Vascular Dementia

The most common vascular dementia symptoms in its early stages are:

• Disorientation, such as getting lost on familiar routes

• Difficulty making plans, making decisions, reasoning, and problem solving

• Confusion and difficulty concentrating

• Difficulty following instructions or difficulty with familiar tasks

• Trouble talking, understanding what people are saying, or remembering the names of familiar objects

• Vision loss or problems seeing in three dimensions

• Changes in mood or personality, such as apathy, depression, or mood swings

• Memory loss or losing things

Many symptoms of advanced vascular dementia are the same as in the early stages, except to a greater extent. As symptoms progress, a person might need help with day-to-day activities, such as dressing, eating, walking, driving and bathing. Advanced stage vascular dementia symptoms include:

• Forgetting current events, personal history, or names of familiar people

• Withdrawing from social activities or behaving inappropriately in social situations

• Waking up at night or having other disturbed sleep

• Changes in character, such as irritability, aggressiveness, or violent behavior

• Greater difficulties with speech

• Occasionally, having delusions or hallucinations

A series of small strokes causes vascular dementia. A block in blood flow to the brain in the smallest blood vessels causes brain cells to die (infarct) from lack of oxygen. This is similar to a stroke which usually affects larger blood vessels, and it can happen multiple times. In fact, another name for vascular dementia is multi-infarct dementia. Damaged or narrowed blood vessels can prevent adequate blood supply and oxygen to the brain.

Medical conditions that contribute to reduced blood flow to the brain and raise your risk of multiple infarctions and vascular dementia are the same ones that increase the risk of coronary artery disease and heart attack. These conditions include hypertension, high cholesterol, diabetes, and hardening of the arteries (atherosclerosis).

There are different kinds of strokes affecting different parts of the brain and at different levels of severity. A silent stroke affects only a small area in the brain and may not cause symptoms of vascular dementia to appear. However, when many silent strokes occur (multi-infarction), brain cells continue to die. As brain damage progresses, symptoms begin to show up. Large strokes that block major blood vessels are also a risk factor for vascular dementia.

Some risk factors for vascular dementia are related to lifestyle, such as smoking and poor diet, which can lead to cardiovascular disease. Men have a slightly increased risk of developing vascular dementia compared to women.

Risk factors include:

• Atherosclerosis, which is the hardening and weakening of the arteries

• Diabetes

• High blood pressure

• High cholesterol

• Older age, beginning at age 65, with the risk increasing the older people get

• Obesity

• Past stroke or heart attack

• Smoking

While you can’t change your age, you may be able to lower your risk of vascular dementia by:

• Keeping your diabetes, blood pressure, and cholesterol levels in check

• Not smoking

• Staying mentally and socially active

• Getting regular exercise and eating a heart-healthy diet

• Maintaining a healthy weight

• Drinking alcohol in moderation

It is impossible to undo the brain damage that causes vascular dementia. However, doctors can treat the underlying causes and risk factors for stroke and vascular dementia. Medications can help manage diabetes, high blood pressure, and high cholesterol, and can even help you quit smoking. Aspirin or prescription blood thinners may prevent the risk of stroke, but do not start taking aspirin without talking with your doctor.

There are no medications specifically for treating vascular dementia, but Alzheimer’s medicines may improve some dementia symptoms. Talk with your doctor about whether these medications might work for your symptoms. See a neurologist who specializes in vascular dementia to learn about dementia medications.

Other vascular dementia treatment options include occupational therapy to cope with changing or loss of physical abilities. This can include breaking down complex tasks into smaller chunks or developing a regular routine to help the person remember what to do. Helping the person continue participating in activities he or she enjoys is also important.

Dementia specialists also treat dementia-related symptoms and conditions, such as depression. Medications and cognitive behavioral therapy are quite effective for depression and mood disorders in general. Medications might also be necessary to address aggressive or violent behavior in the later stages of dementia.

People with vascular dementia will experience symptoms that continue to get worse with time and may eventually lose the ability to perform their daily activities independently. Vascular dementia also may shorten a person’s life expectancy. Some research has shown vascular dementia life expectancy is, on average, about three years after developing dementia following a stroke. Other complications include:

• More strokes or heart disease

• Loss of social skills and ability to interact with others, which can contribute to depression

• Pneumonia, urinary tract infections, and skin infections

• Pressure sores from loss of mobility and inactive lifestyle

• Trauma from falls related to disorientation, dizziness, loss of balance, and gait abnormalities