Subcortical Vascular Dementia: What It Is, And What To Expect If You Have It
Updated February 27, 2020
Reviewer Wendy Boring-Bray, DBH, LPC
Dementia is never 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.
What Is Subcortical Vascular Dementia?
Subcortical vascular dementia is defined as 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?
Alzheimer's Disease is a familiar name to most people. There's been a major push for more research on that type of dementia. While both diseases affect the brain, they affect it 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 have more disruption in their sleep cycles than those with Alzheimer's.
If you're having symptoms that cause you concern, it's 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 symptoms of subcortical vascular dementia.
- Psychomotor slowness - it takes longer to turn thought into action
- Changes in speech
- Unsteady gait
- Frequent falls
- Personality changes
- Mood changes
- Urinary symptoms
- Weakness of loss of sensation in part of your body
- Having good days and bad days
- Evening confusion
- Hallucinations or delusions
- Being able to recognize that you're having memory problems
Diagnosis usually has two phases. First, the person experiencing symptoms or someone who knows them well talks to a doctor to explain their subjective experiences about what has changed. 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 this subcortical vascular dementia is a diagnosis no one wants, it's 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.
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 deal with the symptoms of the disease. Your doctor may prescribe blood thinners to prevent more strokes and improve your circulation. The best thing you can do if you don't have the disease already is to do what you can to prevent it.
For people who don't have dementia right now, there may be some things you can do to prevent it. 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
- 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 problems when you can, managing illnesses like diabetes and high blood pressure, making lifestyle changes like quitting smoking and exercising regularly, you reduce your chances of having this disease.
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 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 is difficult to diagnose, so it's important that you don't assume you know what's wrong. The symptoms may be due to another unrelated disease or disorder that can be treated more successfully.
Even if it turns out that your doctor gives you a diagnosis of subcortical vascular dementia, it's 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 Deal With The Challenges Of Dementia
Dealing with subcortical vascular dementia is a very difficult thing. The challenges you will face begin with receiving the diagnosis. That bit of information can come with a range of strong emotions that can include: anger, emotional numbness, relief, denial, resentment, fear, sadness, hopelessness, and isolation. Recognizing and accepting these feelings can help. Once you get past these feelings, you can move forward more positively.
To better deal with your emotions, talk 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.
It also helps to 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. Find something to enjoy whenever possible. If you start feeling hopeless or depressed, talk to your doctor or a counselor.
How To Help A Loved One With Subcortical Vascular Dementia
It's heartbreaking to see someone you love going through a disease like subcortical vascular dementia. There are some ways you can help them:
- Use your voice and body language to convey a positive attitude.
- Limit distractions when you're speaking to them.
- Use simple words when explaining something or asking them to do something.
- Make sure your questions have an easy answer, preferably yes or no.
- Listen closely and wait patiently for a reply.
- Break down complex activities into simple steps.
- Use distraction and redirection when they're upset or confused.
- Be pleasant, affectionate, and reassuring.
- Talk about happy memories.
- Use gentle humor to lighten the mood.
- Know that you can't change the person, but you can change how you respond to them.
- Notice what triggers unhelpful behavior and avoid those triggers when possible.
- Take precautions to prevent wandering.
- Help give them some structure to their days.
- Support lifestyle changes without nagging or criticizing.
- Take care of your health and personal needs so you can be strong for them.
What To Do When The Emotional Stress Gets Overwhelming
Dealing with the emotions surrounding dementia is 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. You can learn relaxation techniques like deep breathing or systematic muscle relaxation. Another way to deal with it is to talk to someone who understands dementia is knowledgeable about ways to manage the disease. It's especially important to talk to a counselor if you become depressed.
You can talk to a licensed counselor at BetterHelp.com if you or a loved one needs help dealing with the emotional challenges of dementia. A counselor can teach you relaxation techniques, coping skills, and new ways of thinking about this difficult situation. They can also offer support for you so that you can live the best life you can and find moments of joy.