Vascular Dementia: Symptoms And Possible Treatments
Updated February 27, 2020
Reviewer Whitney White, MS. CMHC, NCC., LPC
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 ten percent of dementia cases.
What Is Vascular Dementia?
Though there are several different types of dementia, vascular dementia has some specific details and symptoms. With the basic definition of dementia as a general loss of cognition, impairment of memory disturbed planning or organizing or abstract thinking abilities. Vascular dementia involves this same definition but is the result of specific medical problems. The symptoms of dementia in vascular dementia are caused by restricted blood flow to parts of the brain. This restriction in blood flow may be caused by any number of medical conditions.
Some disorders that 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 can lead deterioration in intellectual functions, occurring 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 like other types of dementia, it can be hard to pinpoint and diagnose.
Symptoms of Vascular Dementia
Vascular dementia symptoms vary but are often affect thinking, perception, and memory. 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 is impaired, symptoms may vary or can even overlap if multiple areas are facing damaged blood flow. Vascular dementia signs and symptoms include:
- Trouble speaking or understanding speech
- Trouble paying attention and concentrating
- Reduced ability to organize thoughts or actions
- Declined ability to analyze situations or develop and communicate plans effectively
- Difficulty in deciding what to do next
- Trouble with memory
- Restlessness and agitation
- Unsteady gait
- Sudden or frequent urge to urinate or inability to control passing urine
- Depression or apathy
- Vision loss
Vascular dementia results from conditions that damage your brain's blood vessels, reducing their ability to supply your brain with the amounts of nutrition and oxygen it needs to perform thought processes effectively. Common conditions that may cause vascular dementia include:
- Stroke Is Blocking A Brain Artery. These usually cause a range of symptoms that may include vascular dementia, but some don't cause any noticeable symptoms. Both silent and apparent strokes include increased risk of vascular dementia as the number of strokes increases over time.
- Narrowed or Chronically Damaged Brain Blood Vessels. These 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, and brain hemorrhage.
In general, the risk factors for vascular dementia are the same as those for heart disease and stroke. Risk factors for vascular dementia include:
- Increasing Age. Rare before age 65, and the risk rises substantially by your 90s.
- History of Heart Attack, Strokes Or Mini-Strokes.
- Abnormal Aging of Blood Vessels (atherosclerosis). Deposits of cholesterol and other substances (plaques) build up in your arteries and narrow your blood vessels.
- High Cholesterol. High levels of low-density lipoprotein (LDL) or "bad" cholesterol.
- High Blood Pressure. This puts extra stress on blood vessels everywhere in your body, including your brain.
- High glucose levels damage blood vessels throughout your body.
- Smoking directly damages blood vessels, increasing the risk of atherosclerosis and other circulatory diseases.
- This is a common risk factor for vascular diseases in general.
- Atrial Fibrillation. Abnormal heart rhythm causes the upper chambers of the heart to beat rapidly and irregularly, out of coordination with 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 blood vessels.
Seven Stages Of Vascular Dementia
The basic seven stages of vascular dementia include the following:
- No Cognitive Decline: There is no true complaint of memory deficit at this point. Clinical interviews show no real memory decline.
- 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, forgetting common names. However, the clinical interview shows no true memory decline or objective deficits in memory of regular daily events.
- Mild Cognitive Decline: Called "Mild Cognitive Impairment" this second stage of vascular dementia may show some more serious subjective notice of memory loss. Things like getting lost in travel, poor performance noted at work, more severely forgotten names, failure to remember content when read, lost objects of value and inability to concentrate well. Some of these issues are clear on clinical interviews as well as objective reviews, while the patient begins expression of denial or slight anxiety.
- Moderate Cognitive Decline: This is "Mild Dementia" where symptoms are clearer on clinical interview. Memory loss includes the patient's personal history or recent events. There is also a deeper loss of ability to travel, manage finances, recognition of time and place or recognition of those who were once familiar. Along with denial the patient often avoids situations where symptoms will usually arise.
- Moderately Severe Cognitive Decline: In "Moderate Dementia" help is officially needed. During the clinical interview, the patient can't remember some piece of major personal information 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. Some common mathematical or other tasks may be difficult, even like counting backward in intervals. While major facts about themselves and others may still be remembered, 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.
- Severe Cognitive Decline: This is "Moderately Severe Dementia" where more valuable memories are lost. Name of the spouse or significant other may be forgotten, along with the overall loss of awareness in regular life. Things like the date and year, their surroundings and difference between familiar and unfamiliar faces are unrecognized. Incontinence may set in, and they may need help with traveling and basic daily life. Personality and mood may change, and there is a chance they may not recognize their face in the mirror or talk at random to strangers while believing their spouse to be under a false identity. More symptoms set in and are much more severe. Without the ability to concentrate and think for long periods of time they are unable to make decisions.
- Very Severe Cognitive Decline: This is "Severe Dementia." This is the final stage, where all verbal abilities are lost as this stage progresses. The patient may not speak at all, or only unintelligible phrases. Even basic motor abilities are lost throughout this stage, where they are eventually unable to walk or carry on common activities. This means the brain is unable to tell the body what to do. As time passes the body begins to become rigid and developmental neurologic reflexes become present.
Treatment and Prevention Of Vascular Dementia
While no drugs have been approved for vascular dementia treatment, some evidence exists that some Alzheimer's drugs may be able to help with patients diagnosed with vascular dementia. There are also steps that can be taken to help increase blood flow in the brain and reduce damage to the brain's blood vessels. These actions will likely not treat or reverse vascular dementia but may help prevent progression into the stages of vascular dementia.
Working with their physicians, patients can help develop a plan that will provide increased lifespan and maintain cognitive stabilization and recovery after a stroke. One of the things to consider in this area are the risk factors 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, increased cholesterol, high blood pressure and more. Many doctors offer protective activities including:
- Quit smoking
- Maintain blood pressure, cholesterol and blood sugar levels
- Keep a healthy diet
- Keep a healthy weight
- Minimize alcohol
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, then it is likely that vascular dementia is possible, and these actions are good to support your brain and cognitive health.