Vascular dementia is a decline of thinking and reasoning abilities due to a decrease in blood flow to specific brain parts.
It is the second most common type of dementia, accounting for 15% to 20% of North American and European cases. Within this article, you will find answers to some of the most common questions like what it is, what causes this condition, and many others. Before touching that point, there will be a concise explanation of the fundamental concepts of the disease.
By reading this article, you will obtain critical insights about Vascular Dementia, its causes, its diagnosis, and its treatment. Please continue reading to learn pearls on this specific issue by the hand of a Doctor.
What is Vascular Dementia?
In order to define what is vascular dementia, it is essential to know what it is dementia. Dementia is a disorder that runs with cognitive decline involving memory and at least another domain.
We can find personality, language, abstract thinking, social skills, and executive functioning among these domains. To make it short, dementia is not a specific condition; it is a syndrome.
This syndrome includes the deterioration of four pillars: memory, thinking, behavior, and the ability to perform everyday activities. There are many types of dementia, including the following:
- Alzheimer’s disease
- Vascular dementia
- Lewy body dementia
- Parkinson’s disease
- Frontotemporal dementia
- Mixed dementia
For this specific article, we will focus on Vascular Dementia. Vascular dementia is a type of dementia that happens when there is a reduced blood flow due to diseased blood vessels.
In order to work correctly, the brain tissue needs a constant supply of blood, oxygen, and nutrients. If there is a blockage, the brain cells stop receiving these essential elements. Then, that situation will eventually lead to brain damage and alter brain function. This is what people commonly know as a stroke or cerebrovascular disease.
Many risk factors may induce strokes and vascular dementia. These include high cholesterol, cardiovascular disease, high blood pressure, vascular problems, smoking, alcohol intake, etc. The cognitive decline will depend on the amount of damage that receives the brain tissue. However, other vascular dementia symptoms may appear in these patients, as we will see further.
How common is vascular dementia, and what are its types?
Vascular dementia is the following most frequent variety of dementia. The most common one is Alzheimer’s dementia. Around 17% of patients who have been diagnosed with dementia will have vascular dementia. It is widespread among people over 65 years old. However, although vascular dementia is very common, it is not a unique condition. There are several types of it, unlike Alzheimer’s dementia.
The following are the subtypes of vascular dementia.
A stroke or cerebrovascular disease happens when there is a sudden cut off in the blood flow that goes directly into the brain.
In many cases, the blockage is due to a clot. This clot’s origin may be variable; it can come directly from the brain blood vessels or the heart if the patient has heart disease.
In other cases, a stroke could exist because of severe and very high blood pressure. This latter situation narrows so hard the arteries within the brain that it lacks the necessary blood flow, hence, oxygen, in order to keep functioning so a stroke occurs.
The strokes may vary in its severity. It depends on the location of the blockage and if the interruption is temporary or permanent. If not appropriately treated, a stroke may even lead to death.
Not everyone who develops a stroke may develop dementia. Yet, Around 20% of the patients develop this condition within the following six months.
Notably, people who suffer from strokes have a higher risk of having further strokes. Suppose this happens, then the risk of developing vascular dementia increases. However, this disease’s development will depend on how large the brain area is affected by strokes.
The estimation is that patients with strokes are nine times more likely to develop dementia over their lifetime than the general population.
Single Infarct and Multi Infarct dementia
These types of vascular dementia are the result of one or many smaller strokes. In this type of dementia, there is a blockage on large or medium blood vessels.
Nonetheless, the symptoms of this type may go unnoticed, as they are very small strokes. If the patient has any symptoms, they may last only a few minutes because the blockage clears itself.
If the symptoms last for less than 24 hours, this is a Transient Ischemic Attack or TIA. There are cases in which an infarct is enough to cause dementia, affecting an essential part of the brain.
On the other hand, there are other cases where there are a series of small strokes over weeks or months. Dementia, in these cases, is the result of the damage of all these small infarcts together.
Subcortical Vascular Dementia (Binswanger disease)
This type of dementia happens when vascular damage to small blood vessels lie deep in the brain. It also receives the name of small vessel disease.
The wall on these tiny blood vessels becomes thick, and the blood flow is reduced. This type of disease often damages the nerve fibers that carry information around the brain; this is the white matter. However, it can also cause subcortical infarcts.
Due to the nature of the problems in this type, this condition’s symptoms vary significantly from those of stroke-related dementia. Sadly, this is the most common type of vascular dementia.
What happens in vascular dementia?
It will depend on the type of vascular dementia, but the principle is the same. The vascular disease produces either focal or diffuse effects on the brain, causing cognitive decline.
There is a lack of blood supply to a specific part of the brain, causing the brain tissue infarction or death. The effects on the patient will depend on how extensive was the infarct and the location. Regarding the latter, remember that the brain divides itself into different parts that are supposed to fulfill specific roles. Therefore, if the affection is within the motor part of the brain, besides dementia symptoms that comprise all of the above (cognitive disorder), there could also exist movement problems when walking or weakness in one side of the body.
Vascular dementia that has a direct correlation to strokes has a broader area of infarction. On the other hand, subcortical vascular dementia or multi-infarct dementia consists of smaller areas affected on the brain. These injuries sum up to finally cause the vascular cognitive impairment of vascular dementia.
Nonetheless, the process will remain the same. Due to a lack of blood, oxygen, and nutrients, the brain cells will die and affect the patient’s cognitive function. The time of reaction will also determine if there will be sequels in the case of a stroke.
So, the longer it takes the patient to receive medical attention, the worse is the prognosis or possible outcomes. If treated on time, the patient may recover blood supply quicker, restoring the brain cells’ nutrients.
What are vascular dementia symptoms?
The symptoms of vascular dementia may vary. It will totally depend on the part of the brain that does not receive enough blood. These symptoms may sometimes overlap with other types of dementia.
Several studies report that many people with cognitive deficits directly correlated to vascular dementia also have Alzheimer’s disease. Vascular cognitive impairment is the hallmark of this disease.
Among the most common symptoms, we can find the following:
- Cognitive decline
- Reduced ability to concentrate and to organize thoughts
- Inability to analyze daily life situations
- Restlessness and agitation
- The slower speed of thought
- Slurry speech
- Unsteady gait
- Depression or apathy
The presentation of these symptoms may be very variable. They can go on noticeable steps, or they can progress gradually. There is no certainty with this disease as it can overlap with other degenerative diseases of the brain.
How is vascular dementia diagnosed?
The diagnosis of vascular dementia is no easy task. Your doctor will probably rule out other conditions that cause similar symptoms first. Like any other disease, it is better to diagnose vascular dementia as early as possible. Early diagnosis will help you make necessary changes to slow down the condition’s progress.
A doctor can diagnose vascular dementia; at times, it will need a doctor specializing in psychiatry or neurology. Your doctor will inquire about your medical history to identify a possible cause for vascular dementia. This includes your family’s medical history of similar conditions or cardiovascular diseases.
Then, the doctor will perform a physical examination. In order to diagnose vascular dementia, the physical exam will include tests of mental abilities. With the help of these tests, the doctor may find subtler manifestations of vascular dementia.
Presentations like the slowness of thought and difficulty solving some problems can go unnoticed by the patient and their family. This is why it is essential to seek medical help at the early stages.
In almost all cases, the doctor will indicate a brain scan to see what is happening inside the brain. Doctors may ask for a brain scan that the radiologist can make with a CT scan or MRI.
Both of these latter imaging techniques are very useful in the diagnosis of brain diseases. They can detect infarctions, loss of white matter, which can help establish the cause of dementia. Also, they can rule out other conditions. For example, brain tumors, bleeding, and infections can cause symptoms similar to those of vascular dementia. Once the diagnosis is precise, your doctor will continue to decide the treatment for this condition.
How is vascular dementia treated?
Unfortunately, there is no specific treatment or cure available for vascular dementia. Once the brain tissue is damaged, there is no way to reverse it. However, there are ways to stop or slow down the progression of the disease.
Some patients may even manage to live well with vascular dementia. With the right measures, you can live a pretty normal life for a while.
The first thing is to treat the underlying cause. If someone has vascular dementia, it is very likely to have cardiovascular diseases too. By treating the underlying condition, you can slow down the worsening of vascular dementia.
You can also prevent some complications that may result in much more incapacitating symptoms. The treatment can include blood pressure medication, anticoagulation (preventing blood clots), and high cholesterol medication. With cardiovascular diseases controlled, the lower the risk of developing strokes and complications that makes dementia worse.
This type of patients can also benefit from keeping a healthy lifestyle. Physical exercise quit smoking, and a healthy diet does a lot of good for your cardiovascular health. Therefore, this will contribute to the prevention of future brain damage.
Rehabilitation often forms part of the treatment too. With rehabilitation and physical therapy, you can help a patient keep their abilities for a longer time.
Does vascular dementia cause personality changes?
Yes, it is very common for patients to experience personality changes. A person with early-stage vascular dementia will be apathetic.
They can also experience mood swings and be unusually emotional. These patients are very likely to develop anxiety and depression too. This is because these patients are more aware of the problems that their dementia is causing them.
As the disease progresses, these patients often experience episodes of irritability and agitation, very similar to Alzheimer’s symptoms. However, each patient may experience different symptoms and changes as there is no certainty how it will affect them.
Is vascular dementia a terminal illness?
Vascular dementia, by itself, is not a terminal illness. However, it is more like a sign that the patient’s quality of life and functionality will come to a halt.
Dementia does not happen out of a sudden. It is a process that occurs slowly and progressively in which there is a degenerative process of the brain. In vascular dementia, this is not the exception.
Vascular dementia results from several years of a declining vascular function due to increased risk factors and diseases.
It is important to remember that it is rare to find vascular dementia in people younger than 65 years old. The vascular risk factors like high blood pressure and high cholesterol may induce changes in the blood vessels that will lead to this condition.
Nevertheless, this is not a terminal illness. Vascular dementia is the prelude of a decline in the lifestyle of the patients. These patients will begin to rely on their families as they progress from mild cognitive impairment to a more severe decline in cognitive function.
On average, these patients live approximately five years after the symptoms begin. In many cases, these patients die from a stroke or a heart attack.
Do you or someone you know have symptoms or risk factors for this condition?
This is a Vascular Dementia Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this condition. Therefore, it would help anyone who uses it to determine the likelihood that their symptoms are because of vascular dementia. Besides, it could also result in positive if that person has many risk factors for developing the condition.
Notably, the tool is free to use and would only take a few minutes.