Vascular Dementia

Definition

Vascular dementia is a cause of dementia. It is caused by disease of the small blood vessels in the brain. Parts of the brain called white matter along with subcortical grey matter are injured by multiple small strokes.

Healthy and Injured Brain Blood Vessels

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Causes

Vascular dementia occurs when cells below the surface of the brain's cortex die because they do not receive enough oxygen and nutrients. This process is due to hardening of the blood vessels within the white matter of the brain, which affects the blood supply. As a result, the oxygen and nutrient supply to the neurons and their supporting cells are also affected.

Factors that play a role in causing the disease include:

• High blood pressure —but probably also blood pressure that is too low for proper brain blood supply
• Cardiovascular disease
• Hardening of blood vessels— atherosclerosis and lipohyalinosis
• Diabetes
• Smoking

Risk Factors

Factors that may increase your chances of developing vascular dementia include:

• Age: usually affects older people
• Alzheimer’s dementia —can occur along with vascular dementia
• High blood pressure—the most closely associated risk factor
• Cardiovascular disease
• Hardening of blood vessels—atherosclerosis and lipohyalinosis
• Diabetes
• Smoking
• Conditions that cause the blood to clot
• Genetic disorders

Symptoms

In some patients, symptoms appear suddenly with neurologic changes like those caused by a stroke. Sometimes, the small strokes that lead to vascular dementia can happen without other symptoms. This makes the condition difficult to detect.

In some cases, symptoms may stabilize or even improve. However, in most patients, the disease continues to progress.

The main symptoms of vascular dementia include:

• Sudden onset in some, but not all, patients
• Progressive loss of intellectual abilities, processing speed, cognitive and motor abilities
• Progressive memory loss
• Slow, unsteady walking

Other symptoms that may be present include:

• Incontinence
• Laughing, crying, or smiling during inappropriate times
• Difficulty speaking
• Swallowing difficulties
• Paralysis or weakness of one or both sides of the body
• Apathy—loss of interest in activities
• Inactivity
• Depression
• Parkinson -like symptoms, such as tremors, loss of coordination, loss of trunk mobility
• Seizures
• Nighttime confusion
• Paranoia
• Disorientation

Diagnosis

The symptoms of vascular dementia can resemble other causes of dementia, such as Alzheimer’s disease.

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:

• Pictures may be taken of your brain and bodily structures. This can be done with:
  • MRI scan
  • CT scan
  • Single photon-emission computed tomography (SPECT)
  • Ultrasound
• Your heart and brain activity may be evaluated. This can be done with:
  • Echocardiogram
  • Electrocardiogram (ECG, EKG)
  • Electroencephalogram (EEG)
  • Neuropsychological testing
• Your bodily fluids may be tested. This can be done with blood work.

Treatment

There is no known cure for vascular dementia. Minimizing risk factors and alleviating symptoms are important in trying to slow disease progression and improve quality of life.

Medicines can be given to help limit or control symptoms and possibly slow progression of the disease. These include:

• Medicines to control:
  • High blood pressure
  • Heart arrhythmias
  • Stroke risk, such as by using aspirin
  • Increased cholesterol
  • Conditions that cause the blood to clot
• Antidepressant medicines
• Nimodipine—may help improve cognitive function in the short-term, but lacks evidence to support its long term use
• Medicines used to treat Alzheimer's disease, such as donepezil and memantine

Prevention

There are no definitive guidelines to prevent vascular dementia. However, the following may help reduce your risk:

• Don’t smoke. If you smoke, quit.
• Eat a diet that is low in fat and low in salt.
• If you drink alcohol, do so only in moderation. Moderate alcohol intake is two drinks per day for men; one drink per day for women.
• Have your blood pressure and blood cholesterol levels checked at least once a year.
• Avoid low blood pressure. If you get dizzy when you stand up or have a history of fainting, talk to your doctor.