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What is Vascular Dementia?

Vascular dementia is one form of dementia that impacts subcortical structures in your brain. In fact, Vascular dementia is the second most common form of dementia. Vascular dementia can cause problems with memory, speech or balance. These changes can happen suddenly or begin mildly and get worse over time. The brain changes of vascular dementia are found in about 40 percent of brains from individuals with dementia. About 10 percent of brains from individuals with dementia show evidence of vascular dementia alone. However, it is very common as a mixed pathology in older individuals with Alzheimer’s dementia, about 50 percent of whom have evidence of infarcts (silent strokes)

Subcortical Dementia

Several disorders affect subcortical structures (white matter, basal ganglia, thalamus) with relative sparing of the cerebral cortex. These include vascular dementia, Parkinson’s disease, Huntington’s disease and progressive supranuclear palsy.

These disorders are characterized by a multitude of physical signs (in contrast to the cortical dementias such as Alzheimer’s disease) and an absence of cortical features (agnosia, aphasia and apraxia). Subcortical dementia is characterized by a slowness and rigidity of thinking with difficulty in planning, organizing and sequencing mental events. These individuals can be forgetful but their amnesia is not severe. They may be apathetic and exhibit difficulties in tasks requiring mental manipulation (such as mental arithmetic), comprehending complex syntax, reversing digits or sequences. In older adults with progressive small vessel ischemic disease, depression, psy­chomotor slowing and executive dysfunction are common.

Vascular Dementia

Vascular dementia includes multi-infarct dementia, stroke with dementia, and subcortical vascular dementia. It is being increasingly recognized that subcortical small vessel disease is a prominent cause of vascular dementia. Consequently, the classical step-wise course with relatively acute deteriorating events is not a necessary requisite for a possible vascular cause for the dementing disorder. Vascular dementia can cause different symptoms depending on where the blood vessels are damaged in the brain. For example, a person who had a stroke may have sudden problems with memory, balance, or speech. However, a person can have several strokes that may be unnoticeably small, but the damage can add up over time. Therefore, the level of cognitive impairment (or cognitive deficit) will depend on the location of the vascular event, the number of vascular events the person has had, and the size of each event.

Major or mild vascular neurocognitive disorder (or vascular cognitive impairment, VCI) are other terms that you may hear about for vascular dementia. Vascular dementia should be diagnosed in individuals whose clinical features are consistent with a vascular etiology (suggested by cognitive deficits with an onset following a cerebrovascular event or decline in complex attention (including processing speed) and frontal-executive functioning, and where there is evidence of cerebrovascular disease from physical examination, history, and/or neuroimaging. These patients may present with physical and mental decline. Neurological examination reveals focal signs (dysarthria, pyramidal weakness, rigidity, akinesia, ataxia and gait disorder). Neuropsychology testing detects a subcortical deficit (as described above). MRI shows nonspecific atrophy with deep white matter lesions and/or lacunar infarcts.

Vascular Dementia Risk Factors

There are multiple risk factors that contribute to the development of vascular dementia that include:

• Hypertension

• Atrial fibrillation and other cardiac conditions

• High cholesterol

• Diabetes

• Metabolic syndrome

• Smoking

• Sleep-disordered breathing

• Sedentary lifestyle

• Hyperhomocysteinemia

Other Forms of Dementia

Although subcortical dementia may resemble the neuropsychological deficits (frontal) of frontotemporal Dementia (FTD), the presence of florid neurological signs and the absence of a prominent personality change and preservation of insight differentiate it. Frontotemporal dementia is considered an anterior cortical syndrome. An early change in personality, loss of insight and prominent behavioral changes constitute the distinct clinical picture in the behavioral variant of FTD. In the language variant of FTD, the person experiences notable language impairments (expressive, receptive, and/or written) at the start of this disorder and then other cognitive functions are impacted as the disease progresses.

Meanwhile, Alzheimer’s disease is considered a cortical dementia characterized by amnesia, aphasia, disorientation, and apraxia. Bilateral parietotemporal defects on head imaging are strongly supportive of the diagnosis of Alzheimer’s disease.

Things to Rule Out

Other things to rule out include side effects of medications, delirium, reversible metabolic disorders, and neurodegenerative conditions with similar symptoms (for example, Alzheimer’s disease). It is important to note that vascular dementia can coexist with other disorders affecting cognition, especially Alzheimer’s disease. If vascular dementia coexists at the same time with another form of dementia (such as Alzheimer’s disease) then they may report this as a Mixed Dementia.

What Can You Do?

There are various ways to help a person with vascular dementia. Research has shown that physical exercise and maintaining a healthy weight help to enhance brain health and reduce the risk of heart problems, stroke and other diseases that affect blood vessels. A balanced diet, enough sleep and limited alcohol intake are other important ways to promote good brain health and reduce the risk for heart disease. Other illnesses that affect the brain, such as diabetes, high blood pressure and high cholesterol, should also be treated if present.

What if I Have Concerns?

If you or a loved one has been diagnosed with dementia, you are not alone. With respect to vascular dementia, many symptoms of vascular dementia go unnoticed or are attributed to another condition, such as stress. Professional neurocognitive testing, such as neuropsychological testing, should be able to detect the changes in memory and function commonly associated with vascular dementia. If you notice changes in yourself or in a loved one, make an appointment to speak with your primary doctor or a specialist (such as a neurologist).

If you have a history of heart attack or stroke, these neurocognitive testing’s can be important. Your primary care doctor may notice very minor changes that might be easy to miss. Recognizing the changes and diagnosing them can speed up treatment and aid in diagnostic clarity. The sooner a person is treated, the better they can do in the future by connecting them with proper resources and services in the community near you.

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