What is Vascular Dementia?
Vascular dementia is the most common type of dementia next to Alzheimer’s disease.
Vascular dementia refers to a decline in memory and cognitive functions caused due to blockage in blood supply to the brain. It is also called as Vascular Cognitive Impairment (VCI).
What are the Causes of Vascular Dementia?
The main cause of vascular dementia is reduced blood supply to a part of the brain. This results in death of the brain cells in the particular part of the brain and leads to impairment of cognitive functions such as memory, thinking or reasoning in individuals. This loss of cognitive functions due to reduced blood supply in the brain is called as vascular dementia.
Factors that increase the risk of a person developing vascular dementia include the following:
- Older age, since the chances of stroke are higher at an older age
- Prior history of stroke, diabetes, heart disease, high blood pressure, high cholesterol, obesity
- Atrial fibrillation, which is a disorder of cardiac rhythm. Clots are formed in the heart, which spread to other organs through the blood
- Lifestyle factors like physical inactivity, unhealthy diet and smoking
- Genetic factors
Depending on the cause of the damage and the part of the brain affected, features of vascular dementia in the particular patient can vary. Types of vascular dementia are:
- Stroke-related dementia
- Subcortical dementia
- Mixed dementia
Stroke-Related Dementia: Stroke occurs when the blood supply to a part of the brain gets cut off suddenly. It is often caused by a clot, but may occur due to a bleed in the brain as well. Dementia that occurs following a stroke is referred to as post-stroke dementia. Post-stroke dementia occurs in about 20% individuals who have suffered from a stroke. The part of the brain where the death of cells occurs due to reduced blood supply is called an infarct. If dementia is due to a single infarct that affects an important part of the brain, it is referred to as single-infarct dementia. If it occurs due to multiple small infarcts, it is called multi-infarct dementia.
Subcortical Dementia: Subcortical dementia is caused due to the stiffening of very small blood vessels deep inside the brain. The damage occurs to the nerve fibers known as white matter. This is the most common form of vascular dementia.
Mixed Dementia: It is a combination of both vascular dementia and Alzheimer''s disease. At least 10% of people with dementia suffer from mixed dementia.
A patient with vascular dementia often exhibits physical symptoms of the stroke like paralysis or loss of bladder control. Dementia symptoms usually worsen in a stepwise manner in a stroke-related dementia, making the patient completely dependent on the caregiver in the later stages. The most common symptoms of vascular dementia include:
- Memory loss
- Communication difficulties:
- Difficulty in following instructions
- Difficulty in planning or organizing
- Concentration problems
- Impaired decision-making abilities
- Less problem-solving capacity
- Loss of social skills
- Unusual changes in mood. Aggression may be present in later stages
It is very difficult to diagnose vascular cognitive impairment. But people who are at high-risk for developing dementia must undergo certain tests to access their cognitive functioning. Diagnosis of vascular dementia involves the following tests:
- History from the patient or relatives
- Complete general and neurological examination. Memory, reasoning and thinking abilities should also be assessed.
- Blood tests to check thyroid or vitamin deficiencies, cholesterol and blood sugar levels.
- ECG to check heart function
- Brain imaging techniques like CT scan, MRI imaging for identifying any infarcts, strokes or abnormalities in the brain.
Treatment cannot cure the person affected with vascular dementia completely. But still certain measures and drugs can help alleviate the symptoms of the disease. As an important cause of vascular dementia is a stroke, medications to prevent the occurrence of strokes can be given to the high-risk individuals.
Diseases such as hypertension, diabetes and obesity that occur due to lifestyle changes can lead to strokes. Therefore drugs to control blood sugar levels, cholesterol and blood pressure can be given to reduce the risk. A healthy diet and regular exercise can also reduce the risk of the disease. One must abstain from alcohol and smoking to lessen the risk of strokes.
Drugs such as anti-platelets (aspirin) can be prescribed to prevent the formation of clots in the blood vessels. Anti-coagulants (warfarin) can prevent strokes. As the person affected with dementia can feel depressed and also restlessness, they can be prescribed anti-depressants. Recently cholinesterase inhibitor medications such as donepezil and galantamine that are given to people with Alzheimer''s disease may provide benefit to some people with vascular dementia, though they are not approved for this purpose.
Carotid endarterectomy is a surgical procedure that can remove blocks in the carotid artery. This is very rarely recommended for patients with vascular dementia.
Care and Support
People affected with dementia need constant support and help from others. Therefore, it is very important for the family members and friends to take care of them during this struggle. Keeping them mentally active can help them with memory and communication. They can also be encouraged to practice diary writing. Rehabilitation can also help them to get better control of the disease. A physiotherapist can help them with movement and a speech therapist can help them for communication.
As vascular dementia pertains to a heart health and healthy blood vessels, it is advisable to maintain good cardiovascular health to prevent vascular dementia.
The following can help in the prevention of vascular dementia:
- Exercise regularly: Physical activity can play a key role in your overall well-being. Regular exercise boosts blood supply in the body which in turn can prevent blockages in the blood vessels. Thus, it helps to reduce the risk of vascular dementia.
- Eat a Healthy Diet: Consume fresh fruits and vegetables as they are rich in antioxidants. Avoid foods that have extra salt.
- Maintain Normal Blood Pressure: As high blood pressure can lead to damage of blood vessels, it is best to maintain the blood pressure in the normal range.
- Lower Blood Cholesterol Levels: Eat ahealthy and low-fat diet to keep your cholesterol levels in check. Cholesterol-lowering medications are prescribed if your cholesterol levels remain high.
- Control Blood Sugar Levels: If you have diabetes, you should control your blood sugar level with diet, physical activity and medications.
- Stop Smoking: Smoking is the most prominent cause of stroke. Therefore, it is best to quit smoking to reduce the risk of vascular dementia.
- Relax & Manage Stress: Learn to manage stress as its turns out to be the key factor for hypertension and heart diseases. Laugh, enjoy yourself to keep stress at bay.
- Vascular dementia - (https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793)
- Vascular dementia - Wikipedia - (https://en.wikipedia.org/wiki/Vascular_dementia)
- Symptoms - Vascular dementia - (https://www.nhs.uk/conditions/vascular-dementia/symptoms/)
- Dementia Symptoms, Types, and Causes - (https://www.helpguide.org/articles/alzheimers-dementia-aging/living-with-dementia.htm)
- About Vascular Dementia - (https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia)
- Vascular dementia: what is it, and what causes it? - (https://www.alzheimers.org.uk/about-dementia/types-dementia/vascular-dementia?documentID=161)
Latest Publications and Research on Vascular Dementia
- Association between diabetes and cognitive function at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA- Brasil). - Published by PubMed
- Berberine for prevention of dementia associated with diabetes and its comorbidities: A systematic review. - Published by PubMed
- Aspirin moderates the association between cardiovascular risk, brain white matter hyperintensity total lesion volume and processing speed in normal ageing. - Published by PubMed
- Plasma parameters and risk factors of patients with post-stroke cognitive impairment. - Published by PubMed
- Anaemia and incidence of post stroke dementia. - Published by PubMed