Vascular Dementia

Vascular dementia is a kind of dementia caused by damaged blood vessels resulting in reduced blood flow to the brain. If you or a loved one is having memory problems, confusion or changes in thinking, it might be time to learn more about this condition. And even if you don’t have these symptoms, preventing them before they start is just as important. 

At Banner Health, we want to help you understand vascular dementia, find answers and get the care you need to live well.

What is vascular dementia?

Vascular dementia is the second most common type of dementia after Alzheimer’s disease. It happens when the brain doesn’t get enough blood. Blood carries oxygen and nutrients to the brain. When there isn’t enough blood, brain cells can become damaged over time.

Like Alzheimer’s disease, vascular dementia can take hold slowly and get worse gradually as blood vessel issues worsen or new ones develop. In some cases, it can happen suddenly after a significant stroke. People with vascular dementia might notice changes in memory, thinking or mood that impact their daily activities.

Health care experts often use the term vascular cognitive impairment (VCI) to describe the full range of cognitive changes caused by reduced blood flow. VCI includes mild cognitive impairment (MCI) that might not interfere with daily life yet, as well as more serious issues that can lead to vascular dementia.

Causes of vascular dementia

Vascular dementia happens when something reduces blood flow to the brain. This stops brain cells from getting the oxygen and nutrients they need. 

Causes include:

• Untreated high blood pressure: High blood pressure may be one of the biggest contributors to vascular dementia. If left untreated, it can lead to small vessel disease (damage to the tiny blood vessels deep in the brain) that can result in slow blood flow and can cause thinking problems.
• Blood vessel narrowing or blockage: Conditions like atherosclerosis (cholesterol plaque and hardening of the arteries) can limit blood flow to the brain. Untreated high cholesterol also increases your risk for narrowing blood vessels, as does diabetes.
• Heart conditions: Irregular heart rhythms or heart disease can increase the chance of blood clots that travel to the brain. 
• Stroke: A major stroke can suddenly stop blood from reaching part of the brain, causing thinking and memory problems.
• Mini stroke or TIA (transient ischemic attack): These minor strokes may not cause obvious symptoms but can add up over time and damage brain tissue.

Risk factors

Certain health conditions and lifestyle factors can raise the risk of developing a VCI and vascular dementia. Some risk factors can be managed, while others cannot.

Risk factors include:

• High blood pressure (hypertension)
• Diabetes
• Poor diet
• Lack of physical activity
• High cholesterol
• Heart disease
• Smoking
• Obesity
• Age (after 60)
• Family history

Types of vascular dementia

Vascular dementia isn't just one condition. Different types can affect the brain in different ways. These include:

• Post-stroke dementia: Happens after a major stroke or several small strokes. It can start suddenly and cause memory problems, confusion and trouble with daily tasks.
• Subcortical vascular dementia (Binswanger disease): Caused by damage to the tiny blood vessels deep in the brain. The symptoms develop slowly and can include slowed thinking, trouble with attention and difficulty planning.
• Multi-infarct dementia: Results from multiple small strokes over time. People might see their thinking or memory get worse in steps, then have times when it stays the same, then suddenly gets worse. 
• Mixed dementia: Occurs when someone has both vascular dementia and Alzheimer’s disease. This can cause memory problems and changes in thinking due to reduced blood flow to the brain.

Knowing what kind of vascular dementia someone has can help providers create personalized care plans. Even small changes in thinking or memory can be a sign of trouble. 

Signs and symptoms of vascular dementia

Vascular dementia can affect people differently. It depends on which parts of the brain are damaged and how serious the damage is. 

Warning signs may include:

• Memory problems: Trouble remembering recent events or names
• Confusion or disorientation: Getting lost in familiar places or not knowing the date or time
• Trouble with planning or problem-solving: Difficulty managing finances, cooking or following directions
• Slowed thinking: Taking longer to make decisions or respond to questions
• Mood changes: Depression, irritability or sudden emotional outbursts
• Physical changes: Weakness, unsteady walking or loss of coordination

These symptoms can be similar to or the same as those experienced with Alzheimer’s disease. 

Symptoms may appear suddenly after a stroke or develop slowly over many years. See your health care provider if you or a loved one develops these symptoms. 

Diagnosing vascular dementia

Vascular dementia is diagnosed by checking your overall health. There isn’t a single test for it. Instead, health care specialists consider symptoms, your medical history and test results to see if reduced blood flow to the brain is causing problems with thinking and memory.

Diagnosis usually starts with asking about your medical history. Your provider will check for risk factors like stroke, mini-strokes, high blood pressure, diabetes and high cholesterol. They will also ask when your symptoms started and if they happened after a stroke or vascular event. 

Tests may include:

• Cognitive testing: Short thinking and memory tests assess attention, problem-solving, processing speed and memory. These tests help identify patterns of cognitive changes commonly seen in vascular dementia.
• Neurological exam: A physical exam checks reflexes, muscle strength, balance, coordination and walking.
• Brain imaging (MRI and CT scans): Imaging tests show evidence of strokes, small-vessel disease or other areas of reduced blood flow in the brain. MRI is most often used because it provides more detail. 
• Blood tests: Lab work helps rule out other causes of cognitive symptoms, such as vitamin deficiencies, thyroid disease or infections.

Because symptoms of vascular dementia can overlap with Alzheimer’s disease, accurate diagnosis is critical for creating the most effective care plan.

Treatment and management

There is no cure for vascular dementia. But treatment can help manage symptoms, slow down the progression of the disease and improve quality of life. Treatment plans are personalized and often focus on protecting brain health and preventing further damage.

It is also important to remember, preventing vascular dementia or lowering your risk is possible. Common treatment plans include the same strategies that can be used to prevent the disease. 

They include:

• Treating high blood pressure and other health risks
• Medications to prevent blood clots and manage heart rhythm problems 
• Medications, such as cholinesterase inhibitors to treat symptoms of dementia or antidepressants to help with depression or other symptoms
• Healthy lifestyle changes such as regular exercise, a heart-healthy diet, quitting smoking and limiting alcohol
• Procedures to improve blood flow, like carotid endarterectomy, angioplasty and stenting
• Cognitive and rehabilitation therapies, such as memory exercises and occupational and physical therapy

You and your health care provider will work together to develop a treatment plan tailored to managing your symptoms and the stage of your disease.

Living with vascular dementia

Vascular dementia gets worse over time and cannot be cured. But how quickly it progresses can be different for each person. Sometimes, the symptoms stay the same for a while. Other times, they change slowly or in steps. In the early stages, you might be able to manage daily tasks with help from family or friends.

As the condition gets worse, you might need more help with daily tasks. Respite care, adult day programs and community resources can give caregivers a break and help them recharge. In the later stages, specialized memory care or long-term care places might be the safest and best environment.

Your health care provider will help you and your loved ones plan ahead, understand your options and connect with resources that support safety, comfort and quality of life.

When to seek help

If you or someone you care about is having memory problems, feeling confused or acting differently, it’s important to see a health care specialist as soon as possible. Early evaluation, especially in the early stages, can help manage symptoms, slow the disease and improve quality of life.

Learn more and take the next step

Vascular dementia can be hard to deal with but you don’t have to go through it alone. Banner Health is here to help you every step of the way, from early evaluation and diagnosis to treatment and support for caregivers.

Call us to make an appointment with a dementia expert or to learn more about our programs and resources. Together, we can help you and your loved ones live well with vascular dementia.