Learn more about this stroke-related type of dementia that causes memory loss and reasoning problems. Prevention is possible, and good heart health is key.
Vascular dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes caused by brain damage from impaired blood flow to your brain.
You can develop vascular dementia after a stroke blocks an artery in your brain, but strokes don't always cause vascular dementia. Whether a stroke affects your thinking and reasoning depends on your stroke's severity and location. Vascular dementia can also result from other conditions that damage blood vessels and reduce circulation, depriving your brain of vital oxygen and nutrients.
Factors that increase your risk of heart disease and stroke — including diabetes, high blood pressure, high cholesterol and smoking — also raise your vascular dementia risk. Controlling these factors may help lower your chances of developing vascular dementia.
Vascular dementia symptoms vary, depending on the part of your brain where blood flow is impaired. Symptoms often overlap with those of other types of dementia, especially Alzheimer's disease dementia. But unlike Alzheimer's disease, the most significant symptoms of vascular dementia tend to involve speed of thinking and problem-solving rather than memory loss.
Vascular dementia signs and symptoms include:
Vascular dementia symptoms may be most clear-cut when they occur suddenly following a stroke. When changes in your thinking and reasoning seem clearly linked to a stroke, this condition is sometimes called post-stroke dementia.
Sometimes a characteristic pattern of vascular dementia symptoms follows a series of strokes or ministrokes. Changes in your thought processes occur in noticeable steps downward from your previous level of function, unlike the gradual, steady decline that typically occurs in Alzheimer's disease dementia.
But vascular dementia can also develop very gradually, just like Alzheimer's disease dementia. What's more, vascular disease and Alzheimer's disease often occur together.
Studies show that many people with dementia and evidence of brain vascular disease also have Alzheimer's disease.
Vascular dementia results from conditions that damage your brain's blood vessels, reducing their ability to supply your brain with the amounts of nutrition and oxygen it needs to perform thought processes effectively.
Common conditions that may lead to vascular dementia include:
Stroke (infarction) blocking a brain artery. Strokes that block a brain artery usually cause a range of symptoms that may include vascular dementia. But some strokes don't cause any noticeable symptoms. These silent strokes still increase dementia risk.
With both silent and apparent strokes, the risk of vascular dementia increases with the number of strokes that occur over time. One type of vascular dementia involving many strokes is called multi-infarct dementia.
In general, the risk factors for vascular dementia are the same as those for heart disease and stroke. Risk factors for vascular dementia include:
The health of your brain's blood vessels is closely linked to your overall heart health. Taking these steps to keep your heart healthy may also help reduce your risk of vascular dementia:
Doctors can nearly always determine that you have dementia, but there's no specific test that confirms you have vascular dementia. Your doctor will make a judgment about whether vascular dementia is the most likely cause of your symptoms based on the information you provide, your medical history for stroke or disorders of the heart and blood vessels, and results of tests that may help clarify your diagnosis.
If your medical record doesn't include recent values for key indicators of the health of your heart and blood vessels, your doctor will test your:
He or she may also order tests to rule out other potential causes of memory loss and confusion, such as:
Your doctor is likely to check your overall neurological health by testing your:
Images of your brain can pinpoint visible abnormalities caused by strokes, blood vessel diseases, tumors or trauma that may cause changes in thinking and reasoning. A brain-imaging study can help your doctor zero in on more-likely causes for your symptoms and rule out other causes.
Brain-imaging procedures your doctor may recommend to help diagnose vascular dementia include:
Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into a tube-shaped MRI machine, which makes loud banging noises while it produces images.
MRIs are painless, but some people feel claustrophobic inside the machine and are disturbed by the noise. MRIs are generally the preferred imaging test because MRIs can provide even more detail than CT scans about strokes, ministrokes and blood vessel abnormalities and is the test of choice for evaluating vascular dementia.
Computerized tomography (CT) scan. For a CT scan, you'll lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles, and a computer uses this information to create detailed cross-sectional images (slices) of your brain.
A CT scan can provide information about your brain's structure; tell whether any regions show shrinkage; and detect evidence of a stroke, ministroke (transient ischemic attacks), a change in blood vessels or a tumor.
This type of exam assesses your ability to:
Neuropsychological tests sometimes show characteristic results for people with different types of dementia. People with vascular dementia may have an exceptionally hard time analyzing a problem and developing an effective solution.
They may be less likely to have trouble learning new information and remembering than are people with dementia due to Alzheimer's disease unless their blood vessel problems affect specific brain regions important for memory. However, there's often a lot of overlap in exam results for people with vascular dementia and people who also have the brain changes of Alzheimer's disease.
While much focus is placed on distinguishing Alzheimer's dementia from vascular dementia, it turns out there is usually substantial overlap. Most people diagnosed with Alzheimer's dementia have a vascular component and similarly most people with vascular dementia have some degree of coexisting Alzheimer's changes in their brain.
Treatment often focuses on managing the health conditions and risk factors that contribute to vascular dementia.
Controlling conditions that affect the underlying health of your heart and blood vessels can sometimes slow the rate at which vascular dementia gets worse, and may also sometimes prevent further decline. Depending on your individual situation, your doctor may prescribe medications to:
Though these haven't been proved to alter the course of vascular dementia, your doctor will likely recommend that you:
People with any type of dementia and their caregivers — whether it's vascular dementia or Alzheimer's disease — experience a mixture of emotions, including confusion, frustration, anger, fear, uncertainty, grief and depression.
Providing care for and supporting a person with dementia is physically and emotionally demanding. Feelings of anger and guilt, frustration and discouragement, worry and grief, and social isolation are common. But paying attention to your own needs and well-being is one of the most important things you can do for yourself and for the person in your care.
If you're a caregiver or care partner:
If you've had a stroke, your first conversations about your symptoms and recovery will likely take place in the hospital. If you're noticing milder symptoms, you may decide that you want to talk to your doctor about changes in your thought processes, or you may seek care at the urging of a family member who arranges your appointment and goes with you.
You may start by seeing your primary care doctor, but he or she is likely to refer you to a doctor who specializes in disorders of the brain and nervous system (neurologist).
Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready and know what to expect from your doctor.
Writing down a list of questions ahead of time can help you remember your biggest concerns and allow you to make the most of your appointment. If you're seeing your doctor regarding concerns about vascular dementia, some questions to ask include:
In addition to the questions you've prepared ahead of time, don't hesitate to ask your doctor to clarify anything you don't understand.
Your doctor is also likely to have questions for you. Being ready to respond may free up time to focus on any points you want to talk about in-depth. Your doctor may ask: