Vascular Dementia

What is vascular dementia?

Vascular dementia is a common type of dementia that happens when there’s decreased blood flow to areas of your brain. The resulting lack of oxygen and nutrients damages brain tissue. This leads to a decline in mental (cognitive) functions that’s severe enough to interfere with daily living. Several conditions can contribute to a lack of blood flow, including stroke.

Vascular dementia is among the most common causes of dementia in people over 65 in North America and Europe. Researchers estimate that 5% to 10% of people with dementia have just vascular dementia. But vascular dementia is more commonly present with Alzheimer’s disease. Providers call this mixed dementia (when you have more than one cause of dementia).

Healthcare providers may use the term “vascular cognitive impairment” (VCI) instead of “vascular dementia.” This is because it represents the wide range of severity in thinking changes that can result from vascular damage — from mild cognitive impairment (MCI) to dementia.

Receiving a dementia diagnosis can turn your life upside down. You and your loved ones may worry about what lies ahead. Vascular dementia affects each person differently, so lean on your healthcare team to guide you through the journey and what to expect.

What are the symptoms of vascular dementia?

Symptoms of vascular dementia can vary widely. They depend on the area(s) of your brain that are affected and the extent of the damage. Symptoms may include:

• Memory loss.
• Walking and/or balance problems.
• Trouble understanding or using words (aphasia).
• Trouble concentrating, following instructions, reasoning, organizing, planning and completing tasks.
• Mood changes, like depression and irritability.
• Personality and behavior changes.
• Apathy.
• Confusion. This may get worse at night (sundown syndrome).
• Uncontrolled episodes of laughing or crying (pseudobulbar affect).
• Bowel or bladder control problems (incontinence).
• Tremors or reduced fine motor control.
• Sleeping issues.

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

What are the stages of vascular dementia?

There are no definitive stages of vascular dementia — it affects each person differently and progresses in a variety of ways depending on which areas of your brain are affected and the severity.

Most commonly, the symptoms appear in steps over the course of 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 happen alongside another form of dementia, like Alzheimer’s disease, which can impact how the symptoms progress.

What causes vascular dementia?

Conditions that damage blood vessels in your brain or partially or fully block blood flow cause vascular dementia. Decreased blood flow results in a lack of oxygen and nutrients to parts of your brain. Without these, brain cells begin to die.

Common causes of vascular dementia include:

• Narrowing (atherosclerosis) and/or blockage of many blood vessels (ischemic strokes) or capillaries (small vessel disease) in your brain.
• Bleeding from a ruptured blood vessel (like a hemorrhagic stroke) in your brain.

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

• Atrial fibrillation (Afib).
• Diabetes.
• Heart disease.
• High blood pressure (hypertension).
• High cholesterol (hyperlipidemia).
• History of stroke.
• Increasing age, especially being 60 or older.
• Smoking.

Types of vascular dementia

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

• Post-stroke dementia: Vascular dementia can happen after only one stroke if the blockage destroys brain tissue that’s needed for more than one thinking ability. Language or memory difficulties are common, but the symptoms ultimately depend on the location of the stroke. These cognitive issues must be present either immediately after or within six months of stroke (and don’t get better) for providers to categorize the condition as post-stroke dementia.
• Multi-infarct dementia: “Infarct” is another term for stroke, so multi-infarct means many strokes affect blood flow to multiple areas of your brain. Symptoms from these strokes are often noticeable when they happen. So, cognitive changes happen in a step-wise fashion (sudden worsening over multiple periods of time).
• Binswanger disease (subcortical vascular dementia): This form of vascular dementia happens when small blood vessels located throughout white matter are blocked over time by atherosclerosis. It occurs gradually over time without sudden episodes of worsening.
• Mixed dementia: When you have more than one cause of dementia symptoms, providers call it mixed dementia. The most common combination with vascular dementia is Alzheimer’s disease, but it can also happen alongside other neurodegenerative conditions.

Is vascular dementia hereditary?

Vascular dementia itself isn’t hereditary (genetic). But the conditions that contribute to it can run in biological families, like high blood pressure and heart disease.

Two rare forms of vascular dementia result from multiple strokes happening in the context of mutations (changes) in certain genes. Both mainly affect the small blood vessels in the white matter of your brain. They are:

• CADASIL: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. CADASIL requires only one parent to have the condition for their biological child to inherit it (autosomal dominant inheritance).
• CARASIL: Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy. CARASIL requires both parents to be carriers of the condition for their biological child to inherit it (autosomal recessive inheritance).

Symptoms unique to CADASIL are migraine headaches and repeated strokes. Common symptoms of CARASIL are stiffness in your legs and difficulty walking.

How is vascular dementia diagnosed?

Confirming a diagnosis of vascular dementia needs evaluation by a specialist. There are many forms of dementia, and several of its symptoms overlap with other conditions.

Your healthcare provider will:

• Ask about the course of your symptoms.
• Ask about your medical history.
• Review your current medications. Some medications can cause dementia-like symptoms.
• Ask about your biological family’s medical history.

They’ll then likely recommend a variety of tests, including laboratory, imaging and neurocognitive tests. You may need to see dementia specialists, like neurologists and geriatricians to get a diagnosis.

Laboratory tests

Laboratory tests rule out other conditions as the cause of dementia symptoms, like infection, inflammation, hypothyroidism and vitamin deficiency (especially vitamin B12).

Sometimes, providers order cerebrospinal fluid (CSF) tests (via a spinal tap) to check for autoimmune conditions and neurodegenerative diseases.

Brain imaging tests

Your provider may order the following imaging tests of your brain:

• Computed tomography (CT) and magnetic resonance imaging (MRI): These imaging tests look for evidence of stroke, bleeding, tumors and fluid in your brain. Providers prefer to use MRIs to check for vascular dementia when possible.
• Amyloid PET scan: This is a special type of PET scan. It aids in detecting an abnormal buildup of amyloid proteins in your brain, which is often present in Alzheimer’s disease. Providers sometimes recommend this test if they suspect co-existing Alzheimer’s disease.

Neuropsychological testing

During neuropsychological testing, your provider uses written and computerized tests to evaluate your mental abilities, including:

• Problem solving.
• Learning.
• Judgment.
• Memory.
• Planning.
• Reasoning.
• Language.

Specially trained psychologists — neuropsychologists — then look at the results to better understand the relationship between your brain health and thinking (cognition).

Receiving a vascular dementia diagnosis

Healthcare providers use the following criteria to diagnose vascular dementia:

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

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

What is the treatment for vascular dementia?

Vascular dementia isn’t reversible, unfortunately — once your brain is damaged, it can’t be repaired completely. Instead, the main goal of vascular dementia 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 compensate for the damage in your brain.

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 modest cognitive improvements by helping to increase 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 help 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:

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

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 advise you and your loved ones on advance care planning for financial and healthcare decisions. They’ll also make referrals for palliative care or hospice when vascular dementia has progressed to its later or end stages.

Can I prevent vascular dementia?

You can’t change some of the risk factors for the condition, like your age or genetics. But you can manage many other risk factors for the condition 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 (glucose) levels within a healthy range. You’ll need to work closely with your healthcare provider to do this.
• 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 checkups and taking your medications as prescribed.

Vascular dementia is unique from many other forms of dementia in that it’s partly preventable. If you have any of these risk factors, talk to your provider about what you can do to manage them.

What can I expect if I have this condition?

Vascular dementia may get worse over time. The changes can happen in sudden steps 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 your 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.

How long can a person with vascular dementia care for themselves?

A person with vascular dementia will need help with at least some aspects of daily function, like managing medications, paying bills or preparing food. Your loved one with this condition may be able to do many things for themselves. But it may not be safe for them to live alone, depending on what abilities are affected. For some people with vascular dementia, more specialized care may be required from facilities that care specifically for people with dementia.

What is the life expectancy for someone with vascular dementia?

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

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

What are the end-of-life symptoms of vascular dementia?

It’s difficult to pinpoint the exact end-of-life symptoms of vascular dementia. It may be more helpful to think of how dementia has affected your loved one holistically. By the later stage of dementia, it’ll have a severe impact on most aspects of your loved one’s life. They’ll need full-time care and support.

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

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

Your loved one’s healthcare team, hospice nurse or palliative care provider are the best people to ask about timelines. They can tell what signs to watch for, so you have a general idea of what to expect.

When should I call my healthcare provider?

You or your caregiver should call your healthcare provider if you notice any worsening of your symptoms or when new symptoms appear. Your provider or healthcare team will want to assess any changes and make adjustments to your treatment plan if needed.