Vascular Dementia or Vascular Cognitive Impairment

Healthwise, whatever affects you below your neck, affects you above your neck. What affects your heart, affects your brain. These were the opening words of a presenter at a workshop that I attended at a recent Alzheimer’s conference. The topic was vascular dementia.

Blood Clot

Blood Clot

Vascular dementia is the second most common type of dementia after Alzheimer’s disease in older adults. This form of dementia accounts for about ten to twenty percent of dementia cases. I have attempted to study as much as possible about this form of dementia because my mother was diagnosed with it. She was also diagnosed with Alzheimer’s disease. Mom had what is commonly called “mixed dementia.” I discovered that this condition is not so rare.

For several years before Mom’s diagnosis, she had experienced TIA’s, transient ischemic attacks, better known as “mini-strokes.”  TIA’s occur when blood flow to the brain is blocked or reduced for a short period of time. These “mini-strokes” are often so small that they may go unnoticed. TIA’s can serve as a warning sign that a major stroke may be coming. My family did not realize at the time that the TIA’s could also be a harbinger of vascular dementia.

Compared to Alzheimer’s and other forms of dementia, vascular dementia has different symptoms, a different rate of progression, and a different treatment approach. I have included several video resources at the end of this post. I hope you check them out.

Vascular dementia has specific names, based on the changes in the brain that cause it. The most common forms are:

  • Stroke-related dementia: a) multi-infarct dementia occurs after a series of small strokes; or b) post-stroke dementia after a stroke.
  • Small vessel disease or subcortical vascular dementia: changes in very small blood vessels deep within the brain.

Causes of Vascular Dementia

Problems start in the blood vessels that supply the brain with blood and oxygen. Damage to the brain resulting in brain cells dying off is caused by the lack of blood supply from bleeding, clotting, or narrowing of arteries.  These conditions happen for one of two reasons: 1) when there is a loss of elastin within the walls of large conducting arteries; or 2) when fibrin builds up within the micro-vessels. Elastin is a protein forming the main constituent of arteries. Elastin is partly responsible for the arteries’ flexibility. Fibrin is also a protein produced by our body in response to bleeding. Fibrin is the major component of a blood clot.   Blood Clot Cerebral Brain

Risk Factors

Aging is one factor contributing to vascular dementia. Risk is the highest after age 65, but vascular dementia can occur at any age. Persons over 65, like myself, start to experience weakening of our arteries with the loss of elastin within their walls, and a build-up of fibrin. Vascular dementia occurs in about 4.2% of all 70+ year olds. It is also more common in men, African Americans, and Asians. In Japan, vascular dementia accounts for about 50% of all dementias.

According to the U.S. Department of Health and Human Services, “Scientists believe that the same risk factors that lead to a stroke can lead to cognitive impairment and vascular dementia.” Not all strokes lead to dementia. However, according to the UC Gardner Neuroscience Institute, “…up to one-third of those who have a stroke will develop dementia within six months.” If an individual has a history of multiple strokes, their risk of developing vascular dementia increases over time with the number of strokes experienced. All stroke-like symptoms require medical care, the earlier the better.

Other health conditions that narrow blood vessels, such as high cholesterol, high blood pressure, and diabetes, can also lead to vascular dementia. Diabetes is a major risk factor.

Symptoms of Vascular Dementia

The early signs are cognitive, motor, behavior, and affective related, not so much in memory loss. The deterioration is in a stepwise decline, where stable periods are interrupted by sudden downward episodes. This is unlike Alzheimer’s disease which progresses in a more gradual decline. Symptoms can include:

  • An abrupt change in the person’s ability to think
  • Memory deficits, but can retrieve memories when given cues
  • Difficulty with executive functioning, logical reasoning, or multi-tasking
  • Problems concentrating, including short periods of sudden confusion
  • Difficulty with language where speech becomes less fluent
  • Gait disturbance, difficulty in their ability to walk, prone to falls
  • Motor impairment, especially fine motor coordination
  • Muscle weakness
  • Urinary incontinence
  • Mood changes such as depression, apathy, or anxiety
  • Inappropriate laughing or crying
  • Depression

Depending on which part of the brain is affected, the person might have paralysis or weakness of a limb. Some persons may exhibit changes in their personality. They become either more impatient, irritable, or angry, or more sweet or docile.

Preventative Measures and Control of Risk Factors

Currently, there is no cure for vascular dementia. Early detection and accurate diagnosis are important as vascular dementia is at least partially preventable. Here are things to do to help prevent it:

  • Stop smoking.
  • Get regular medical checkups and blood tests.
  • Exercise.
  • Eat a healthy diet.
  • Control the risk factors for a stroke. Looking at the health of your heart is critical. This involves getting an evaluation for heart disease. People with heart disease, hypertension, and heart arrhythmias are at an increased risk of stroke.
  • Since diabetes is a major risk factor, get your glucose under control.
  • Check for elevation in the “bad” types of cholesterol. Control high cholesterol.

According to the Alzheimer’s Society, “The drugs that are routinely prescribed for a person with Alzheimer’s disease do not have benefits for vascular dementia, and are not recommended for it. However, these drugs may be prescribed to treat mixed dementia.”

For a person with any form of dementia, it is important that they stay active and continue to do the things they enjoy. To help someone with vascular dementia cope with the cognitive symptoms, breaking down complex tasks into smaller steps will make it easier for them. Also keeping the home environment not too noisy or too busy makes it easier for them to concentrate. A regular daily routine is also most helpful. For the physical difficulties, especially after a stroke, the person might benefit from rehabilitation, physiotherapy, occupational therapy, or speech and language therapy.

As a caregiver, do your best to get as much information as you can if your loved one is diagnosed with vascular dementia. The more you know, the better prepared you will be. I wish I had understood this condition better at the time I was caring for my mother.

I wish you peace, patience, and joy in your caregiving today and every day!

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Information for this post was partially based on the keynote address, “The Dementia Prevention Initiative: A Personalized Approach to Reducing the Risk of Dementia,” March 17, 2017, given by neurologist James Galvin, MD, M.P.H., Director of the Institute for Healthy Aging and Lifespan Studies at Florida Atlantic University.

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This fifty second video shows how a stroke occurs:

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This three-minute video from the Alzheimer Society gives a brief explanation of vascular dementia:

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Dr. Stephen Tai Chen, MD, a geriatric psychiatrist, presents a twenty-two minute UCLA health webinar on “Diagnosis and Management of Vascular Dementia” in this video:

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