Introduction 

What is dementia? 

Dementia is a term used to describe a group of conditions that impact a person's cognitive abilities, including thinking, memory, and decision-making skills, which affect their daily activities.

People who are older, especially those over the age of 60, are at a higher risk of developing dementia, with an estimated number of 5 million people within this age range currently living with dementia.  

Vascular dementia is a type of dementia that occurs when there is a disruption in the blood flow to the brain. This results in difficulties in thinking, memory, and behavioural changes. 

Any illness that affects the brain through the involvement of blood vessels is referred to as a cerebrovascular disease. Therefore, vascular dementia is also a type of cerebrovascular disease that affects cognition and brain function based on the size, location, and number of blood vessels affected.¹

Understanding the causes and symptoms of vascular dementia is important, as it is the second most common form of dementia, following Alzheimer’s disease.² This knowledge allows individuals to make informed lifestyle choices aimed at reducing the risk of developing the condition. Additionally, it provides us with the ability to effectively support those living with vascular dementia.

Causes of vascular dementia

An overview of the vascular system 

The vascular system refers to a network of blood vessels that circulate blood throughout the body. The main components of the vascular system are arteries and veins. 

Arteries carry oxygen-rich blood from the heart to the body tissues, while the veins carry oxygen-depleted blood from the tissues back to the heart, respectively. 

What happens in vascular dementia? 

Vascular dementia arises from decreased blood flow to the brain, often resulting from damage to the brain's blood vessels. This reduced blood supply ultimately causes the death of these vessels, resulting in a decline in brain function. Typically, it follows a stroke event where major brain vessels become blocked.³ Due to various mechanisms leading to such blockages, there are several types of vascular dementia.

What are the factors that increase the risk of vascular dementia? 

• Age: Age is a significant factor, with individuals aged 60 to 75 facing an increased risk. Generally, the older one is, the greater the risk of developing vascular dementia.
• Atherosclerosis:  Plaques that build up gradually in the blood vessels that feed the brain can cause narrowing of those blood vessels and eventually lead to restricted blood flow to the corresponding brain region being supplied by them.
• High blood pressure: In severe cases of uncontrolled high blood pressure, blood vessels may rupture or break, resulting in a specific type of stroke known as a hemorrhagic stroke, where bleeding occurs into the brain.
• Cardiac diseases (such as arrhythmias, and heart failure): Diseases that impact the heart's function can disrupt the proper circulation of blood throughout the body. This increases the risk of blood clot formation within these vessels, subsequently raising the potential for a stroke to occur.
• Endocrine conditions (such as diabetes): Diabetes, especially when untreated, can lead to microvascular diseases, affecting small blood vessels throughout the body. This impairs blood flow to the brain, leading to an increased risk of both stroke and vascular dementia.
• Lifestyle factors that can lead to vascular dementia include smoking, alcoholism, an uncontrolled high-cholesterol diet, a lack of exercise, and being overweight or obese.

Symptoms of vascular dementia

The symptoms of vascular dementia typically emerge gradually and may worsen progressively.⁴ However, in certain instances, symptoms can appear within weeks or months following a stroke, initially presenting as difficulties in thinking without reaching full-blown dementia.

In some cases, these symptoms may resolve spontaneously, but in others, dementia may develop within six months.⁵ Such cases often carry a poorer prognosis.

The symptoms can manifest in several forms, but they can be mainly categorised into three types: cognitive symptoms, physical symptoms, and emotional symptoms.

Summary 

Vascular dementia is a prominent form of dementia, arising from compromised blood flow to the brain due to vascular system damage, often following a stroke. This condition, the second most common type of dementia after Alzheimer's disease, requires understanding for individuals to make more informed lifestyle choices and to provide support for people living with the condition.

Causes of vascular dementia include factors such as atherosclerosis, high blood pressure, cardiac diseases, diabetes, and certain lifestyle habits such as smoking, excessive alcohol consumption, poor diet, lack of exercise, and obesity.

Symptoms of vascular dementia can manifest gradually, worsen over time, or emerge suddenly after a stroke, initially presenting as cognitive difficulties. While symptoms may resolve in some cases, others progress to full-blown dementia within six months, often indicating a poorer prognosis. These symptoms encompass cognitive, physical, and emotional aspects, ranging from memory problems and speech impediments to gait disturbances and emotional changes like depression and agitation.

FAQs

What is the life expectancy of a person with vascular dementia? 

• Life expectancy differs from person to person, and it depends on the stage and severity of the condition. However, the life expectancy for vascular dementia in general is about 5 years.⁶

What is the first symptom likely to be seen in vascular dementia? 

• An early symptom of vascular dementia may include, but is not limited to: slowness of thought, and problems with understanding. These are usually very mild and often even unnoticeable.⁷

Is there a cure for vascular dementia? 

• There is currently no cure for vascular dementia, however, you can make lifestyle changes to reduce your risks. These include regular exercise, cultivating a healthy diet, and taking medications to control conditions such as high blood pressure, cardiac arrhythmias, diabetes, etc.⁸