Vascular Dementia

Vascular Dementia: Overview

Vascular dementia is a decline in intellectual ability resulting from diminished blood flow to the brain.  Brain cells need a good supply of blood in order to function properly; if this supply is reduced or interrupted even briefly, damage to the brain can occur.

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Various conditions can cause or worsen damage to the blood supply to the brain, for example stroke, high blood pressure, heart problems, high cholesterol and diabetes.

There are three different types of vascular dementia:

  • Stroke-related dementia: A stroke occurs when the blood supply to part of the brain is cut off for a while, leading to brain tissue damage.  The cause is usually a burst blood vessel (called a hemorrhagic stroke) or a blood clot (an ischemic stroke).
  • Sub-cortical vascular dementia: Also known as 'small vessel disease' or Binswanger's disease, this occurs after damage to the tiny blood vessels deep within the brain.
  • Mixed dementia: In about 10% of vascular dementia cases, Alzheimer's disease is also present and has also caused damage to the brain.

Incidence; Causes and Development; Contributing Risk Factors

After Alzheimer's disease, vascular dementia is the next most common form of dementia, affecting some 10-20% of those with dementia.  Vascular dementia is often present alongside Alzheimer's disease and becomes more likely in both men and women as they get older.

The most common type of vascular dementia is multi-infarct dementia, caused by a series of small strokes which might not even be noticed by the patient.  Approximately 20% of people who suffer stroke will suffer reduced brain function.

Other causes of vascular dementia include:

  • vasculitis
  • inflammation of the blood vessels
  • severe hypotension
  • various genetic diseases
  • endocarditis (infection of a heart valve)
  • lesions caused by a brain hemorrhage
  • amyloid angiopathy (resulting from build-up of amyloid protein in the brain's blood vessels, which may cause hemorrhagic strokes)
  • lupus erythematosus and temporal arteritis can damage blood vessels in a way that leads to vascular dementia

Because the cardiovascular system is responsible for delivering blood to the brain, many of the risk factors that increase the risk of cardiovascular disease also increase the risk of vascular dementia – for example high cholesterol levels and smoking.

Risk factors include:

  • chronic/untreated high blood pressure
  • vascular disease
  • previous strokes
  • previous heart attacks
  • high blood pressure
  • untreated diabetes (type 2 in particular)
  • heart disease
  • sleep apnea
  • lack of exercise
  • excessive alcohol consumption
  • smoking
  • a high-fat diet
  • family history of stroke
  • family history of cardiovascular disease
  • Afro-Caribbean, Indian, Bangladeshi, Pakistani or Sri Lankan ethnicity

Signs and Symptoms

The resulting symptoms depend on the part of the brain that was damaged.  For example, if the area affected is responsible for movement of an arm or leg, paralysis might occur.  Symptoms are often limited to one side of the body.

Signs and symptoms vary and are not always present.  They include:

  • difficulty walking
  • clumsiness
  • slowness
  • lack of facial expression
  • difficulty speaking
  • wandering at night
  • memory loss
  • confusion
  • difficulty with calculating, decision making, problem solving, planning and organizing
  • reduced attention span
  • mood swings
  • personality changes
  • other problems commonly found in those who have had a stroke, such as depression-like behavior and incontinence

Treatment and Prevention

It is important that the underlying condition(s) that are damaging the vascular system and affecting the blood supply to the brain are identified and treated as soon as possible in order to stop or slow down the progression of vascular dementia.

Prognosis

Symptoms often begin suddenly after a stroke, and often progress in steps with sudden reductions in ability each time.  However, if the damage to the brain occurs mid-brain, cognitive impairment may resemble Alzheimer's disease in that it is gradual and progressive.  Unlike Alzheimer's patients, however, those with vascular dementia often maintain their personality and normal levels of emotional responsiveness until the later stages of the disease.

The outcome depends on whether the patient has more strokes, in which case vascular dementia may get worse.  In some cases, symptoms may lessen over time.

Conditions that suggest Vascular Dementia:

Mental

Senile Dementia

Vascular dementia is the second most common cause of dementia after Alzheimer's Disease.

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Vascular Dementia suggests the following may be present:

Mental

Senile Dementia

Vascular dementia is the second most common cause of dementia after Alzheimer's Disease.

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