Vascular Dementia

What is vascular dementia?

Vascular dementia is a common type of dementia. Vascular dementia can affect your thinking skills, memory, language, behavior and personality. Vascular dementia can occur after a stroke or other conditions where there’s decreased blood flow to areas of your brain. Without proper blood flow, needed oxygen and nutrients aren’t delivered and brain tissue is damaged.

Vascular dementia is diagnosed if there’s a decline in at least two types of thinking skills (like memory and language) that are related to a blood vessel blockage in your brain and impair your ability to function in daily life. If fewer than two abilities are impaired, or if changes in cognition don’t impact your daily function, this condition is called vascular cognitive impairment.

Vascular dementia is the second most common cause of dementia in older adults after Alzheimer’s disease.

What abilities are affected?

Forgetfulness and problems with reasoning or problem solving are often the most noticeable change in someone with vascular dementia but other abilities can be impaired, too, including thinking speed, communication skills, spatial skills (like sense of direction or depth perception), or attention and concentration. The size and location of damaged brain areas determine which abilities are affected. If additional strokes occur or problems with reduced blood flow continue, more and more brain tissue is damaged and more abilities are affected.

How common is vascular dementia?

About 15% to 20% of older adults who are diagnosed with dementia have vascular dementia. It’s most common in older adults between the ages of 60 and 75. Vascular dementia affects more males than females. People who are Black are more likely to have vascular dementia than people from other races.

Who is at risk for vascular dementia?

Many of the medical conditions that would put you at risk for heart disease and stroke are the same risk factors that can make you more vulnerable to vascular dementia. You may have a higher risk if you:

• Are of older age (greater than > 60).
• Have high blood pressure (hypertension).
• Have had one or more strokes.
• Have diabetes.
• Have high cholesterol and lipid levels.
• Have an irregular heart rhythm (arrhythmias, atrial fibrillation).
• Are a smoker.
• Are physically inactive.
• Are overweight.
• Have a family history of rare inherited diseases of the blood vessels that block the flow of blood in the brain.

Can different patterns of brain damage lead to vascular dementia?

Yes, there are different terms for vascular dementia that reflect the number and type of blood vessels involved and the way the symptoms progress.

• Multi-infarct dementia: “Multi” means many, and “infarct” means stroke, so multi-infarct means many strokes that affect blood flow to multiple areas of your brain. Changes from these strokes are often noticeable when they happen, and so cognitive changes occur in a step-wise fashion (sudden worsening over multiple periods of time).
• Binswanger disease: This is a term for vascular dementia that happens when small blood vessels located throughout white matter (deep areas of your brain containing the “wiring” or connections between brain areas) are blocked over time by atherosclerosis (“hardening of the arteries”). This type of dementia, also called subcortical vascular dementia, occurs gradually over time (without sudden episodes of worsening).
• Vascular dementia from a strategic single-infarct: Vascular dementia can occur after only one stroke if the blockage destroys brain tissue that’s needed for more than one thinking ability.

What are the symptoms of vascular dementia?

Symptoms vary from person to person. They depend on the area(s) of the brain affected and the extent of the damage. Symptoms may be most obvious and sudden when they happen after a major stroke. However, more typically, symptoms appear in steps over many years. There may even be short periods of time when you seem to improve. If more strokes happen, there can be a further decline, though.

Symptoms may include:

• Memory problems.
• Walking and/or balancing problems, shuffling steps, muscle weakness.
• Trouble understanding or using words.
• Trouble concentrating, following instructions, reasoning, organizing, planning, understanding and completing tasks.
• Depression, irritability, personality and behavior changes.
• Confusion (which may increase at night; “sundowning”).
• Uncontrolled fits of laughing or crying.
• Bowel or bladder control problems (incontinence).
• Tremors or reduced fine motor control (clumsiness).

What causes vascular dementia?

Vascular dementia is caused by conditions that damage blood vessels in your brain or partially or fully block blood flow. Reducing blood flow prevents oxygen and nutrient delivery to your brain. Without these, brain cells begin to die.

Common causes of vascular dementia include:

• Narrowing (atherosclerosis) and/or blockage of many blood vessels (ischemic strokes) or tiny capillaries (small-vessel disease) that feed brain cells in your brain.
• Bleeding from a ruptured blood vessel (like a hemorrhagic stroke) inside your brain.
• Other conditions that damage blood vessels, including infection, inflammation, high blood pressure and high cholesterol levels.

How is vascular dementia diagnosed?

Your healthcare provider will gather your medical history and family medical history, review your medications and conduct a physical exam. They may order additional tests such as blood work, brain scans, neuropsychological (thinking skills) evaluation or psychiatric/psychological assessment. You may be referred to a neurologist for some of the evaluations and tests.

Medication review

Some medications’ side effects can cause confusion, which is also a symptom of vascular dementia. These medications include sleeping pills, drugs for urinary incontinence, tranquilizers, antihistamines and pain relievers.

Blood tests

Blood tests may be ordered to detect health problems that affect brain function. Your blood will be examined for signs of infection, inflammation, underactive thyroid, vitamin deficiency (especially B12) and liver or kidney function problems.

Imaging test of your brain may include

• Computed tomography (CT) or magnetic resonance imaging (MRI). CT uses X-rays and a computer to show detailed images of your brain. MRI uses magnets, radiowaves and a computer to create detailed images of your brain. These imaging tests look for evidence of stroke, bleeding, tumors and fluid on your brain.
• FDG-PET scan. This is a special type of brain scan that aids in determining the type of dementia by the pattern of how a type of glucose is absorbed by brain tissue.

Neuropsychological testing

Your mental abilities, including problem-solving, learning, judgment, memory, planning and reasoning, and language are assessed with written and computerized tests.

Psychiatric/Psychological evaluation

A mental health professional may check you for signs of depression, mood changes or other mental health issues that might cause memory loss.

How is vascular dementia treated?

Once brain damage has been done, it can’t be repaired. Treatment is aimed at preventing or slowing down additional damage by managing the factors that are modifiable.

Treatments

• Medications to treat diseases that can lead to vascular dementia: Your healthcare provider will prescribe medications (as needed) to lower your high blood pressure, reduce high cholesterol levels, regulate blood sugar (diabetes) and thin your blood to prevent blood clots.
• Procedures to improve blood flow to your brain: These procedures could include carotid endarterectomy, angioplasty and stenting.
• Medications to improve thinking problems: Cholinesterase inhibitors are the drug class prescribed to help with dementia symptoms in Alzheimer’s disease. If your symptoms involve loss of memory, lack of awareness and confusion, or you also have Alzheimer’s disease, your healthcare provider may prescribe this class of drugs. Examples include donepezil (Aricept®), rivastigmine (Exelon®), galantamine (Razadyne®). Memantine (Namenda®) is another class of drugs approved to treat dementia in Alzheimer’s disease.
• Medication to treat depression: Depression commonly occurs with vascular dementia and may add to problems with brain function. Your healthcare provider may prescribe antidepressant medications if you have depression.
• Lifestyle changes to manage risk factors that lead to vascular dementia: See the “prevention” section.

Physical, occupational and speech therapy

You may work with physical and occupational therapists to improve your physical and functional abilities. A speech therapist can help with practicing cognitive tasks and learning how to compensate for impairments using computer programs, games and other teaching methods.

Counselors and support groups

You may benefit from seeing a social worker or counselor to manage emotional issues or depression. Ask your social worker or healthcare provider for information about dementia support groups — for you and your caregiver — in your local area.

Can vascular dementia be prevented?

Possibly the most important difference between vascular dementia and other types of dementia is that vascular dementia may be more preventable. The blockage of blood vessels that feed your brain is something that can be delayed or even prevented for many if risk factors are managed throughout your life. You can take steps to decrease risk factors for conditions that affect your blood vessels. These conditions include heart disease, atherosclerosis, diabetes, blood pressure and cholesterol.

Brain-protecting strategies include:

• Keeping “your numbers” within normal limits: blood pressure (normal BP: less than < 120/80 mm Hg), cholesterol levels (total: less than < 200 mg/dL; LDL less than < 100 mg/dL; triglycerides less than <150 mg/dL) and blood sugar levels (less than < 126 mg/dL).
• Losing weight, getting fit. Exercise for 30 minutes on most days.
• Eating a healthy, well-balanced diet (like the Mediterranean or Dash).
• Stopping smoking. Ask your healthcare provider if you need help or connection with quit programs.
• Cutting back on alcohol consumption. Men should have no more than one alcohol-containing beverage a day; women should have no more than two.
• Managing your stress. Try relaxation exercises, meditation, yoga and other methods.
• Taking all your medications as prescribed by your healthcare provider. If your symptoms change or worsen, call your healthcare provider. Never stop or change your dose without talking with your healthcare provider first.

Some risk factors for vascular dementia can’t be prevented, like older age or genetics, but many risk factors can be.

What can I expect if I have been diagnosed with vascular dementia?

Vascular dementia may get worse over time. The changes can happen in sudden steps or gradually. Each person has their own unique journey. Generally, people with vascular dementia have a shorter life expectancy due to increased risk for additional stroke or heart attack. Treatments may help slow the progress of the disease. You and your healthcare provider will work together to develop a treatment plan best suited for managing your symptoms and stage of disease.

When do I need to call my healthcare provider after I’ve been diagnosed with vascular dementia?

You, or your caregiver, should call your healthcare provider if they notice any worsening of your symptoms or when new symptoms appear. Your healthcare provider or healthcare team will want to assess any changes and adjust drug dosages or change medications as needed or conduct more tests to determine what’s causing the change in your symptoms.

How long can person with vascular dementia care for themselves?

A person with vascular dementia will need help with at least some aspects of daily function, such as managing medications, paying bills or preparing food. You or your family member with vascular dementia may be able to do many things for themselves; although, it may not be safe for them to live alone, depending on what abilities are affected. For some people with vascular dementia, more specialized care may be required from facilities that care specifically for people with dementia.

What’s the difference between dementia and vascular dementia?

Dementia means that someone has experienced cognitive decline that’s severe enough to interfere with daily living. There are many types of dementia, including Alzheimer’s disease, Lewy body dementia, vascular dementia, frontotemporal dementia, dementia due to Parkinson’s disease and others.

What’s the difference between vascular dementia and Alzheimer’s disease?

Although both are conditions under the larger umbrella of dementia, there are important differences. First, the cause of these dementias is different. Alzheimer’s disease is caused by a buildup of amyloid plaques and tau proteins between and inside nerve cells in your brain. This causes brain cells to die. Vascular dementia is caused by a lack of blood flow to areas of your brain, which results in brain tissue damage and death.

Another difference is the rate at which symptoms develop. Alzheimer’s symptoms usually develop at a slow, steady pace. Vascular dementia’s course is usually more like a staircase with sudden periods of decline (sometimes followed by some improvement) and then by more sudden periods of decline, as additional strokes happen.

Also, some symptoms appear at different points in time in these diseases. Memory loss is an early symptom of Alzheimer’s disease; a person with early Alzheimer’s will often ask the same question within minutes without realizing it, fail to recognize a family member or may seem to forget the meanings of common words. This isn’t necessarily an early sign of vascular dementia unless that area of the brain is damaged early in the course of the disease. Instead, vascular dementia tends to affect executive functions first — abilities like reasoning, judgment and problem-solving. Memory problems often appear as forgetfulness; although, a person will often remember the thing they forgot when given more time to think about it or when given some hints.

Is vascular dementia hereditary?

Vascular dementia isn’t hereditary, but the disorders that cause vascular dementia can be.

There are two rare forms of vascular dementia that are caused by mutations in certain genes. Both mainly affect the small blood vessels in the white matter of your brain. They are:

• CADASIL: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
• CARASIL: Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy.

CADASIL requires only one parent to have the condition for your child to inherit it; CARASIL needs both parents to be carriers of the condition (have no outward symptoms of the condition) for your child to inherit it and show symptoms.

Shared symptoms include decreased thinking and understanding abilities, confusion and changes in personality and behavior. Symptoms unique to CADASIL are migraine headaches and repeated strokes. Common symptoms of CARASIL are stiffness in the legs and difficulty walking.

Is there a cure for vascular dementia?

Once you’ve been diagnosed with vascular dementia, there isn’t a cure. However, it may be possible to prevent further decline with medication, procedures to improve blood flow to your brain and healthy lifestyle choices. Each person’s rate of decline is unique to them.

Are any medications specifically approved to treat vascular dementia?

No medications are specifically approved by the U.S. Food and Drug Administration (FDA) to treat vascular dementia. However, many drugs can be prescribed to manage your risk factors for vascular dementia, such as drugs to treat high cholesterol levels and high blood pressure, as well as to manage diabetes and its complications. Your healthcare provider may prescribe medications used to treat Alzheimer’s disease if they think you’ll benefit based on your specific symptoms.

What is mixed dementia?

Mixed dementia is when more than one type of dementia occurs in your brain at the same time. For instance, it’s not uncommon for Alzheimer’s disease to be present in your brain at the same time as vascular dementia or Parkinson’s disease dementia.

A note from Cleveland Clinic

If you or a loved one has been diagnosed with vascular dementia, know that you aren’t alone. Almost everyone has been touched by dementia in one or more of its many forms. Vascular dementia, unlike other types, may be able to be delayed or even prevented if you live a healthy lifestyle and can avoid or tightly manage the very common conditions of heart disease, strokes and diabetes — all conditions that ultimately affect blood vessels and are the underlying causes of vascular dementia.

You may not be able to change your course much if you’ve already had these conditions for years and have now been diagnosed with vascular dementia. There’s always hope, however. More and more is being learned about dementia and ways to better manage it. Knowing your condition gives you and your family time to prepare and plan for your future. You can learn about the type of care you may need and where you wish to receive it. Your entire healthcare team is ready to help you. Your healthcare team will manage your condition, adjust your care as your needs change, educate you and your family, and provide emotional support. Ask about local support groups, which can also be a tremendous source of practical help and emotional comfort.