Vascular Dementia: Symptoms And Possible Treatments
Often considered the second most common form of dementia, vascular dementia or vascular cognitive impairment (VCI) tends to be underdiagnosed in the same manner as Alzheimer's disease. Second to Alzheimer's, they are both considered common, with vascular dementia making up roughly 10% of dementia cases. Without a cure, a diagnosis at any stage of vascular dementia can feel daunting, and a person developing vascular dementia may experience symptoms related to anxiety and depression on top of those they are already experiencing from dementia. Recognizing the symptoms of vascular dementia can help you spot it and potentially speed up the process of finding an effective treatment plan.
What is vascular dementia? How blood flow impacts the brain
There are several different types of dementia, one of which is vascular dementia. Vascular dementia is a brain vascular disease that has its own unique symptoms, such as a general loss of cognition, impairment of memory, disorganized planning, and abstract thinking abilities. There are also different types of vascular dementia, including multi-infarct dementia and mixed dementia. People living with vascular dementia experience these challenges as a result of a specific medical problem. Vascular dementia is caused by restricted blood flow to different parts of the brain, which can be caused by a number of medical conditions.
Some disorders and underlying conditions are known to contribute to or cause vascular dementia include cerebrovascular disease, central nervous system infection, brain trauma or tumors, vitamin deficiencies, metabolic and endocrine conditions, immune disorders, multiple sclerosis, Parkinson's disease, and more. All of these reduce blood supply to the brain which can affect blood vessels and lead to deterioration in intellectual functioning throughout different parts of the brain.
It is important to remember that vascular dementia may have a gradual onset or progression. Because the symptoms of vascular dementia are so similar to other types of dementia, it can be difficult to get vascular dementia diagnosed.
What are the symptoms of vascular dementia?
Vascular dementia symptoms vary but often affect thinking, perception, problem solving, and memory of current or past events. These symptoms may follow a particular event that causes blood flow problems like a major stroke, or they may present more slowly over time. Depending on the part of your brain where blood flow has impinged, symptoms may differ or can even overlap if multiple areas are facing damaged blood flow or brain tissue. Vascular dementia signs and symptoms include:
- Confusion or disorientation
- Trouble speaking or understanding speech
- Vision loss
- Trouble paying attention or concentrating
- Reduced ability to organize thoughts or actions
- Declined ability to analyze situations
- Trouble effectively developing and communicating plans
- Difficulty performing tasks or deciding what to do
- Trouble remembering new or stored information
- Feelings of restlessness and agitation; mood changes
- An unsteady gait
- Sudden or frequent urges to urinate or an inability to control passing urine
- Depression or apathy
The American Stroke Association and American Heart Association issued a joint statement in 2011 on vascular contributions, which outlines the diagnostic criteria for dementia caused by vascular changes. It requires neurocognitive testing, computerized tests, and brain imaging via magnetic resonance imaging.
How can you treat and prevent vascular dementia?
e no drugs have been approved for vascular dementia treatment, there are some clinical trials and evidence that show that some Alzheimer's drugs may be able to help people diagnosed with vascular dementia. Besides medication, certain kinds of therapy may be beneficial for people living with vascular dementia, depending on their common symptoms and what stage of the disease they’re in. There are also steps that people can take to help increase blood flow in the brain and reduce further damage to blood vessels in important brain regions. These actions will likely not treat or reverse vascular dementia but may help prevent further decline and progression into the more enervating stages of the disease.
Working with their physicians, people with vascular dementia can develop a plan to extend their lifespan and maintain cognitive stabilization and recovery, especially after a stroke. It is important to consider the risks that can lead to strokes and other brain circulation issues. Many of these are the same as some risks to heart health like smoking, obesity, high cholesterol, high blood pressure, and more. Many doctors recommend activities to treat vascular dementia and prevent strokes, including:
- Quitting smoking
- Maintaining healthy blood pressure, cholesterol, and blood sugar levels
- Eating according to a healthy diet
- Exercising
- Staying within a healthy weight range
- Minimizing alcohol consumption
It is important to remember that these tips are also actions that can help to prevent vascular dementia. So, if you are already at risk for diabetes, obesity, high blood pressure or cholesterol, heart disease, or other vascular issues, vascular dementia could be possible, and these actions may help support your brain and cognitive health.
Causes and risks of vascular dementia
Conditions that may cause vascular dementia
Vascular dementia results from conditions that damage your brain's blood vessels. When the blood vessels are impaired, it reduces their ability to supply your brain with the amount of nutrition and oxygen it needs to perform thought processes effectively, which can result in brain damage to certain brain areas and affect the behavior of remaining brain cells. Common conditions that may cause small vessel disease, vascular dementia and blood vessel issues include:
- A stroke blocking a brain artery: These usually cause a range of stroke symptoms that may include vascular dementia, but some don't cause any noticeable symptoms. Both silent and apparent strokes include an increased risk of vascular dementia, especially as the number of strokes increases over time.
- Narrowed or chronically damaged brain blood vessels: Conditions that narrow or inflict long-term brain vessel damage include the wear and tear associated with aging, high blood pressure, abnormal aging of blood vessels (atherosclerosis), diabetes, a buildup of protein in small blood vessels, and brain hemorrhage (cerebral amyloid angiopathy).
Risk factors for issues with blood vessels
In general, the risk factors for vascular dementia are the same as those for heart disease and stroke or other issues with the heart and blood vessels. They include:
- Increasing age (Vascular dementia rarely manifests before age 65, and the risk rises substantially by the 90s).
- History of heart attack, strokes, or mini-strokes (transient ischemic attack)
- Abnormal aging of blood vessels (atherosclerosis) occurs when deposits of cholesterol and other substances (plaques) build up in the arteries and narrow the blood vessels.
- High cholesterol
- High blood pressure puts extra stress on blood vessels everywhere in the body, including the brain.
- High glucose levels damage blood vessels throughout your body.
- Smoking tobacco directly damages blood vessels, increasing the risk of atherosclerosis and other circulatory diseases. This is a common risk factor for vascular changes and vascular diseases in general.
- Atrial fibrillation is an abnormal heart rhythm that causes the upper chambers of the heart to beat rapidly and irregularly, out of coordination with the lower chambers. This increases the risk of stroke by causing blood clots to form in the heart that can break off and go to the brain’s blood vessels.
What are the seven stages of vascular dementia?
While sometimes changes occur suddenly, the basic seven progressive stages of vascular dementia include the following:
1. No cognitive decline
There is no true complaint of memory deficit at this point. Clinical interviews show no real memory decline or cognitive changes.
2. Very mild cognitive decline
This is referred to as "Age-Associated Memory Impairment" where there are subjective complaints of memory deficit. These notes include forgetting where one has placed familiar objects and forgetting common names. However, the clinical interview shows no true memory decline or objective deficits in memory of regular daily events. Impairments like forgetting to pay bills, trouble remembering appointments, or other small lapses in memory are rare or only last for short periods.
3. Mild cognitive decline
Called "Mild Cognitive Impairment," this second stage of vascular dementia may show some more serious subjective notice of memory loss. Indicators include getting lost in travel, showing poor performance as noted at work, forgetting names more frequently or using the wrong word, changes in behavior, forgetting recently read content, losing valuable objects, and having difficulty concentrating. Some of these issues are clear in clinical interviews as well as in objective reviews, while the interviewee begins to express denial or slight anxiety.
4. Moderate cognitive decline
This is "Mild Dementia" where symptoms are more clearly discerned from a clinical interview. Memory loss includes the interviewee's personal history or recent events. There is also a deeper loss of ability to travel, manage finances, or recognize places, people, and time. Symptoms may also include poor sleep patterns, difficulty reading, and changes in mood. Along with denial, the person may avoid situations where symptoms usually arise.
5. Moderately severe cognitive decline
In "Moderate Dementia" help is officially needed. During the clinical interview, the interviewee can't remember some piece of major personal details like their address or phone number, or even common details from the past like graduation date, the name of high school or college, or names of family members. In addition to forgetting past events, misplacing items may become common. Some common mathematical or other tasks may be difficult, even counting backward in intervals. While people may still remember major facts about themselves and others, like their names and those closest to them, and need no assistance with physical tasks, some common daily activities like choosing clothes and making decisions may require assistance.
6. Severe cognitive decline
This is "Moderately Severe Dementia" where people lose more valuable memories. They may forget their spouse’s name or lose total awareness. Things like the date and year, their surroundings, and the difference between familiar and unfamiliar faces may be unrecognizable or nonsensical. They may need help with traveling, managing incontinence, and navigating basic daily life. Their personality and mood may change, and there is a chance they may not recognize their own face in the mirror or talk at random to strangers while believing their spouse to be operating under a false identity. More symptoms set in and are often more severe, such as anger hallucinations. Without the ability to concentrate and think for long periods of time, people living with vascular dementia are often unable to make decisions.
7. Very severe cognitive decline
This is "Severe Dementia." It is the final stage, where a person progressively loses all verbal abilities. The interviewee may not speak at all or only mutter unintelligible phrases. They even lose basic motor abilities throughout this stage, where they are eventually unable to walk or carry out common activities. This means that the brain is unable to tell the body what to do. As time passes, the body begins to become rigid, and developmental neurological reflexes become present.
Online therapy for vascular dementia, Alzheimer’s disease, and other cognitive illnesses
While there is currently no cure for vascular dementia, therapy can help people cope with its symptoms at different stages. Individuals who develop vascular dementia are more likely to experience symptoms of depression and anxiety than people who aren’t living with vascular dementia. Online therapy can be a valuable experience for those who develop dementia, particularly if physical mobility is a challenge. It can also be beneficial for caregivers, who may be experiencing mental health concerns as they learn to care for their loved ones.
By using a platform like BetterHelp, you can meet with qualified therapists at your convenience. There’s no need to drive long distances or even leave the house; rather, you can get care right from the comfort of your home. If you are struggling to verbalize your thoughts, there are numerous adaptive technology extensions that can integrate with BetterHelp’s video conferencing platform
The effectiveness of online therapy
Getting vascular dementia treated can be a challenging experience whether you have the condition yourself or are caring for someone with it. Both those with the disease and caregivers alike may experience mental health challenges like depression or anxiety. One study found that online cognitive behavioral therapy (CBT) was proven to be effective in treating participants experiencing symptoms of mental illness, including anxiety and depression. Participants experienced a reduction in their symptoms, showing the viability of an online-based intervention for mental health care.
Takeaway
It can be challenging to live with a condition that progressively impairs both motor and cognitive functioning. Likewise, caring for someone with this disorder can be difficult and requires much patience and understanding. Support is available for people living with vascular dementia and their caregivers. Whether one-on-one, with an advocate, or alongside family, online therapy can help people living with vascular dementia come to terms with their diagnosis, manage their symptoms, and find joy in their lives. Additionally, it can allow caregivers to process their feelings and learn how to care for their loved ones more effectively.
What is the main trigger for vascular dementia?
Vascular dementia is primarily caused by reduced blood flow to the brain, which can result from various conditions and risk factors. The main trigger for vascular dementia is often vascular disease, which affects the blood vessels that supply blood to the brain.
What are the 7 stages of vascular dementia?
Vascular dementia, like other forms of dementia, can progress through stages of increasing severity. These stages may overlap, and not everyone with vascular dementia will experience all of them. The progression can vary from person to person. However, here are the general stages of vascular dementia:
- No Impairment (Stage 1): At this stage, there are no apparent symptoms or signs of cognitive impairment. The person functions normally in their daily life.
- Mild Cognitive Impairment (Stage 2): In this stage, individuals may experience mild cognitive changes that are often attributed to normal aging. Memory lapses, slight difficulty with decision-making, and subtle changes in language may be noticed. In the early stages, these changes may not significantly impact daily life or independence.
- Mild Vascular Dementia (Stage 3): As vascular dementia progresses, symptoms become more noticeable. Memory problems, difficulty with planning and organization, and decreased concentration become more apparent. These changes can interfere with daily activities and may be noticeable to family and friends.
- Moderate Vascular Dementia (Stage 4): In this stage, cognitive decline becomes more pronounced. Individuals may have difficulty with tasks such as managing finances, planning meals, and organizing daily routines. They may also experience personality changes, mood swings, and emotional outbursts.
- Moderately Severe Vascular Dementia (Stage 5): As the disease advances, individuals require more assistance with daily activities. They may have difficulty with basic self-care tasks, such as dressing, bathing, and eating. Communication skills deteriorate, and they may become less aware of their surroundings.
- Severe Vascular Dementia (Stage 6): At this stage, individuals are largely dependent on others for care. They may have difficulty recognizing familiar faces, including those of close individuals in the family. Mobility and physical functioning decline, and there is an increased risk of falls and other health complications.
- Very Severe Vascular Dementia (Stage 7: In the final stage of vascular dementia, individuals lose the ability to communicate verbally and may become nonverbal. They require round-the-clock care for all aspects of daily life, including eating, toileting, and mobility. They may also be at risk for complications such as infections.
The progression of vascular dementia can be influenced by various factors, including the individual's overall health, the effectiveness of medical management, and the presence of other medical conditions. Early diagnosis and appropriate medical care can help slow the progression and improve the quality of life for individuals with vascular dementia.
What are the 3 features of vascular dementia?
Vascular dementia is characterized by cognitive impairment that results from damage to the brain's blood vessels. While the specific symptoms and features of vascular dementia can vary from person to person, there are three key features that are commonly associated with the condition:
- Cognitive Impairment: Vascular dementia is primarily characterized by cognitive deficits, which can include problems with memory, attention, executive function, language, and visuospatial abilities. These cognitive impairments can range from mild to severe and typically result from damage to a specific part of the brain due to reduced blood flow. The nature and extent of cognitive deficits can vary based on the location and severity of vascular damage.
- Stroke or Vascular Events: Vascular dementia often arises as a result of strokes or other vascular events in the brain. These events can be either large, causing noticeable symptoms like paralysis or loss of speech, or small and "silent," with no immediate noticeable symptoms. Cumulative and widespread damage from these vascular events can lead to cognitive decline over time. Multiple strokes or vascular lesions in the brain are a hallmark feature of vascular dementia.
- Stepwise or "Staircase" Pattern: Vascular dementia often exhibits a stepwise or "staircase" pattern of progression, where there may be periods of relative stability in cognitive function followed by sudden declines after new strokes or vascular incidents. This pattern is distinct from some other forms of dementia, like Alzheimer's disease, which typically exhibit a more gradual and progressive decline. The stepwise pattern is due to the discrete nature of vascular events causing sudden cognitive changes.
How do you know if you've got vascular dementia?
The diagnosis of vascular dementia typically involves a comprehensive evaluation by a healthcare professional, such as a neurologist or geriatrician. Here are the steps and assessments involved in determining if someone may have vascular dementia:
- Clinical Assessment: A healthcare provider will begin by conducting a thorough clinical assessment. This includes reviewing the individual's medical history, including any history of stroke, hypertension, diabetes, or other vascular risk factors. They will also assess the individual's current symptoms and cognitive function.
- Physical Examination: A physical examination may be conducted to check for signs of vascular disease, such as high blood pressure or heart problems.
- Neuropsychological Testing: Neuropsychological tests are used to evaluate cognitive function in various domains, including memory, attention, language, and executive function. These tests can help identify cognitive impairments and assess the severity of the condition.
- Brain Imaging: Brain imaging, such as CT (computed tomography) scans or MRI (magnetic resonance imaging) scans, may be performed to visualize the brain's structure and detect any evidence of vascular damage, such as strokes or white matter changes.
- Blood Tests: Blood tests may be conducted to assess risk factors for vascular dementia, such as cholesterol levels, blood sugar levels, and markers of inflammation.
- Assessment of Daily Functioning: The healthcare provider may inquire about the individual's ability to perform daily activities independently, as impairment in daily functioning is a hallmark of dementia.
- Review of Medications: The healthcare provider will review the individual's current medications, as certain medications can contribute to cognitive impairment.
- Exclusion of Other Conditions: It's important to rule out other potential causes of cognitive impairment, such as Alzheimer's disease, Lewy body dementia, or other neurological conditions.
- Discussion with Caregivers: Input from family or caregivers is valuable in understanding the individual's cognitive and functional changes over time.
Diagnosing vascular dementia can be complex, as it often coexists with other types of dementia or cognitive conditions. The specific symptoms and progression of vascular dementia can vary from person to person. A definitive diagnosis may require multiple assessments and follow-up evaluations over time.
Who is most at risk for vascular dementia?
Several factors can increase the risk of developing vascular dementia. While anyone can be at risk, certain individuals are more likely to develop this condition. The primary risk factors for vascular dementia include:
- Age: The risk of vascular dementia increases with age. It is more common in older adults, especially those over the age of 65.
- Vascular Risk Factors: Several cardiovascular risk factors increase the likelihood of vascular dementia. These include:
- Hypertension (High Blood Pressure): Uncontrolled high blood pressure is a significant risk factor, as it can damage blood vessels in the brain.
- Diabetes: Poorly managed diabetes can lead to vascular complications that contribute to cognitive impairment.
- High Cholesterol: Elevated levels of cholesterol in the blood can lead to atherosclerosis, narrowing blood vessels in the brain.
- Heart Disease: Conditions like atrial fibrillation (an irregular heartbeat) and coronary artery disease can increase the risk of strokes, which can cause vascular dementia.
- History of Strokes: Individuals who have a history of strokes or transient ischemic attacks (TIAs, also known as "mini-strokes") are at a higher risk of developing vascular dementia. Strokes can cause damage to specific areas of the brain, leading to cognitive impairment.
- Smoking: Smoking is a modifiable risk factor for vascular dementia. It can increase the risk of atherosclerosis, blood vessel damage, and vascular disease.
- Obesity: Being overweight or obese is associated with an increased risk of vascular disease, which can contribute to vascular dementia.
- Physical Inactivity: A sedentary lifestyle and lack of regular physical activity can be risk factors for vascular disease and vascular dementia.
- Genetics: While genetics plays a role in the development of dementia, it is often more strongly associated with other forms of dementia, such as Alzheimer's disease. However, a family history of vascular disease may increase the risk of vascular dementia.
Many of these risk factors are modifiable through lifestyle changes and medical management. Managing conditions like high blood pressure, diabetes, and high cholesterol, adopting a heart-healthy lifestyle, and avoiding smoking can reduce the risk of vascular dementia.
Can vascular dementia be treated?
Vascular dementia is a progressive condition caused by reduced blood flow to the brain, often resulting from vascular disease and stroke-related damage. While vascular dementia itself cannot be reversed or cured, there are treatment approaches that can help manage the condition, address its underlying causes, and improve the individual's quality of life.
For individuals affected by dementia, dementia care may begin with lifestyle modifications that may help to manage underlying risk factors. This includes controlling conditions like hypertension (high blood pressure), diabetes, high cholesterol, and heart disease through lifestyle modifications. In some cases, medications may also be used to manage these conditions. Along with lifestyle changes, patients may undergo cognitive rehabilitation to improve cognitive thinking skills and daily functioning.
Do vascular dementia patients sleep a lot?
Sleep disturbances can be common in individuals with vascular dementia, but the specific sleep patterns and symptoms can vary from person to person. While some individuals with vascular dementia may experience difficulties with sleeping patterns including increased sleep duration and daytime sleepiness, others may have disrupted or irregular sleep patterns.
What age is vascular dementia?
Vascular dementia, like many forms of dementia, is more commonly diagnosed in older adults, typically occurring in individuals over the age of 65. However, it's important to note that vascular dementia can occur at various ages, and its onset can be influenced by multiple factors, including individual risk factors, genetics, and the presence of vascular risk factors and conditions.
The risk of developing vascular dementia tends to increase with age due to the cumulative effect of vascular changes in the brain over time. As people age, they may develop conditions such as hypertension (high blood pressure), atherosclerosis (hardening of the arteries), and other vascular risk factors that can contribute to the development of vascular dementia.
How long do vascular dementia patients live?
The life expectancy of individuals with vascular dementia can vary significantly depending on various factors, including the stage of the disease, the presence of other medical conditions, the effectiveness of medical management, and individual factors such as age and overall health. Vascular dementia is a progressive condition that typically develops over time, and its course can be unpredictable.
On average, individuals diagnosed with vascular dementia tend to have a shorter life expectancy compared to those without the condition. However, it's essential to emphasize that there is no fixed or specific timeline for how long a person with vascular dementia will live. Some individuals may live for several years after diagnosis, while others may have a shorter prognosis.
What are the 10 warning signs of dementia?
Dementia is a progressive condition characterized by cognitive decline and changes in memory, thinking, and behavior. It's important to recognize the early warning signs of dementia, as early diagnosis and intervention can lead to better outcomes. Here are 10 common warning signs of dementia:
- Memory Loss: Forgetfulness that disrupts daily life, such as forgetting recently learned information or important dates.
- Difficulty with Familiar Tasks: Struggling to perform tasks that were once routine, such as cooking a meal or managing finances.
- Language Problems: Difficulty finding the right words, following or joining conversations, or repeating oneself frequently.
- Disorientation: Confusion about time, place, and location, leading to getting lost in familiar places or becoming disoriented.
- Poor Judgment: Making poor decisions or showing impaired judgment, such as giving away money to strangers or neglecting personal hygiene.
- Difficulty with Abstract Thinking: Struggling with complex tasks that involve abstract thinking, such as planning or organizing.
- Misplacing Items: Frequently misplacing things and being unable to retrace one's steps to find them.
- Changes in Mood and Behavior: Experiencing changes in mood, personality, or behavior, such as becoming agitated, irritable, or withdrawn.
- Loss of Initiative: A decreased interest in initiating activities, social interactions, or hobbies that were previously enjoyed.
- Difficulty with Visual Perception: Problems with visual perception, including difficulty reading, judging distance, and identifying colors or contrasts.
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