Vascular Dementia

 

Vascular dementia, also known as multi-infarct dementia is the second most common cause of dementia in older people. Because it has a lower profile than Alzheimer's, many people don't suspect vascular dementia when forgetfulness becomes problematic. It's also difficult to diagnose so it's difficult to know exactly how many people suffer from vascular dementia. Current estimates attribute 15% to 20% of dementia cases in older adults to vascular dementia.

Determining the root cause can help determine the best action plan. If it's vascular dementia, certain lifestyle changes can help prevent further damage. WebMD takes a look at vascular dementia, its causes, symptoms, and prognosis.

What Is Vascular Dementia?

Compared to Alzheimer's disease, which happens when the brain's nerve cells break down, vascular dementia happens when part of the brain doesn't get enough blood carrying the oxygen and nutrients it needs.

Though they happen in different ways, it is possible to have both vascular dementia and Alzheimer's disease. Discouraging as this sounds, there is ample reason to control the risk factors that contribute to vascular dementia. Allowing the condition to run its course without intervention can make Alzheimer's disease worse.

What Causes Vascular Dementia?

Vascular dementia occurs when vessels that supply blood to the brain become blocked or narrowed. Strokes take place when the supply of blood carrying oxygen to the brain is suddenly cut off. However, not all people with stroke will develop vascular dementia.

Vascular dementia can occur over time as "silent" strokes pile up. Quite often, vascular dementia draws attention to itself only when the impact of so many strokes adds up to significant disability. Avoiding and controlling risk factors such as diabetes, high blood pressure, smoking, and high cholesterol can help curb the risk of vascular dementia.

Catching the condition early also helps limit the impact and severity of vascular dementia. Early detection requires an awareness of risk factors and, more importantly, efforts to keep them under control. Anyone who suspects vascular dementia should talk with his or her doctor.

Symptoms of Vascular Dementia

Symptoms of vascular dementia depend on what part of the brain is affected and to what extent. Like Alzheimer's disease, the symptoms of vascular dementia are often mild for a long time. They may include:

  • Problems with short-term memory
  • Wandering or getting lost in familiar surroundings
  • Laughing or crying at inappropriate times
  • Trouble concentrating, planning, or following through on activities
  • Trouble managing money
  • Inability to follow instructions
  • Loss of bladder or bowel control
  • Hallucinations or delusions

Symptoms that suddenly get worse often signal a stroke. Doctors look for symptoms that progress in noticeable stages to diagnose vascular dementia. Alzheimer's, by comparison, progresses at a slow, steady pace. Another clue is impaired coordination or balance. In vascular dementia, problems walking or balancing can happen early. With Alzheimer's, these symptoms usually occur late in the disease.

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Who Is at Risk for Vascular Dementia?

Some risk factors for vascular dementia can be managed; others, like age and gender, cannot. Among all factors, high blood pressure carries the greatest risk; vascular dementia almost never occurs without it.

Likewise, a high risk of stroke goes hand in hand with risk for vascular dementia. One-quarter to one-third of strokes are thought to result in some degree of dementia. People who smoke, consume excessive amounts of alcohol, have diabetes, or heart disease also have a higher rate of the condition.

Vascular dementia most commonly occurs in people between the ages of 60 and 75. Men seem to be more vulnerable than women, and the condition affects African-Americans more often than other races. People whose age, sex, or race puts them at increased risk of vascular dementia have that much more reason to manage risk factors within their control.

Vascular Dementia Treatment

Currently, no available treatments can repair the damage of vascular dementia once it's happened. Nonetheless, diagnosis provides important knowledge and the opportunity to prevent further damage.

Prevention typically involves bringing high blood pressure under control through exercise, diet, and medication. The same goes for diabetes if it exists. Patients should stop smoking and curb the use of alcohol.

Though medical options are limited, behavioral interventions such as cues and reminders can improve the quality of life for everyone involved. Family members and friends can place notes in visible locations around the house with daily plans and instructions for how to use basic items. Stepping up communication, reminding the person with vascular dementia what day it is, where they live, and what is going on in the family, can help keep them connected to the here and now.

Prognosis for People With Vascular Dementia

If the conditions that cause vascular dementia go untreated, the prognosis is not good. A person with vascular dementia may seem to improve for periods of time until another stroke takes away more brain function, memory, and independence. Eventually, untreated vascular dementia usually ends in death from stroke, heart disease, or infection.

Although vascular dementia is a serious condition, catching it early and preventing further damage are the best medicine. People with vascular dementia can work with their doctors and families to detect and manage the condition.

WebMD Medical Reference Reviewed by Suzanne R. Steinbaum, MD on January 23, 2017

Sources

SOURCES:

National Institute on Aging: "Forgetfulness: Knowing When to Ask for Help."

Mental Health America: "Factsheet: Multi-infarct Dementia."

Alzheimer's Association: "Vascular Dementia."

University of California, San Francisco, Memory and Aging Center: "Vascular Dementia."

Chapman, D.P. Preventing Chronic Disease, [serial online] April 2006.

National Institute on Aging: "Alzheimer's Disease Fact Sheet." 

Erkinjuntti, T. Stroke, 2004; vol 35: p 1010.

National Institutes of Neurological Disorders and Stroke: "NINDS Multi-Infarct Dementia Information Page."

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