Vascular Dementia

Vascular dementia is when there’s decreased blood flow to areas of your brain. Blood provides oxygen and nutrients. A lack of it damages brain tissue. It leads to symptoms that affect daily living, like memory loss, confusion, and personality and behavioral changes.

Several conditions can cause a lack of blood flow, including stroke.

Vascular dementia is one of the most common types of dementia in people after age 65 in North America and Europe. About 5% to 10% of people with dementia have only vascular dementia. But it often happens along with Alzheimer’s disease. When someone has both, providers call it mixed dementia (having more than one cause of dementia).

You may hear your healthcare providers use the term “vascular cognitive impairment” (VCI) instead of “vascular dementia.” This term covers the full range of thinking changes from vascular damage — from mild cognitive impairment (MCI) to dementia.

Because vascular dementia can look different for each person, your healthcare team can help you understand your diagnosis and what to expect moving forward.

Types of vascular dementia

Healthcare providers use different terms for vascular dementia. They reflect the number and type of blood vessels involved and how symptoms develop. They include:

• Post-stroke dementia: This can happen after one stroke if the blockage destroys the brain tissue needed for more than one thinking skill. Language or memory problems are common. But symptoms depend on where the stroke happened. These thinking issues must start right after the stroke or within six months, and they don’t get better.
• Multi-infarct dementia: “Infarct” is another word for stroke. This means many strokes affect blood flow to multiple areas of your brain. Symptoms are often noticeable when these events happen. Cognitive changes happen in a step-like way with sudden worsening over time.
• Binswanger disease (subcortical vascular dementia): In this form, atherosclerosis slowly blocks small blood vessels in your brain’s white matter. It happens gradually without sudden episodes of worsening.
• Mixed dementia: This happens when more than one disease causes dementia symptoms. The most common is vascular dementia with Alzheimer’s disease. But it can also occur with other brain conditions.

Vascular dementia symptoms

Symptoms of vascular dementia can vary widely. They depend on which parts of your brain it damages and how severe it is. Symptoms may include:

• Bowel or bladder control problems
• Confusion (that may get worse at night)
• Difficulty understanding or using words
• Memory loss
• Mood changes, like irritability
• Personality and behavior changes
• Problems with reasoning, organizing and planning
• Sleeping issues
• Tremors or reduced fine motor control
• Trouble concentrating, following instructions and completing tasks
• Uncontrolled episodes of laughing or crying
• Walking and/or balance problems

It’s important to see your healthcare provider if you or a loved one develops these symptoms.

Vascular dementia stages

There are no clear stages of vascular dementia. It affects each person differently and progresses in a variety of ways.

Most often, symptoms get worse over many years. But they may be most obvious and sudden after a major stroke. There may even be short periods when symptoms improve. But if more strokes happen, they can cause further decline.

Vascular dementia can also occur along with Alzheimer’s disease. Having both can affect how symptoms change over time.

Vascular dementia causes

Conditions that damage blood vessels in your brain or partially or fully block blood flow cause vascular dementia. When blood flow decreases, parts of your brain don’t get enough oxygen and nutrients. Without these, brain cells begin to die.

Common causes include:

• Narrowing (atherosclerosis) or blockage of larger blood vessels (ischemic stroke) or capillaries (small vessel disease) in your brain
• Bleeding from a broken blood vessel (like a hemorrhagic stroke) in your brain

Risk factors

Certain factors increase your risk of having blood vessel issues and vascular dementia, including:

• Age (after 60)
• Atrial fibrillation (Afib)
• Diabetes
• Heart disease
• High blood pressure (hypertension)
• High cholesterol (hyperlipidemia)
• History of stroke
• Smoking

Is vascular dementia hereditary?

Vascular dementia itself isn’t hereditary (passed down through genes). But conditions that raise the risk, like high blood pressure and heart disease, can run in biological families.

Two rare types happen because of gene mutations (changes):

• CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy): A child can inherit CADASIL if one parent has the condition (autosomal dominant inheritance). Symptoms include migraine headaches and repeated strokes.
• CARASIL (cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy): A child can inherit CARASIL only if both parents carry the gene (autosomal recessive inheritance). Common symptoms include stiff legs and trouble walking.

Complications of vascular dementia

By the later stage of dementia, it will have a severe impact on most aspects of your or your loved one’s life. People in later stages often need full-time care and daily support.

Late-stage or end-of-life symptoms may include:

• Depression and apathy
• Hallucinations and delusions
• Near or total loss of language skills
• Physical challenges that make it nearly impossible to do activities of daily living without help, like eating, washing and dressing
• Restlessness, anger or agitation
• Severe memory loss

Your or your loved one’s healthcare team, hospice nurse or palliative care provider is the best to ask about timelines. They can explain what signs to look for and give you a general idea of what to expect.

How doctors diagnose vascular dementia

A healthcare provider needs to evaluate you to confirm a diagnosis. There are many types of dementia, and several symptoms are similar to other conditions.

Your provider will:

• Ask about the symptoms you have
• Ask about your medical history
• Review your current medications
• Ask about your biological family’s medical history

What tests diagnose vascular dementia?

Your provider will likely recommend a variety of tests. You may also see dementia specialists, like neurologists and geriatricians, for a diagnosis. The following tests help diagnose this condition:

• Laboratory tests: These rule out other causes of dementia symptoms. Sometimes providers order a cerebrospinal fluid test (spinal tap) to check for autoimmune conditions or other neurodegenerative diseases.
• Brain imaging tests: CT and MRI scans check for stroke, bleeding, tumors or fluid in your brain. An amyloid PET scan can detect abnormal amyloid protein buildup in your brain. This is often seen in Alzheimer’s disease. Providers may recommend this if they suspect Alzheimer’s along with vascular dementia.
• Neuropsychological testing: Written and computerized tests measure thinking skills like memory, problem-solving, reasoning, planning, judgment and language. A neuropsychologist reviews the results to better understand the link between brain health and cognition.

Diagnostic criteria for vascular dementia

Healthcare providers use the following criteria to diagnose vascular dementia:

• Neurocognitive testing confirms the diagnosis of dementia or mild cognitive impairment (MCI).
• There’s brain imaging evidence (usually with MRI) confirming a recent stroke or other vascular brain changes. These are consistent with the types of cognitive impairment you have.
• There are no signs that other factors may be contributing to cognitive decline.

These criteria suggest the greatest likelihood that mild cognitive impairment or dementia is due to vascular damage and not another cause.

Vascular dementia treatment

Vascular dementia isn’t reversible. Brain damage can’t be fully repaired. Instead, the main goal of treatment is to prevent or slow down further damage by managing risk factors. Treatment also involves helping you find new ways of doing things to make up for brain damage.

Medication

Unlike for Alzheimer’s disease, there aren’t any medications that have U.S. Food and Drug Administration (FDA) approval for this condition specifically. But providers may prescribe cholinesterase inhibitors for vascular dementia. Studies show that they may result in slight or modest cognitive improvements by increasing blood flow in your brain.

Memantine is another medication that’s approved for Alzheimer’s disease and may help with vascular dementia.

Your provider may prescribe other medications to help manage risk factors for stroke. These include medications for high blood pressure, high cholesterol and diabetes.

Rehabilitation and advance care planning

You may work with specialists to manage symptoms of vascular dementia. For example, physical and occupational therapists can help you improve your physical abilities and find new ways of doing everyday tasks. A speech-language pathologist can help with speaking, swallowing and learning other ways to communicate.

Other specialists you may work with include:

• Clinical social workers
• Geriatric case managers
• Recreational therapists
• Registered dietitians
• Psychologists or psychiatrists

These specialists will work with you and your loved ones to make sure you have ongoing care that matches your needs and goals. They’ll help you plan ahead for medical and financial decisions. They’ll also make referrals for palliative care or hospice when vascular dementia progresses to its later or end stages.

When should I see my healthcare provider?

You or your caregiver should call your healthcare provider if you notice any new or worsening symptoms. Your provider or care team will want to assess any changes and adjust your treatment plan if needed.

What can I expect if I have vascular dementia?

Vascular dementia may get worse over time. The changes can happen suddenly or gradually. Each person has their own unique journey. Treatments may help slow the progress of the disease. You and your healthcare provider will work together to develop a treatment plan best suited for managing symptoms and the stage of the disease.

Lean on loved ones for support during this time. Together, you can make a plan to ensure your quality of life and wishes are respected as dementia progresses.

Vascular dementia life expectancy

The life expectancy depends on the severity of the disease. Vascular dementia has wide-ranging severity and affects each person differently.

The life expectancy for vascular dementia is lower than it is for people with Alzheimer’s disease. This is because someone with vascular dementia is more likely to die from a stroke or heart attack than from dementia itself.

Can vascular dementia be prevented?

Vascular dementia is unique from many other forms of dementia in that it’s partly preventable. There are some risk factors that you can’t change, like your age or genetics. But you can manage many others to try to prevent it — mainly those that damage your blood vessels. Steps you can take include:

• Keeping your blood pressure, cholesterol and blood sugar levels within a healthy range
• Reaching and maintaining a weight that’s healthy for you
• Getting regular physical activity (try to aim for 30 minutes on most days)
• Eating heart-healthy foods, like those in the Mediterranean or DASH diets
• Quitting smoking
• Limiting alcohol consumption
• Managing your stress
• Seeing your provider regularly for check-ups and taking your medications as prescribed

If you have any of these risk factors, talk to your provider about what you can do to manage them.