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Vascular Dementia

Vascular dementia is a decline in thinking skills caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients.

Brief Overview of Vascular Dementia

Inadequate blood flow can damage and eventually kill cells anywhere in the body. The brain has one of the body’s richest networks of blood vessels and is especially vulnerable. In vascular dementia, changes in thinking skills sometimes occur suddenly following strokes that block major brain blood vessels. Thinking problems also may begin as mild changes that worsen gradually as a result of multiple minor strokes or other conditions that affect smaller blood vessels, leading to cumulative damage.

A growing number of experts prefer the term “vascular cognitive impairment (VCI)” to vascular dementia because they feel it better expresses the concept that vascular thinking changes can range from mild to severe.

Vascular dementia is widely considered the second most common cause of dementia after Alzheimer’s disease, accounting for 20 to 30 percent of cases. Many experts believe that vascular dementia remains underdiagnosed “like Alzheimer’s disease” even though it is recognized as common.

Symptoms of Vascular Dementia

Symptoms can vary widely, depending on the severity of the blood vessel damage and the part of the brain affected. Memory loss may be a significant symptom depending on the specific brain areas where blood flow is reduced.

Vascular dementia symptoms may be most obvious when they occur soon after a major stroke.

Sudden Post-Stroke Changes in Thinking and Perception May Include:

  • Confusion
  • Disorientation
  • Trouble speaking or understanding speech
  • Vision loss

Multiple small strokes or other conditions that affect blood vessels and nerve fibers deep inside the brain may cause more gradual thinking changes as damage accumulates. Common early signs of widespread small vessel disease include impaired planning and judgment; uncontrolled laughing and crying; declining ability to pay attention; impaired function in social situations; and difficulty finding the right words.

Diagnosis of Vascular Dementia

Because vascular cognitive impairment may often go unrecognized, many experts recommend professional screening with brief tests to assess memory, thinking, and reasoning for everyone considered to be at high risk for this disorder. Individuals at highest risk include those who have had a stroke or a transient ischemic attack (TIA, also known as a “mini-stroke”).

Additional high-risk groups include those with high blood pressure, high cholesterol, or other risk factors for heart or blood vessel disease.

Causes and Risks of Vascular Dementia

As with Alzheimer’s disease, advancing age is a major risk factor for vascular cognitive impairment or dementia.

Additional risk factors are the same ones that raise risk for heart problems, stroke, and other diseases that affect blood vessels. Many of these vascular factors also increase the risk of Alzheimer’s.

There are many things that can be done to reduce your risk of diseases that affect your heart and blood vessels, and also may help protect your brain.

Strategies for Reducing Your Risk of Vascular Dementia Include:

  • Don’t smoke
  • Keep your blood pressure, cholesterol, and blood sugar within recommended limits
  • Eat a healthy, balanced diet
  • Exercise
  • Maintain a healthy weight
  • Limit alcohol consumption

Treatment and Outcomes of Vascular Dementia

The U.S. Food and Drug Administration (FDA) has not approved any drugs specifically to treat symptoms of vascular dementia, but there is some clinical trial evidence that certain drugs approved to treat Alzheimer’s may also offer a modest benefit in people diagnosed with vascular dementia.

Controlling risk factors that may increase the likelihood of further damage to the brain’s blood vessels is an important treatment strategy. There is substantial evidence that treatment of risk factors may improve outcomes and help postpone or prevent further decline.

Individuals should work with their physicians to develop the best treatment plan for their symptoms and circumstances.

Like other types of dementia, vascular dementia shortens lifespan. Some data suggest that those who develop dementia following a stroke survive three years, on average. As with other stroke symptoms, cognitive changes may sometimes improve during recovery and rehabilitation from the acute phase of a stroke as the brain generates new blood vessels and brain cells outside the damaged region take on new roles.