Vascular dementia is the second most common cause of dementia in older adults after Alzheimer’s disease, accounting for approximately 15-20% of dementia cases. This disorder, also known as multi-infarct dementia, refers to the cognitive changes due to conditions that affect the blood vessels in the brain and impair the blood flow to different portions of the brain. Consequently, the lack of oxygen and nutrients due to inadequate blood supply damages and kills the brain cells, which results in significant damage and loss of these cells. The loss of brain function and cognition typically depends on the location, size, and number of vascular changes.
What causes Vascular Dementia?
A sudden stroke can sometimes trigger changes in thinking, leading to vascular dementia due to the blockage of a major blood vessel in the brain. These changes can be mild at first and may progressively worsen and cause widespread damage due to multiple minor strokes or any other condition that affects smaller blood vessels. Many experts use the term “vascular cognitive impairment” (VCI) rather than “vascular dementia” to better express the notion of mild to severe changes in vascular thinking. It is essential to know that stroke can increase the risk of developing dementia. It does not necessarily cause vascular dementia.
Changes in White Matter
Some other common brain abnormalities in people with vascular dementia include diseased small blood vessels and changes in white matter. This white matter (or connecting wires) is responsible for the conduction of neural messages between parts of the brain.
The Brain-Heart Connection
Researchers are investigating the role of these changes and their underlying causes in the onset and development of vascular dementia. Their research suggests a strong relationship between cardiovascular disease and cerebrovascular disease and the ensuing cognitive impairment and dementia. This field of research is known as “vascular contribution to cognitive impairment and dementia” (VCID). It is helping scientists better comprehend this connection and whether the prevention and treatment of cerebrovascular and heart disease could also aid in impeding dementia. VICD research includes investigating various blood flow interrupting conditions, such as hemorrhages (bleeding from damaged blood vessels), infarcts (portions of dead tissue due to inadequate blood supply), cerebral hypoperfusion (impaired blood flow), and small vessel disease (associated with white matter abnormalities and stroke).
What are the signs and symptoms of vascular dementia?
The symptoms of vascular dementia initiate gradually or occur suddenly and worsen as the disease progresses over time, with possible brief spans of improvement. Vascular dementia can also co-exist with other dementia, such as Lewy body dementia and Alzheimer’s disease. During diagnosis, its symptoms may be similar to Alzheimer’s because the vascular deterioration begins in the brain areas responsible for storing and recovering information, leading to memory loss (similar to Alzheimer’s disease).
The patient may show the most apparent symptoms shortly after a major stroke. Vascular dementia patients may exhibit the following signs:
- Difficulty carrying out previously easy tasks
- Getting lost on familiar routes
- Trouble learning new information or following directions
- Difficulty with language, reading, and writing
- Forgetting past or recent events
- Sleep disturbances
- Misplacing items
- Loss of interest in people or things
- Hallucinations and delusions
- Personality and behavioral changes
- Poor judgment and loss of ability to perceive danger
How is vascular dementia diagnosed?
In 2011, the American Heart Association and American Stroke Association issued a joint scientific statement on vascular contributions to mild cognitive impairment (MCI) and dementia. According to the diagnostic approach recommended in the statement, the following criteria can suggest the highest probability that vascular changes are the cause of MCI or dementia:
1. Neurocognitive testing confirms the diagnosis of MCI or dementia. These computerized tests provide a comprehensive assessment of particular cognitive skills (memory, reasoning, judgment, and problem-solving).
2. An MRI (magnetic resonance imaging) scan of the brain to confirm a recent stroke or other vascular brain changes. The pattern and severity of the affected tissues should be coherent with the kinds of impairment reported in cognitive testing.
3. There is no evidence of the involvement of nonvascular factors in cognitive decline.
The statement also mentions that discrepancies in these criteria may imply a probability rather than a strong possibility that vascular factors are responsible for these cognitive changes.
Vascular dementia often remains undetected. Therefore, many experts recommend professional cognitive screening for individuals at a higher risk of disease development. These individuals include those who have had a stroke or a ministroke (transient ischemic attack – TIA) or those with an increased risk of developing vascular diseases.
Treatment of Vascular Dementia
Although the FDA has not particularly approved any drug for the treatment of vascular dementia, clinical trials suggest the usage of approved Alzheimer’s drugs may be an effective treatment against it. The treatment principally involves addressing the underlying disease such as hypertension, diabetes mellitus, and hyperlipidemia to prevent the progression and worsening of vascular dementia.
Another strategy is to control the risk factors associated with the possible increased risk of disease development. Research significantly suggests that treating risk factors can help prevent further cognitive decline.
People with vascular dementia should talk to their health care providers to devise the best treatment plan according to their circumstances and symptoms.
What is the lifespan of people with vascular dementia?
Vascular dementia shortens the lifespan of the affected individuals, just like other types of dementia. Research suggests that individuals who develop vascular dementia it after a stroke may live up to an average of three years.