About Vascular Dementia
Vascular dementia is an overall term used to describe problems with reasoning,
planning, judgment, memory and other thought processes caused by damage to the
brain, due to 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 can be determined on your stroke's severity and location. Vascular
dementia can also be a result of other conditions that damage blood vessels and
reduce circulation, depriving your brain of vital oxygen and nutrients.
The risk of vascular dementia can also be raised by factors that increases the risk
of heart disease or strokes such as diabetes, high blood pressure, high cholesterol
and smoking. Controlling these factors may help lower the risk of developing
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 those of Alzheimer's disease.
Vascular dementia signs and symptoms include:
Trouble paying attention and concentrating
Reduced ability to organize thoughts or actions
Decline in ability to analyse a situation, develop an effective plan and
communicate that plan to others
Difficulty deciding what to do next
Problems with memory
Restlessness and agitation
Sudden or frequent urge to urinate or inability to control passing urine
Depression or Apathy
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.
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. But vascular dementia can also develop very gradually, just
like Alzheimer's disease. What's more, vascular disease and Alzheimer's disease
often occur together.
Vascular dementia results from damage to 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
increases with the number of strokes that occur over time. One type of vascular
dementia involving many strokes is called multi-infarct dementia.
Narrowed or chronically damaged brain blood vessels - Conditions that narrow or
inflict long-term damage on your brain blood vessels also can lead to vascular
dementia. These conditions include the wear and tear associated with aging, high
blood pressure, abnormal aging of blood vessels (atherosclerosis), diabetes, and
The risk factors for vascular dementia are in general, the same as those for heart
disease and stroke. Risk factors for vascular dementia include:
Increasing age - Your risk of vascular dementia rises as you grow older. The
disorder is rare before age 65, and the risk rises substantially by your 90s.
History of heart attack, strokes or ministrokes, If you've had a heart attack,
may be at increased risk of having blood vessel problems in your brain. The
damage that occurs with a stroke or a ministroke (transient ischemic attack) may
increase your risk of developing dementia.
Abnormal aging of blood vessels (atherosclerosis) - This condition occurs when
deposits of cholesterol and other substances (plaques) build up in your arteries
narrow your blood vessels. Atherosclerosis can increase your risk of vascular
dementia by reducing the flow of blood that nourishes your brain.
High cholesterol - Elevated levels of low-density lipoprotein (LDL), the "bad"
cholesterol, are associated with an increased risk of vascular dementia.
High blood pressure - When your blood pressure's too high, it puts more stress
blood vessels everywhere in your body, including your brain. This increases the
of vascular problems in the brain.
Diabetes - High glucose levels damage blood vessels throughout your body. Damage
brain blood vessels can increase your risk of stroke and vascular dementia.
Smoking - Smoking directly damages your blood vessels, increasing your risk of
atherosclerosis and other circulatory diseases, including vascular dementia.
Obesity - Being overweight is a well-known risk factor for vascular diseases in
general, and therefore, presumably increases your risk of vascular dementia.
Atrial fibrillation - In this abnormal heart rhythm, the upper chambers of your
heart begin to beat rapidly and irregularly, out of coordination with your
lower chambers. Atrial fibrillation increases your risk of stroke because it
blood clots to form in the heart that can break off and go to the brain blood
Because vascular cognitive impairment may often go unrecognized, many experts
recommend professional screening with brief tests to assess memory, thinking and
reasoning for everyone considered to be at high risk for this disorder. Individuals
at highest risk include those who have had a stroke or a ministroke or have high
blood pressure, high cholesterol, or other risk factors for heart or blood vessel
If brief screening tests suggest changes in thinking or reasoning, a more detailed
assessment is needed. Core elements of a workup for vascular dementia typically
A thorough medical history, including family history of dementia
Evaluation of independent function and daily activities
Input from a family member or trusted friend
In-office neurological examination assessing function of nerves and reflexes,
movement, coordination, balance and senses
Laboratory tests including blood tests and brain imaging
According to a 2011 scientific statement issued by the American Heart Association
(AHA) and the American Stroke Association (ASA), and endorsed by the Alzheimer's
Association and the American Academy of Neurology (AAN), the following three
criteria suggest the greatest likelihood that mild cognitive impairment (MCI) or
dementia is caused by vascular changes:
The diagnosis of dementia or mild cognitive impairment is confirmed by
neurocognitive testing, which involves several hours of written or computerized
tests that provide detailed evaluation of specific thinking skills such as judgment,
planning, problem-solving, reasoning and memory.
There is brain imaging evidence, usually with magnetic resonance imaging (MRI),
showing evidence of either: a) A recent stroke, or b) Other brain blood vessel
changes whose severity and pattern of affected tissue are consistent with the types
of impairment documented in neurocognitive testing.
There is no evidence that factors other than vascular changes are contributing to
cognitive decline. The guidelines also discuss cases where the diagnosis may be less
clear-cut, such as the common situation where vascular changes coexist with brain
changes associated with other types of dementia.