Diagnosis And Treatment Of Vascular Dementia 

Overview 

Dementia is an umbrella term for numerous diseases that destroy nerve cells and cause damage to your brain. More specifically, vascular dementia is a prevalent and detrimental condition that affects approximately 180,000 people in the UK (NHS). It is caused by a lack of blood flow to specific regions of the brain, leading to a wide spectrum of potential cognitive deficits. Conditions under the dementia scope typically affect an individual’s memory, thinking, and cognitive function. Learning about the implications of vascular dementia and the current diagnosis and treatment strategies may help better your understanding of the condition. 

Understanding vascular dementia 

Unlike Alzheimer’s disease which primarily involves a neurodegenerative process (progressive death and loss of function of neurons), vascular dementia is a form of dementia that is due to acute or chronic damage to the brain’s blood vessels, resulting in cognitive decline. This damage may occur due to a variety of different reasons, such as stroke, ‘mini-strokes’ (transient ischaemic attacks (TIAs)), small vessel disease (Binswagner’s disease), or other vascular abnormalities.¹ Hence, vascular dementia may manifest abruptly or develop gradually over time. 

The clinical presentation of the condition varies widely, highlighting the complex nature of the disease and how detrimental it can be.² Depending on what region of the brain is damaged, there can be a wide range of symptoms or mental/physical effects. The NHS has listed the following traits as the most common symptoms of vascular dementia:

• Issues with concentrating
• Trouble speaking or understanding speech
• Changes in personality, mood, or behaviour 
• Difficulty with planning and understanding 
• Disorientation or confusion
• Impaired mobility and coordination 
• Symptoms seen in Alzheimer’s disease: this includes issues with memory and language 

Types of vascular dementia

Vascular dementia has several subtypes, each with distinct characteristics based on the underlying clinical presentation. The four main types of Vascular Dementia recognised by the Alzheimer’s Society include:

1. Subcortical vascular dementia: This is the most prevalent form of vascular dementia and typically stems from conditions that affect small blood vessels in your brain such as ‘small vessel disease’. Over time, these vessels become damaged, reducing the proper blood flow to the specific region of the brain they’re connected to.³ This subtype of vascular dementia progresses slowly, predominantly affecting the sub-cortex of the brain, a crucial region of the brain necessary for processing information and emotions.
2. Stroke-related dementia: Vascular dementia can result from stroke, occurring when blood flow to a region of the brain is suddenly obstructed. Most strokes are caused by narrowed blood vessels blocked by clots, originating either in the brain or the heart. Depending on the location or severity of the stroke, it can lead to various cognitive impairments. Current studies observed that 25%-30% of individuals who survived a stroke developed either immediate or delayed vascular cognitive impairment or vascular dementia.⁴
3. Multi-infarct dementia: This subtype is characterised by cognitive decline resulting from multiple small strokes (infarcts) in the brain. Similar to stroke-related dementia, the overall accumulation of these smaller infarcts disrupts blood flow to the brain, causing harm to normal brain function.
4. Mixed dementia: It is characterised by the presence of more than one cause of dementia in an individual. In most cases of mixed dementia, patients have both Alzheimer’s disease and vascular dementia issues. This subtype of dementia is a prevalent condition found in approximately 22% of the elderly population.⁵

Diagnosis of vascular dementia

Due to the intricate nature of vascular dementia, pinpointing an exact diagnosis for the condition is difficult. Your doctor will utilise your medical history to determine potential symptoms that can help diagnose your condition. In addition to this, doctors and physicians also administer a variety of tests to ensure a precise diagnosis.

Blood tests

Several tests can be conducted to understand your heart and blood vessel health. This includes measuring your blood pressure, cholesterol, and blood sugar levels. Additional blood tests will also be conducted to rule out any causes of symptoms seen in dementia (NHS). These include checking for:

• Liver and kidney function
• Thyroid function 
• Vitamin B12 and folate levels 
• HbA1c (diabetes) 

Neurological & neurocognitive tests

Dementia directly affects the brains of individuals, greatly diminishing their neurological functions and cognition over time. As a result, doctors must conduct multiple assessments of your mental abilities using neurocognitive tests. This involves completing tasks and questions that evaluate your memory, judgement, problem-solving, reasoning, and planning (Alzheimer's Association). 

Doctors may also inspect your overall neurological (your brain and central nervous system) health (Mayo Clinic). This involves physical evaluation of your reflexes, strength/muscle tone, balance, coordination, and sense of touch and sight. Ensuring you have a healthy neurological function also helps the diagnosis process. 

Brain imaging 

Once the initial tests have been conducted, brain imaging can be used to help diagnose vascular dementia as well. These scans can help identify and visualise potential causes of vascular dementia such as strokes, vascular diseases, or trauma, and help explain an individual’s symptoms. 

Doctors utilise two main types of scans to help with dementia diagnosis: 

• Magnetic resonance imaging (MRI) scans
  • MRI imaging utilises strong magnetic fields and radio waves to create detailed pictures of your brain. This machine is like a tunnel, which can make people feel claustrophobic, but remaining still and relaxed is essential for a good outcome. The images produced are incredibly detailed and show any abnormalities, strokes/mini-strokes, blood vessel abnormalities, or changes in blood flow.

• These images also show if there is any shrinkage in specific areas of the brain. For example, in frontotemporal dementia, the frontal and temporal lobes shrink. Hence, these images can help pinpoint which areas are the most affected. 

• Computerised tomography (CT) scans
  • Unlike MRI scans, CT scans use X-rays to take detailed pictures of the brain. For CT scans, you lie down on a bed that slides into a large, doughnut-shaped machine that rotates around your body. As the machine rotates, it will take X-ray images of your brain or body from different angles. A computer algorithm then combines all the images to produce a cross-sectional (slices) image of the brain. 

• These scans can show the structure of your brain, areas that are suffering from shrinkage, strokes/mini-strokes, or changes in blood flow. 

If the findings from the MRI or CT scans are inconclusive, your doctor may suggest using other scans such as SPECT scans or PET scans to help with the diagnosis. 

Treatment 

Unfortunately, there is no cure for vascular dementia. However, several approaches can be used to help reduce its progression by focusing on the condition’s underlying health conditions and risk factors. The NHS has listed the following approaches to help with this:

• Eating a healthy and balanced diet
• Getting fit 
• Reducing alcohol intake 
• Losing weight if you’re overweight 
• Stopping smoking
• Taking prescribed medicines can help treat high blood pressure, prevent blood clots or lower cholesterol. Request an appointment with your doctor for further advice on specific medications. 

There are also other ways to help reduce the impact of vascular dementia as well. For example, rehabilitation therapies (physiotherapy, occupational therapy, or psychological therapy) or dementia activities such as memory cafes may help alleviate any existing problems.  

Summary

Vascular dementia, closely linked with Alzheimer’s disease, manifests in four main subtypes: subcortical vascular dementia, stroke-related dementia, multi-infarct dementia, and mixed dementia. Despite its classification, diagnosing vascular dementia remains challenging. Physicians utilise a range of assessments, from blood tests to neurological evaluations, to discern cognitive impairments. Advanced imaging techniques like MRI and CT scans provide detailed brain images, aiding in understanding the condition's underlying causes and biological changes. While no cure exists for vascular dementia, various strategies can reduce its impact, including lifestyle modifications for prevention and a range of therapies for management. Rehabilitation therapies and dementia-focused activities offer support for individuals with the condition, aiming to enhance quality of life and functional independence.