Subcortical Vascular Dementia: What It Is, And What To Expect If You Have It

Dementia is seldom a welcomed diagnosis. Subcortical vascular dementia is a more specific diagnosis, but it means little to most people. However, by learning more about it, you can understand better what it is, what to expect, and what you can do about it. In many cases, understanding what you or a loved one might experience and what you may be able to do to counteract the changes dementia can bring about may help you find some peace.

What Is Subcortical Vascular Dementia?

Subcortical vascular dementia is a small vessel disease that's a type of vascular dementia. Vascular dementia is a common form of dementia. It happens when the supply of blood to the brain is diminished. This can be caused by a series of small strokes, for example.

How Is Subcortical Vascular Dementia Different from Alzheimer's Disease?

While both dementia and Alzheimer’s disease affect the brain, they do so in different ways. In subcortical vascular dementia, there is more damage to the white matter of the brain, less atrophy in the hippocampus, and no cerebrovascular amyloid deposits or plaques.

There are two main types of subcortical vascular dementia, although it may have many different causes. The two primary types are Binswanger's Disease, which has more damage to the white matter of the brain due to hardening of the arteries, and multiple lacunar infarctions, which is related more to mini strokes.

As for symptoms, forgetfulness is typically more severe for Alzheimer's patients. Also, people with subcortical vascular dementia tend to have more disruption in their sleep cycles than those with Alzheimer's.

Symptoms

If you're having symptoms that cause you concern, it may be important to keep track of them. Write them down, or if this is difficult for you, ask a loved one to take notes. The following are some of the subcortical vascular dementia symptoms.

• Psychomotor slowness - it takes longer to turn thought into action

• Forgetfulness

• Changes in speech

• Unsteady gait

• Clumsiness

• Frequent falls

• Personality changes

• Mood changes

• Urinary symptoms

• Weakness of loss of sensation in part of your body

• Having good and bad days – symptoms may be more severe on some days 

• Evening confusion

• Depression

• Hallucinations or delusions

• Being able to recognize that you're having memory problems

Diagnosis

Diagnosis usually has two phases. First, the person experiencing symptoms or someone who knows them well talks to a doctor to explain their experiences. Second, the doctor makes an evaluation based on objective facts like test results.

There are three main criteria for reaching a diagnosis of subcortical vascular dementia:

• It comes on suddenly and quickly causes loss of independence.

• Brain imaging tests show lesions in specific parts of the brain.

• There's evidence that a stroke or strokes happened at about the same time and is responsible for the loss of function.

While subcortical vascular dementia may be a diagnosis virtually no one wants, it can be important to find out what the problem is as quickly as possible for several reasons. First, there may be lifestyle changes you can make to slow the progression of the disease. Second, loved ones can understand best how to support you. Finally, knowing can relieve some of the confusion about what is happening to you.

Treatment

Currently, no medical treatment can cure subcortical vascular dementia once you have it. Treatments are designed to prevent further damage, slow the progression of the disease, or help you manage its symptoms. Your doctor may prescribe blood thinners to prevent more strokes and improve your circulation. 

Perhaps the best thing you can do if you don't have the disease already but may be at risk is to do what you can to prevent it.

Prevention

For people who don't have dementia right now, prevention may be possible. It all starts with knowing what puts you at risk. The risk factors for all types of vascular dementia include:

• Getting older

• History of heart attacks, strokes, or mini strokes

• Atherosclerosis, also known as hardening of the arteries

• High cholesterol

• High blood pressure

• Diabetes

• Obesity

• Smoking

• Arterial fibrillation (A-fib)

While the evidence isn't overwhelming at this point, there may be two more things you can do to decrease your risk of vascular dementia. Modest alcohol consumption - the equivalent of 1-2 glasses of wine per day - might help. Taking vitamins like folic acid and B12 may also reduce your risk. Because these remedies are not well-proven yet, it's important for you to talk to your doctor before you try them.

By avoiding health risks when you can, managing illnesses like diabetes and high blood pressure, and making lifestyle changes like quitting smoking and exercising regularly, you can reduce your chances of developing subcortical vascular dementia.

What To Expect

Knowing what to expect can help you plan for future needs. The course of this disease can be different for different people. 

Early on, you may notice some problems with memory, problem-solving, and planning. There may be times when the disease is stable and unchanging for long periods. Then, the disease may suddenly start getting worse again. 

Controlling the risk factors mentioned above can slow the progression of the disease. Survival after diagnosis of any vascular dementia is typically around eight years.

How To Slow The Progression

You can't reverse or stop subcortical vascular dementia once it's started. What you can do, though, is to make lifestyle changes that slow it down. Here are some ways to do that.

• Quit smoking

• Eat the right amount of healthy foods

• Exercise regularly

• Manage your diabetes

• Manage your high blood pressure

• Get treatment for A-fib

• Work with your doctor to lower your LDL cholesterol

• Take medications as prescribed

What To Do When You Suspect Subcortical Vascular Dementia

If you're experiencing any of the symptoms for subcortical vascular dementia listed above, talk to your doctor immediately. This disease can be difficult to diagnose, so it’s often important that you don't assume you know what's wrong. The symptoms may be due to another unrelated disorder that can be treated more successfully.

Even if it turns out that your doctor gives you a diagnosis of subcortical vascular dementia, it can be helpful to know what the problem is. Then, you can make the lifestyle changes that might help and plan for the care you will likely need in the future.

How To Manage The Challenges Of Dementia

It’s normal to experience strong emotions after receiving a diagnosis or learning that a loved one is living with subcortical vascular dementia. You might feel anger, numbness, denial, fear, sadness, or isolation, among other things. Recognizing and accepting these feelings can help. 

Another thing that can be highly beneficial is talking to your loved ones about how you feel. Build a good support system of people care about you. Go to dementia support groups to interact with people who understand what it's like to have dementia.

Finally, it may help to try and stay involved with your usual activities as much as you can. If you like to fish or play cards, keep doing that for as long as you can. Know that there will be good and bad days and try to take advantage of times when you feel your best.

How To Receive Professional Support

Navigating the emotions surrounding dementia can be hard for both those who have it and those close to them. If the emotional stress becomes too great, though, there are things you can do to overcome it, including talking to a mental health professional like a therapist. 

Working with a therapist may help you learn to work through difficult feelings, come to terms with a diagnosis, and learn how to prepare for the changes that dementia might cause. When you speak to a licensed therapist online, you can do so from the comfort of your own home – there’s no need to waste valuable time and money going to and from an in-person office.

Online therapy has been shown to be a more accessible option for many who take advantage of it. One recent review of over a dozen studies analyzing the benefits of online cognitive behavioral therapy (CBT) found that digital treatment was more cost-effective for clients than in-person therapy. The same review also noted that online therapy can be just as effective as traditional options for treating symptoms of depression, which may accompany a dementia diagnosis.

Takeaway

Subcortical vascular dementia is a disease that, like other types of dementia, can lead to damage in the brain and resulting changes in behavior, cognitive ability, and nobility. Thickened, narrowed blood arteries in the brain characterize this type of dementia and lead to the death of brain tissue as blood supply becomes harder and harder for the body to maintain. While a diagnosis may be painful to hear, seeking one sooner rather than later can help you slow the progression of the disease.