Vascular dementia is a blanket term that refers to dementia resulting from impaired blood flow to the brain. It is generally considered to be the second or third leading cause of dementia symptoms, accounting for approximately 20 to 30 percent of cases. Some experts are beginning to propose the use of the term “vascular cognitive impairment” (VCI). Another term that is often used is “multi-infarct dementia.”
This condition could be due to one large stroke, in certain parts of the brain, or a cumulative effect from several small strokes. Or it could be due to a number of other conditions that reduce blood flow and reduce circulation, or otherwise deprive the brain of needed oxygen or other nutrients. Brain injury is also a common culprit.
Often the particular kind of stroke(s) that lead to vascular dementia will be “silent,” meaning that they don’t cause any overtly apparent physical changes. Whereas another type of stroke may cause a person to be paralyzed on one side of the body, for example, or have slurred speech, this “silent” stroke may not be as readily apparent until the individual may forget his phone number or have trouble buttoning his shirt.
Other conditions that can cause vascular dementia are those which can limit the supply of oxygen and vital nutrients to the brain for one reason or another. For instance, during a heart attack blood flow is stopped, or slowed down drastically, for a period of time. Some diseases will cause a chronic narrowing of the blood vessels, such as high blood pressure, diabetes, hardening of the arteries, lupus, and others.
Symptoms of vascular dementia will resemble those of other forms of dementia, with wide variations in both type and severity, depending on what part of the brain is affected. If there has been a single large stroke, the onset of symptoms will be fairly sudden. If it develops as a result of a series of “mini-strokes,” there will be a gradual progression of symptoms. However, instead of the steady deterioration that is seen in Alzheimer’s, a person with vascular dementia will show more of an inconsistent stair-step decline in function where they will proceed for a time at a consistent level of impairment, and then suddenly lose function to some extent.
Although vascular dementia can begin suddenly, it often develops gradually, like Alzheimer’s. (It can actually co-exist with Alzheimer’s; studies are showing that, in many people have “mixed dementia”, or dementia symptoms which are due to more than one disease process.) Symptoms of vascular dementia can include:
- Difficulty paying attention
- Inability to organize thoughts or actions
- Reduction in ability to analyze a situation, develop an effective plan, and communicate that plan to others
- Difficulty deciding what to do next
- Memory loss
- Restlessness and agitation
- Unsteady gait
- Urinary incontinence, or difficulty urinating
- Wandering, especially at night
- Uncontrolled laughing and crying
- Difficulty participating in social situations
- Difficulty finding the right words
The risk factors for vascular dementia are pretty much the same as for heart disease and stroke. These include increasing age, history of heart attack or stroke, atherosclerosis, high cholesterol, high blood pressure, diabetes, and smoking. Because vascular dementia can so often go unrecognized, many experts recommend regular screenings. Screenings for depression are also recommended, as this condition can often co-exist with vascular dementia, and can contribute to cognitive symptoms.
There are no specific tests which confirm that you have vascular dementia as opposed to Alzheimer’s, for example. It is possible to make a pretty confident deduction, however, based on the results of the following tests:
- Medical history
- Lab tests
- Neurological exam
- Brain imaging (CT scan and MRI)
- Carotid ultrasound
- Neuropsychological testing
- Evaluation of independent functioning and daily activities
Treatment of vascular dementia consists partly of controlling underlying conditions and risk factors to prevent further damage, and possibly even improve function somewhat. Some of the same medications used to treat Alzheimer’s will also prove effective in providing at least some temporary relief from vascular dementia symptoms. Other forms of treatment which have proven successful include physical, occupational, and speech therapy, to improve function as possible and to design compensatory strategies and modifications. Support systems for the individual with dementia and his/her family and caregivers are readily available, and should be utilized. And end-of-life planning should be implemented while the individual is still able to participate, as vascular dementia ultimately is not a survivable condition.