What is Vascular Dementia?

Many people assume that forgetfulness is a normal part of getting older. Whilst this can be true for mild cases, some people develop problems with their cognition that are more serious and interfere with their day-to-day activities.^{1, 2}

Dementia (also known as major neurocognitive disorder) is a brain condition characterised by a progressive decline in memory and other intellectual skills.² Vascular dementia is the second most common subtype of dementia after Alzheimer’s disease. Like many forms of dementia, vascular dementia is more common among older people, but younger people can be affected, too.²

In this article, we’ll explore what causes vascular dementia, how the condition is diagnosed and managed, and what to do if you’re worried about your memory or that of someone you love.

Overview

Vascular dementia develops due to a reduction in blood supply to areas of the brain, which leads to the permanent death of brain cells.² Symptoms can vary between affected people, depending on the specific subtype of vascular dementia and which areas of the brain have been damaged.⁴

Treatment for vascular dementia is largely supportive, and there is currently no cure.² However, there is a great deal of support available if you have been diagnosed and it is still possible to live well with the condition. 

What causes vascular dementia? 

Vascular dementia occurs when areas of the brain do not receive enough blood. Inadequate blood supply means that there is not enough oxygen and nutrients for brain cells in those areas to survive, leading to cell death. 

Blood supply can be reduced due to a narrowing of blood vessels by fatty plaques that build up over time - a process known as atherosclerosis. Other problems with the blood vessels within the brain can have the same effect, as can the formation of blood clots within vessels.²

What are the risk factors for vascular dementia?

Another condition caused by a disruption to blood supply is a heart attack. This explains why many of the risk factors for vascular dementia are the same ones that you may more commonly associate with heart health. Addressing modifiable risk factors (those that we can change) is the best way to reduce your risk of developing vascular dementia.³

Non-modifiable risk factors (those out of our control)

• Age: Vascular dementia becomes more common with age, and the incidence (how often the disease occurs) doubles with every additional 5.3 years of age.⁴

Modifiable risk factors (those we can change)

• High blood pressure (hypertension): Numerous studies have shown that managing high blood pressure reduces the risk of vascular dementia.³
• Smoking: Smokers have a higher risk of vascular dementia, which can be reduced by quitting.⁵
• High cholesterol: Having high levels of “bad” cholesterol and low levels of “good” cholesterol are risk factors for developing fatty plaques in the blood vessels (atherosclerosis).⁶
• Diabetes: Those with diabetes are more likely to develop vascular dementia.³ Improving your control of your blood sugars reduces your risk.⁷,⁸ Unlike type I diabetes, type II diabetes is often preventable by keeping active, eating well, and maintaining a healthy body weight. Speak to your healthcare team to find out more about reducing your risk.⁹
• Obesity: People who are obese in mid-life are more likely to develop vascular dementia.¹⁰
• Heart disease: Certain heart problems, like an irregular heartbeat and clogged arteries, increase the risk of vascular dementia.³

What are the symptoms of vascular dementia?

Symptoms of vascular dementia can vary widely, depending on the affected parts of the brain and the subtype of vascular dementia. Compared with Alzheimer’s disease, memory loss can be less significant, which means that vascular dementia may be initially mistaken for other conditions.¹¹

• Multi-infarct dementia (MID) is a type of vascular dementia caused by many small strokes. There may be sudden, noticeable changes in cognitive abilities following each stroke. People with MID may have problems with attention, speech, reading, writing and executive function (the ability to plan, organise, and make decisions). Working memory (our ability to temporarily hold information needed to complete immediate tasks) can be affected, especially in later stages.¹¹

• Strategic infarct dementia: Some areas deep within the brain are particularly important for our cognitive functioning. Strategic infarct dementia arises when a stroke occurs in one of these areas. Symptoms appear abruptly and depend on the area involved. For example, a stroke affecting important areas at the front of the brain can lead to personality or behavioural changes, and if the area affected is responsible for language, then a person may develop communication difficulties. The executive function may be preserved.¹¹

• Subcortical ischaemic vascular dementia arises when small vessels supplying the subcortical areas of the brain (which lie deep within the brain, under the outer layer) become blocked or damaged. Symptoms tend to appear slowly and progress gradually. Individuals may present with issues with movement and coordination, delayed mental processing, and/or problems with attention, learning and verbal memory (the ability to remember verbal information such as a list).¹¹

Some people have mixed dementia - a combination of vascular dementia and Alzheimer’s disease. Memory impairment is generally more significant than amongst those with pure vascular dementia, and the condition may progress more quickly.¹¹

How is vascular dementia diagnosed? 

There is no single test that can be used to diagnose vascular dementia or dementia more broadly. 

Initially, your healthcare provider will speak with you to determine what symptoms you or your loved ones are worried about. It’s really helpful to bring someone else who knows you well to your appointment so that they can offer any additional information that may help your team reach a diagnosis. Your team will also want to understand how your symptoms are affecting your day-to-day function and how this differs from the past.¹²

There are several medical conditions that can mimic the symptoms of dementia, such as delirium (sudden, temporary confusion that arises due to a medical problem such as infection). To determine whether you are displaying symptoms of dementia or another problem, it’s likely that you will be offered:¹² 

1. A physical examination
2. Cognitive testing: To identify any changes to your memory and thinking
3. Blood tests: To help exclude other causes of cognitive changes, such as infection or thyroid problems
4. Sometimes, a brain scan (such as a CT scan) may be used to look for changes within the brain if the cause of your symptoms is uncertain.

In the UK, it’s typical for your general practitioner (GP) to refer you to a specialist if their initial enquiries suggest you could have dementia.

What are the treatment options for vascular dementia? 

It’s important that if you are diagnosed with vascular dementia, you and your loved ones have access to appropriate information and support. The National Institute for Clinical Excellence (NICE) states that people diagnosed with dementia in the UK should be offered post-diagnostic support from a professional with experience working with people living with dementia. They can help you coordinate your care, understand your condition, connect you with further support that you may benefit from, and plan for the future.

 Your healthcare provider will likely review any medication you are currently taking. Any medications that can worsen cognition may be stopped if the benefits of doing so outweigh any risks. If you have mixed dementia, there are several medications which have been shown to slow the progression of Alzheimer’s disease. However, these medications are not used to treat pure vascular dementia.¹³

Sometimes, people with vascular dementia can develop behavioural symptoms that cause them distress. In these cases, medication such as antipsychotics may be prescribed to help manage these symptoms.¹³

What is the outlook for people diagnosed with vascular dementia?

Vascular dementia is a progressive condition, and you will require more care as time passes. For some people, this will mean moving to a residential care facility. Although life expectancy is shortened, the good news is that it’s still possible to live well with vascular dementia with the right support.³

I’m worried that I could be developing dementia - what should I do? 

It’s important to reach out for help if you’re worried that you or someone you love could be developing dementia. Any medical problems can mimic the symptoms of dementia, so reaching an accurate diagnosis can help you access the right support. 

Many excellent patient support organisations around the world can help support you if you are being worked up for or have been diagnosed with dementia. Although many of these organisations refer to Alzheimer’s disease in their name, they also provide support to people with other forms of dementia. 

UK: Alzheimer’s Society

Scotland: Alzheimer Scotland

Ireland: The Alzheimer Society of Ireland

USA: The Dementia Society of America

Canada: Alzheimer Society

Australia: Dementia Support Australia

New Zealand: Dementia New Zealand

Summary

Vascular dementia is the second most common form of dementia. It arises when blood vessels within the brain become damaged or blocked. This causes areas of the brain to be deprived of blood carrying oxygen and nutrients, leading to brain cell death. 

Vascular dementia becomes more common as we get older. Other risk factors include high blood pressure, high cholesterol, diabetes and smoking. Addressing any risk factors (especially high blood pressure) is the best way to reduce your risk of developing vascular dementia. 

Symptoms of vascular dementia vary depending on the specific subtype of the condition and the parts of the brain that are affected. Compared with Alzheimer’s disease, memory may be affected to a lesser extent, which can mean that vascular dementia is initially mistaken for another problem. 

Vascular dementia is diagnosed through a combination of history, examination, blood tests and imaging. If you are given a diagnosis in the UK, you should be offered post-diagnostic support. Care is mainly supportive, although if you have mixed dementia, there are several medications that may slow the progression of the disease. 

Your care needs will increase with time. However, with the right support, it’s still possible to enjoy life with dementia. Reaching out to a support organisation in your country can help connect you to services in your area that may be of help.