Vascular Dementia: Causes, Symptoms and Treatments
Vascular Dementia (VaD), also known as Vascular Cognitive Impairment (VCI), is often present in people diagnosed with Alzheimer’s disease (AD), but may also develop in the absence of Alzheimer’s. In fact, vascular dementia — along with Lewy Body Dementia (LBD) — accounts for the second most common cause of age-related cognitive decline and dementia.
While Alzheimer’s is diagnosed in 60 to 70 percent of all dementia cases worldwide, vascular dementia diagnoses accounts for 17 to 25 percent. Many patients suffering progressive cognitive decline have both or all three subtypes of dementia. (When testing uncovers multiple types of dementia, it’s called mixed dementia.)
Whether or not combined with Alzheimer’s and Lewy Body, vascular dementia produces its own set of mental and functional challenges. Because disease progression differs somewhat from those with AD or LBD, it’s important for someone suffering cognitive degeneration to receive a proper diagnosis in order to plan for appropriate memory care services.
What is Vascular Dementia?
Vascular dementia is a subtype of cerebrovascular disease. “Vascular” refers to the blood vessels, “cerebro” refers to the brain. In VaD, the blood vessels in the brain have changed to such a degree that blood fails to flow at optimal rates (hypoperfusion). The vessels may have become hardened (atherosclerotic) by the build-up of plaque in the artery walls. They may have ruptured, causing blood leaks into the brain. Additionally, vessels may become compressed by other structures in the brain caused by AD or LBD.
Blood leakage and vessels that have been constricted by plaque alter the flow of oxygen-rich blood to the brain tissues and nerves. Along with blood clots moving into the brain from other places in the body, burst plaques can completely stop blood flow, which results in an ischemic stroke. When vessel walls become thin in places (aneurisms), they can burst or leak, causing hemorrhagic strokes.
With prompt treatment, strokes may not lead to long-term disability. However, when the underlying cause of the stroke resists effective, ongoing treatment, brain tissue can continue to suffer injury. The result can be vascular dementia.
Vascular dementia is often tied to cardiovascular disease, as well, since the same mechanisms that impair heart function, arteries and blood vessels in the body also impact the brain.
The terms “vascular cognitive impairment” and “vascular dementia” encompass all types of dementia with vascular causes as distinct from AD and dementia brought about by other conditions such as Lewy body and Parkinson’s Disease. Often, a person diagnosed with vascular dementia suffers from several vascular conditions at the same time. These could be:
- Any cause of infarction (obstruction of blood), often due to a thrombus (blod clot formed at the site) or embolus (blood clot, fatty deposit, air bubble or other object carried along in the bloodstream until it lodges and blocks the flow)
- Hemorrhage (bleeding)
- Large artery disease (hardened arteries of the neck and head)
- Cardioembolism (when the heart pumps foreign material to the brain)
- Small vessel disease (abnormalities in the smaller vessels of the heart or brain)
- Other, less common cerebrovascular or cardiovascular diseases.
Regardless of the source, any type of condition that prevents full blood flow — with its load of oxygen — to the brain can bring about vascular dementia.
Vascular Dementia Symptoms
Signs of vascular dementia often overlap with those of other neurodegenerative disorders, especially Alzheimer’s. This makes it difficult to make a clean diagnosis without sophisticated imaging. Based on the following manifestations, medical investigation should progress to imaging tests such as MRI, ultrasound, CT scans or PET scans:
- Trouble swallowing
- Difficulty in walking, disruptions in stability and normal gait
- Trouble balancing or dizziness
- Recurring falls
- Difficulty moving
- Mood swings
- Changes in urinary urges and frequency
- Mild confusion
- Personality changes
- Difficulty in paying attention
- Accelerated cognitive decline under the age of 65
Sadly, some physicians may proceed to treatments or referrals to specialists based on the string of single symptoms as they manifest. For example, urinary incontinence may be treated as a stand-alone syndrome with anticholinergics (drugs that prevent certain neurotransmitters in the brain), which have been shown to cause symptoms of dementia themselves. Mood changes may earn a prescription for anti-anxiety or anti-psychotic drugs.
Rather than looking for an overarching cause of multiple symptoms, a patient may end up in a situation of taking a multitude of medications (known as polypharmacy) that can exacerbate dementia symptoms. Delayed diagnosis of cerebrovascular disease could allow advancement from mild cognitive impairment to full-on dementia.
Stages and Progression
Absent a stroke, vascular dementia may progress slowly over time. With a large stroke, though, onset will likely be sudden.
With strokes, VaD may proceed in a stepped fashion, meaning each stage can persist without change for a period of time, then suddenly get worse. Usually, smaller strokes continue to occur in this type of development, and each event adds more damage to the brain.
As vascular dementia advances, the symptoms become more indistinguishable from middle and later stages of AD. They include:
- Memory loss
- Inability to communicate clearly
- Difficulty in reasoning
As with AD, but less often, a patient may experience delusions and hallucinations.
Causes and Risk Factors
Three main causes account for development of vascular dementia:
- Cerebrovascular and cardiovascular diseases
- Amyloid deposition from Alzheimer’s disease and/or the presence of Lewy bodies
Risk factors for developing vascular dementia are often interrelated. Those factors that cause strokes typically arise from cardiovascular diseases, and it is thought that the deposition of amyloids (clumps of protein that form plaques in the brain) or Lewy bodies (protein deposits in nerve cells) impede normal blood flow (hypoperfusion) by compressing the vessels, which also contributes to risk of stroke.
Therefore, those conditions that create the same risk factors for all vascular diseases also pertain to VaD. They include:
- High blood pressure
- High cholesterol
- Physical inactivity
- Genetic predisposition
- Poor diet
- Systemic inflammation (inflammation throughout the body caused by oxidative stress in the cells)
Diagnosis and Treatment
Due to the similarity of symptoms between Alzheimer’s disease and vascular dementia, diagnosing VaD requires imaging tests. Ordinary neuropsychological assessments may not reveal VaD, especially when there’s been no clinical history of strokes. Magnetic Resonance Imaging (MRI), ultrasound, positron emission tomography (PET) and transcranial doppler ultrasound (TCD) are useful tools to discern whether symptoms derive from AD, VaD, LBD, or some combination. Because disease progression and treatment modalities can differ between the three, it’s important to get an accurate diagnosis.
At present, no pharmaceutical drug has been approved specifically for vascular dementia treatment, according to the Alzheimer’s Association. Although some drugs used to treat Alzheimer’s may also show modest improvements in VaD, treatment is mostly based on managing the underlying vascular disease. Preventing further damage to the vessels and tissues through lowering blood pressure and cholesterol, managing diabetes and losing weight should slow cognitive decline in age-related vascular dementia. Also important is keeping the mind stimulated and challenged, the body active and the diet wholesome.
If VaD came on as a result of stroke, it may improve with time and rehabilitation as the damaged blood vessels and brain tissue repair themselves around the wreckage. During this time, it may be best for the patient to receive professional care.
If the underlying cause is not stroke, and the patient faces ongoing degeneration, they should, with the help of their relatives and caretakers, consider the advantages of moving to a living environment designed specifically for people with dementia.
Vascular Dementia Care Options
For many, remaining in the home will be the first choice, if possible. However, if you or someone you love has been diagnosed with vascular dementia, the need to receive skilled care in a supportive environment may become evident. Over time, home care may become impractical or even dangerous. If the prognosis is less than ideal, you want a memory care community that understands what you’re going through and provides the means to maintain — or even improve — quality of life in safe and comfortable surroundings.
At Heritage, we offer a variety of dementia care options delivered in an atmosphere of loving respect and dignity. We care for the whole person, following the principles of our Valeo™ wellness philosophy.
By crafting a program as individualized as our residents are, our team ensures:
- Physical care through physical activity and delicious, fresh, chef-prepared meals
- Social opportunities by encouraging new relationships with people and even animals
- Intellectual stimulation that helps preserve memories
- Mental focus by encouraging expression through creativity programs
- Rich spiritual connection with your faith
We believe day-to-day living should be filled with friendships and joy. Here at Heritage, we’re committed to providing memory care that brings our residents more than daily physical and mental maintenance. We aim to spark delight and happiness all around our community. Each and every member of our team — from the housekeepers to the physicians — are specially trained to understand what people with dementia are going through and the services and amenities that help.
We will fold you into our Heritage family, and we hope you will do the same with us. To learn more, request our free Guide for Finding the Right Memory Care Community.