<ul>
	<li>Early Stages: Because the symptoms are mild, it can be challenging to diagnose at this stage. The patient is usually aware of the fact that their memory and mental capabilities have declined over time.</li>
	<li>Middle Stages: The symptoms become more noticeable at this stage.</li>
	<li>Late Stages: In later stages, there&rsquo;s a significant development in cognitive and physical symptoms. This often occurs after a severe event like a large stroke. 
	&nbsp;</li>
</ul>

Treatment

It&rsquo;s possible to stop further brain damage and halt the progression of the disease with proper and timely intervention. However, there is currently no treatment for the illness and no means to undo the harm that has already been done. 
&nbsp;

<h5>Medication </h5>

Medicine can be used to treat the underlying cause of vascular dementia. This includes:

<ul>
	<li>Medication to treat high blood pressure</li>
	<li>Medication, such as statins, to treat high cholesterol</li>
	<li>Medication, like low-dose aspirin or clopidogrel, to reduce the chances of further strokes by blood clots</li>
	<li>Anticoagulant medication, such as warfarin, which also reduces the risk of blood clots</li>
	<li>Medication to treat diabetes</li>
</ul>

Some people who exhibit extreme distress or persistent violence can harm themselves or others and, therefore, the doctor will refer their case to a consultant psychiatrist. Only a psychiatrist can prescribe an antipsychotic medication like haloperidol.

NOTE: Alzheimer&#39;s disease medications, like donepezil, galantamine, rivastigmine, or memantine, may be used in case the patient has vascular dementia along with Alzheimer&#39;s disease; they are not used to treat vascular dementia alone. 
&nbsp;

<h5>Surgery</h5>

Surgical procedures, such as carotid endarterectomy, angioplasty, and stenting are employed to increase blood flow to the brain.<a href="#accordion">[1]</a> 
&nbsp;

<h5>Other Therapies</h5>

<ul>
	<li>Occupational therapy&nbsp;</li>
	<li>Speech and language therapy </li>
	<li>Physiotherapy </li>
	<li>Relaxation techniques</li>
	<li>Psychological therapies such as cognitive stimulation 
	&nbsp;</li>
</ul>

<h5>Lifestyle Changes</h5>

The following lifestyle changes will also help to reduce the underlying cause:

<ul>
	<li>Eat a balanced diet with low salt to control blood pressure and low fats to control the cholesterol</li>
	<li>Exercise to maintain a healthy weight</li>
	<li>Quit smoking</li>
	<li>Quit alcohol 
	&nbsp;</li>
</ul>

NOTE: Make changes to your home for your safety. For instance, remove potential hazards, keep the home well-lit, and add grab bars and handrails for support. 
 
&nbsp;

Complications of vascular dementia are:

<ul>
	<li>Heart disease</li>
	<li>Future stroke</li>
	<li>Loss of ability to care for oneself or perform basic functions</li>
	<li>Loss of the ability to interact</li>
	<li><a href="https://merisehat.pk/disease/pneumonia">Pneumonia</a>, skin infections, urinary tract infections</li>
	<li>Pressure sores<a href="#accordion">[8]</a> 
	&nbsp;</li>
</ul>

The risk factors of vascular dementia are the same as those for stroke and other heart diseases. The risk factors consist of:<a href="#accordion">[4]</a> 
&nbsp;

<ul>
	<li>Age: This disorder is rare before the age of 65 and the risk increases after the age of 90.</li>
	<li>History Of Strokes, Heart Attacks, And Mini-Strokes: If the individual has experienced a heart attack before then they may be at an increased risk of developing blood vessel problems in the brain. This increases the chances of having brain damage and dementia.</li>
	<li>Atherosclerosis: An abnormal aging of blood vessels occurs when cholesterol and plaque deposit in the insides of the arteries, narrowing the vessels, and reducing the blood flow to the brain.</li>
	<li>High Cholesterol: An increase in the levels of low-density lipoprotein, which is also known as &ldquo;bad cholesterol,&rdquo; is associated with an increased risk of dementia.</li>
	<li><a href="https://merisehat.pk/disease/hypertension-57">High Blood Pressure</a>: High blood pressure puts extra stress on the vessels all over the body, including the brain. </li>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a>: An increased level of glucose in the blood can damage the vessels all over the body. Damage to the brain vessels can lead to stroke.</li>
	<li>Smoking: It damages the blood vessels, causing atherosclerosis and other circulatory diseases, which increases the risk of dementia.</li>
	<li><a href="https://merisehat.pk/disease/obesity">Obesity</a>: This is a risk factor for vascular diseases in general, which also makes it a risk factor for vascular dementia.</li>
	<li><a href="https://merisehat.pk/disease/atrial-fibrillation-80605">Atrial Fibrillation</a>: The abnormal and irregular rhythm of the heart can cause clots to form in the heart which could break off or block a vessel in the brain.</li>
	<li>Family History: If a close family member has had a stroke, then it increases the risk. </li>
	<li>Ethnicity: The chance of developing vascular dementia is higher if the person is South Asian, African, or Caribbean because these populations are more likely to suffer from associated conditions like diabetes and high blood pressure<a href="#accordion">[6]</a>.</li>
	<li>Excessive alcohol consumption</li>
	<li>Poor diet and physical inactivity 
	&nbsp;</li>
</ul>

The following steps can be taken to maintain a healthy heart and, in turn, prevent vascular dementia:

<ul>
	<li>Keep the blood pressure in the normal range, which is less than &lt;120/80 mm Hg</li>
	<li>Prevent the onset of diabetes type 2 with diet and exercise, and maintaining the blood sugar levels at less than &lt;126 mg/dL</li>
	<li>Quit smoking and alcohol consumption</li>
	<li>Exercise for around 30 minutes daily</li>
	<li>Maintain healthy cholesterol</li>
	<li>Reduce stress.</li>
	<li>Reduce salt intake<a href="#accordion">[4]</a> 
	&nbsp;</li>
</ul>

<ul>
	<li>According to a retrospective investigation, over half of those who had early-onset dementia had a history of alcohol use disorders, which tripled their risk of developing dementia. Of the 57,000 patients with dementia diagnosed before the age of 65, 57% (66% of males and 37% of women) had a history of alcohol use disorders<a href="#accordion">[2]</a>.</li>
	<li>In a Rotterdam trial, total fat intake was linked to an increased risk of vascular dementia, whereas fish consumption was linked inversely&nbsp;to dementia<a href="#accordion">[2]</a>. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Vascular dementia is a type of dementia that causes a decline in cognitive skills, including reasoning, planning, memory, language, and judgment as a result of reduced blood flow to the brain.</li>
	<li>The symptoms of vascular dementia depend on the involvement of brain tissue that was damaged due to lack of blood supply. </li>
	<li>Up to one-third of stroke survivors experience dementia within six months, which can be caused by either a succession of little strokes over time or a single large stroke. This is why vascular dementia is also known as post-stroke dementia.</li>
	<li>It&rsquo;s possible to stop further brain damage and halt the progression of the disease with proper and timely intervention. However, there is currently no treatment for the illness and no means to undo the harm that has already been done.</li>
	<li>A person is diagnosed with vascular dementia if they have a decline in at least two types of cognitive abilities, such as language and memory, that are linked to a blood artery blockage in their brain and affect their ability to carry out daily tasks. 
	&nbsp;</li>
</ul>