An Overview of Vascular Dementia

Vascular dementia results from impaired blood flow to the brain. After Alzheimer's disease, it's one of the most common types of dementia, along with Lewy body dementia. Learning about vascular dementia can help you know how to reduce your risk as well as know what to expect if you've been diagnosed.

Vascular dementia was formerly called "multi-infarct dementia" because it was thought to only be caused by small strokes. However, the name was changed to "vascular dementia" to reflect the array of conditions that can impair the blood's ability to circulate to the brain. More recently, some physicians use the term "vascular cognitive impairment," perhaps because it seems to capture the wide range (from mild to severe) of cognitive decline that vascular dementia can cause. Vascular dementia often occurs alongside Alzheimer's disease, resulting in mixed dementia.

Between 5% and 10% of people over the age of 65 in developed countries have vascular dementia. The risk of developing it increases dramatically with age. Vascular dementia is estimated to account for between 20% to 40% of all dementia cases.

People with vascular dementia often display multiple cognitive problems including:

• Memory impairment
• Aphasia
• Apraxia
• Agnosia
• Problems with executive functioning

In most cases, symptoms make it difficult to hold a job, carry out household responsibilities, or maintain social relationships. People with vascular dementia also experience neurological symptoms including:

• Exaggerated reflexes
• Problems with walking and balance
• Weakness in the limbs, hands, and feet

Depending on the individual and on the cause of dementia, delusions, confusion, agitation, urinary problems, and/or depression can also accompany vascular dementia. Interestingly, memory loss usually occurs later in vascular dementia compared to Alzheimer's disease.

In vascular dementia, the first symptoms are often the neurological ones, such as problems with reflexes, walking, and muscle weakness. On the other hand, memory problems and behavioral symptoms are commonly the first issues noticed in Alzheimer's.

Additionally, vascular dementia often progresses in a step-wise fashion. For example, the person will seem stable for a period of time, then suddenly get much worse, then continue to alternate between stable periods and sudden drops in functioning. Alzheimer's disease typically progresses in a more gradual, downward fashion.

Vascular dementia can occur either by a narrowing or a complete blockage of blood vessels in the brain, which deprives brain cells of nutrients and oxygen they need to function properly.

In addition, vascular dementia often results from several small strokes that occur over time. It can also occur after a single major stroke, which is sometimes referred to as "post-stroke dementia."

Conditions like high blood pressure and diabetes that don't block blood vessels, but simply narrow them, can also lead to vascular dementia.

People who develop vascular dementia often have a history of certain conditions:

• Heart attack
• Stroke
• High blood pressure
• Diabetes
• High cholesterol

In particular, if an individual has a history of multiple strokes, the risk of developing vascular dementia increases with the number of strokes experienced over time.

Other factors that may increase your risk include if you are a smoker, a male, of African American descent, if you have had Atrial Fibrillation, or have a family history of vascular dementia.

As with Alzheimer's disease, a complete diagnostic workup should be performed in order to rule out other possible causes of the person's symptoms. Vascular dementia is usually identified through imaging procedures, which can reveal strokes and narrowed or blocked arteries. Neuropsychological tests might also be conducted to determine the nature and extent of cognitive impairment.

Doctors often prescribe patients with vascular dementia the same medications that are used to treat Alzheimer's. This may include both a cholinesterase inhibitor (Aricept, Exelon, or Razadyne) and Namenda.

Managing cardiovascular problems through medication and/or lifestyle changes may also help slow the worsening of vascular dementia symptoms. It's critical to monitor blood pressure, pulse, cholesterol, blood sugar, and weight, all of which impact brain health and the ease of blood flow to the brain.

Behavior management strategies are also useful for handling the challenging behaviors that sometimes accompany vascular dementia.

Currently, there is no cure for vascular dementia. If the dementia was caused by multiple strokes, the person may get worse in a step-wise progression, where stable periods are interrupted by sudden downward episodes.

Life expectancy for someone with vascular dementia is highly individual and depends on the nature of the cardiovascular problems that are causing dementia, along with the person's age and other medical conditions.

Vascular dementia results from impaired blood flow to the brain and is the second most common type of dementia after Alzheimer's disease. A host of cognitive and neurological impairments accompany vascular dementia, including memory impairment and trouble with coordination such as walking and balancing. It is best to consult a doctor or healthcare professional (or accompany a loved one to the doctor if you suspect they are at risk) to rule out other similar conditions. Though there is no cure, there are treatment options and ways to manage.