What is Vascular dementia
Vascular dementia is the second most common cause of dementia after Alzheimer’s dementia. Vascular dementia is caused by certain conditions which block or reduce blood flow to the brain. This in turn affects thinking and memory skills. Vascular dementia is the cause in around 1 in 5 diagnoses of dementia. Another 1 in 5 suffer with a mixed form of dementia where vascular dementia and Alzheimers disease are both present.
Causes of Vascular Dementia
When any part of the body is deprived of blood it can die. This is called an infarct. When this happens in an area of the brain it is called a stroke. Thus vascular dementia can be caused by:
-high blood pressure (hypertension)
-irregular heart rhythms (arrhythmias)
-diseases which damage the arteries in the brain.
Signs and Symptoms of Vascular dementia
Symptoms of vascular dementia can include memory loss. However the symptoms depend on which area of the brain is affected. Signs of vascular dementia can often occur after a stroke or mini-stroke. Sometimes the strokes can be so small that a person may not even be aware. Then over time these mini-strokes can add up causing the symptoms of vascular dementia (multi-infarct dementia MID). Signs and symptoms of vascular dementia include:
-weakness in parts of the body (like arms or legs)
-Slurred speech, dizziness
-Trouble remembering things like recent events
-Difficulty with concentration like following a conversation fully
-Sometimes hallucinations can even occur or delusions (false beliefs or paranoid ideas)
–Depression can occur
-Mood/emotion swings can occur like laughing or crying for no apparent reason
Risk Factors for Vascular Dementia
The risk factors for vascular dementia are the same as those associated with strokes. Diabetes, high cholesterol, high blood pressure, and heart disease can all increase the risk of developing vascular dementia. No treatment can actually reverse any damage already done to the brain. However by treating risk factors we can reduce the chance of further strokes happening in the future. Medicines can be used to control blood pressure or reduce cholesterol for example. Also exercise, stopping smoking, healthy diet, reducing intake can all help reduce the risk of having a stroke.
Vascular Dementia Diagnosis
Because symptoms can sometimes go unrecognised, many experts now recommend professional screening for vascular dementia. Brief memory tests to assess thinking, memory and reasoning should be completed for people considered to be at high risk of developing the disorder. These can be completed at memory clinics. The assessment will involve review by a doctor (usually a psychiatrist). This will ensure other causes of memory and thinking problems are ruled out. Others causes could be things like depression or even physical causes like vitamin deficiency.
Brain scans (like MRI or CT scans) are also used to confirm the diagnosis. If a patient is suffering with vascular dementia then the scan will usually show “vascular changes” like a stroke or other small blood vessel disease. The scan can also show other signs like changes found in Alzheimer’s disease.
Treatment for Vascular dementia
As above, medication to help with the risk factors is important. This can include high blood pressure medication, cholesterol medication, diabetes medication, etc. Lifestyles changes can also play a part. Patients are advised to exercise more, quit smoking, eat healthy and reduce alcohol consumption. All of these changes to risk factors may not stop the disease progressing but they can slow it down.
There are currently no licensed drugs for the treatment of vascular dementia. However the doctor may choose to use a number of medications such as antidepressants, antipsychotics or antidementia drugs for relief of symptoms.
Other talking therapies are also available like cognitive stimulation therapy. This involves taking part in activities and exercises. They are designed to improve memory, language skills, and problem-solving skills. Reality orientation therapy is another treatment available for vascular dementia. This works by aiding people with orientation using different aids and reminders. This can improve a person’s confidence and self-esteem whilst reducing feelings of confusion or memory loss.
Vascular dementia life expectancy and prognosis
The course of vascular dementia can vary considerably and it is impossible to predict accurately. In the early stages only small difficulties like memory problems might be apparent. Vascular dementia can be associated with long periods of stability with no worsening. However then something can happen (like a mini-stroke) and symptoms can suddenly become worse. This is why the progression of vascular dementia is sometimes called “step-wise”. The life expectancy of people with vascular dementia can vary from two years to over ten years with an average of around 5 years.