Prevention Strategies For Reducing The Risk Of Vascular Dementia

Overview

Today’s ageing population means that the world is seeing increased cases of dementia. Vascular dementia is the second most common form of dementia and has a greatly reduced life expectancy. For all types of dementia, there are clear risk factors that can be modified in an attempt to reduce the incidence and development of the condition. In this article, we will look at the definition of dementia with a special focus on vascular dementia. We will also discuss the risk factors and strategies that may help prevent its development. 

Dementia

Dementia is a term that covers a group of neurocognitive disorders that are often associated with age. Dementia results from gradual damage and change to the brain or blood vessels. This damage can have profound effects on an individual’s memory and ability to carry out everyday activities of living. The four main types of dementia and their symptoms are illustrated below in this source from The National Institute On Aging.

What is vascular dementia?

Vascular dementia is a condition that occurs when the blood vessels that deliver blood to the brain, or areas of the brain, become damaged. When the blood vessels are damaged, this reduces blood flow to the brain cells and starves them of adequate oxygen and nutrients. These starved brain cells become damaged and do not function properly. This causes the symptoms of vascular dementia such as memory decline, confusion, depression, and thought-processing issues. Cognitive impairment will vary according to the part of the brain that has been damaged.¹ Vascular dementia, like other forms of dementia, is a progressive disease. The condition is rare in people under 65 years of age. 

Subtypes of vascular dementia

Vascular dementia has four subtypes which affect the brain differently.² 

• Subcortical ischaemia
• Vascular dementia
• Post-stroke dementia
• Multi-infarct dementia

Incidence of vascular dementia

Vascular dementia is the second most common type of dementia. Approximately 15% of all dementia cases are diagnosed as vascular dementia. In 2018, it was estimated that 50 million people worldwide have dementia. This figure is predicted to rise to more than 152 million by 2050. 

What is the life expectancy with vascular dementia?

The life expectancy for a person diagnosed with vascular dementia is around three to five years. This is because someone with vascular dementia is more likely to die from a stroke or heart attack than from dementia itself.³ 

Symptoms and signs of vascular dementia

Vascular dementia is often difficult to diagnose and treat as the presenting symptoms can be variable and to different degrees. Symptoms can include:

• Difficulty organising, planning and making decisions in daily life. This is known as executive functioning
• Problems following the steps of simple tasks, such as making a cup of tea or a sandwich
• Slower thinking
• Disrupted concentration
• Confusion
• Memory decline
• Speech difficulties such as word-finding difficulties or reduced fluency
• Depression
• Hallucinations

Risk factors for vascular dementia

The risk factors for vascular dementia include having a lower educational background, obesity, diabetes, hypertension, high cholesterol, metabolic syndrome,^{4 5} smoking,⁶ and excessive alcohol intake.⁷ There is also emerging evidence that head injury, pollution⁸ and later-life depression are also thought to be risk factors.⁹

Importance of early diagnosis and treatment

Diagnosing and beginning treatment for vascular dementia as early as possible can improve the person’s well-being and quality of life and also supports those caring for them. It is also important to treat any co-existing health conditions such as hypertension and high cholesterol. Early diagnosis allows the individual and their family to get timely support and advice. 

Diagnosis of vascular dementia

The first point of contact for diagnosis would be the GP who can make an assessment by asking some questions and conducting some tests. In some instances, they might be able to make a diagnosis there and then, depending on the person’s history and presenting symptoms. Usually, however, they will refer the person to a more specialist clinic or practitioner such as a geriatrician or memory clinic.

Medical history review

A medical practitioner typically takes a medical history and asks questions about the person’s lifestyle. The aim of this is to identify potential risk factors for dementia such as older age, smoking, excessive alcohol intake, history of stroke (especially in recent months),¹⁰ hypertension, diabetes, cardiovascular disease, and high cholesterol. 

Examination

 Practitioners may use various assessment tools to test the person’s cognitive and neurological functioning. Tools frequently used include the Mini Mental State exam, vascular dementia assessment scale cognitive subscale (VADAS-cog),¹¹ or the Montreal Cognitive Assessment scale.¹² 

Brain imaging 

MRI or CT scans can be undertaken to establish the type and location of brain dysfunction. Brain scans can also rule out other causes of symptoms such as tumours or a build-up of fluid. 

Treatment approaches for vascular dementia

Management of vascular risk factors

As vascular dementia is highly associated with cardiovascular issues, it is vital to manage these as effectively as possible. The treatment approaches to vascular dementia aim to manage existing comorbidities and encourage lifestyle modifications. 

Lifestyle modifications

The main actions and treatment approaches to reduce lifestyle risk factors are:

Treat hypertension

Hypertension is known to be a risk factor for stroke and vascular dementia. Therefore, it is important to manage blood pressure by lifestyle strategies such as diet, exercise, and sometimes medication. 

Provide hearing aids where hearing is an issue

Hearing loss is associated with a higher f likelihood of developing dementia¹³ and can lead to social isolation. Treatment for hearing difficulties, where possible, is important for reducing this risk factor.

Discourage excess alcohol use 

Alcohol consumption is linked to cognitive decline and other health risks. However, there is some evidence that mild consumption could be beneficial.⁷

Prevent head trauma

There appears to be a link between head trauma and the development of dementia.¹⁴ As people of older age can be more susceptible to falls, it is important to remove trip hazards in the home and take other steps to reduce the likelihood of falls.

Stop smoking

Smoking is associated with many cardiovascular diseases and cancers. Support to stop smoking is essential, and readily available through GP practices. 

Reduce obesity and associated Type 2 diabetes

Obesity and Type 2 diabetes have a strong association with vascular dementia, as well as with stroke and hypertension. A combination of healthy eating, exercise and, where appropriate, medication are important for managing these factors. 

Healthy diet

The traditional Mediterranean diet refers to a balanced diet containing fruits, vegetables, cereals, legumes, and low amounts of saturated fats with olive oil as the main source of fat. The typical Mediterranean diet includes moderate consumption of fish, low to moderate intake of dairy products, low consumption of red meat and meat products, and a moderate amount of alcohol.

Physical activity

Exercise is known to have benefits for weight management, health, cognitive function, and mental health.¹⁵ It is thought that aerobic exercise and muscle strengthening exercises are effective in slowing cognitive decline.¹⁶

Meaningful activities

It is important to provide the person with dementia with meaningful activities that enhance or maintain their life skills and cognitive abilities. These could be board games, reminiscence groups, musical activities, storytelling, or dancing. 

Medications 

As yet, there are no effective drugs for vascular dementia, but the affected individual is likely to be on other medications to manage their co-existing conditions. 

Supportive therapies

Benefits may be gained from the support of an occupational therapist for daily task management strategies, a physiotherapist where there have been falls and issues with mobility, a speech and language therapist for advice on communication and swallowing issues, and an activities coordinator for advice on meaningful leisure activities. 

There is also a possibility that some targeted cognitive rehabilitation may improve global cognitive decline but this requires further evaluation. 

Access to healthcare and specialist services

Ongoing care can be by via a GP, district nurse, physiotherapist, occupational therapist, or memory clinic. Often, a multidisciplinary team involving some or all of these professionals will work together to support the person with vascular dementia and their family. Support is also available from organisations such as DementiaUK and online forums. 

Challenges in following prevention strategies

Declining cognitive function can make it difficult for someone with vascular dementia to follow treatment strategies and medication regimes. The support of caregivers can be crucial for therapeutic interventions to be beneficial. 

It is important for those supporting the person with dementia to understand that this is very difficult for them. For instance, if a person has reduced memory, they may forget what they are meant to do. Aids and strategies such as written notes, notice boards, and pictures may be needed. 

Future directions 

Further clarification of the illness and treatment of risk factors is vital to target future treatments that may be effective in preventing or delaying cognitive decline.

Importance of research and awareness

As the population ages, the awareness of dementia seems to be increasing. However, the distinction between different types of dementia is perhaps not so obvious to the general public. Further identification of risk factors is also vital to identify and treat the condition earlier and more effectively. More funding is needed to increase research into diagnosis and treatment and to raise awareness of the condition and how it may be managed. 

Summary

Vascular dementia is the second most common form of dementia worldwide. Life expectancy is only around five years after diagnosis. Risk factors for developing vascular dementia include age, smoking, excessive alcohol intake, high blood pressure, obesity and head trauma. 

 Assessing and managing these conditions is key to the prevention and treatment of vascular dementia. Early diagnosis is vital to facilitating support and advice to the person and those who support them. Treatment generally involves maintaining a healthy diet, physical activity, and enhanced leisure opportunities aimed at keeping cognitive function optimal.