Vascular dementia
- Dr Nicholas Clarke, Consultant in Old Age Psychiatry
Vascular dementia happens when your brain isn’t getting enough blood. It’s the second most common type of dementia. Dementia can cause problems with memory and thinking. Vascular dementia sometimes happens after a stroke or a series of ‘mini-strokes’.
About vascular dementia
Vascular dementia is caused by problems with small blood vessels in the brain. It affects around one in five people with dementia. You’re more likely to develop vascular dementia as you get older – most people are over 70 when it starts. Unlike Alzheimer’s disease, vascular dementia is more common in men than in women. Some people have Alzheimer’s disease as well. This is called mixed dementia.
Vascular dementia symptoms can come on suddenly and may start after a stroke. The first signs may be personality changes and problems with concentration and decision-making. Other common dementia symptoms – for example, memory loss – usually happen later on.
Vascular dementia usually gets worse over time. It may be caused by a series of small strokes called transient ischaemic attacks (TIAs). In between these ‘mini-strokes’, the condition stays stable. Transient ischaemic attacks are more common in middle-aged and older people. They’re also more common in men than in women.
Causes of vascular dementia
Doctors understand vascular dementia causes better than the causes of some other types of dementia. If blood vessels supplying the brain leak or get blocked, brain cells eventually die. This causes symptoms of vascular dementia.
Vascular dementia may be caused by a stroke. This is when the blood supply to the brain gets cut off or reduced. Sometimes vascular dementia is caused by a series of ‘mini-strokes’. This is called multi-infarct dementia.
Vascular dementia can be caused by a bleed (haemorrhage). This can damage nearby brain tissue as well as causing dementia later on. Small bleeds may happen if protein deposits collect on the walls of small arteries and weaken them. These deposits are beta-amyloid proteins, which are also linked to Alzheimer’s disease.
If small vessels deep in the brain aren’t getting enough blood, this can cause a rarer type of vascular dementia. This is called subcortical vascular dementia. It develops more gradually than other types of vascular dementia.
The risk factors for stroke and vascular dementia are the same. These include:
- smoking
- being very overweight
- having high blood pressure
- having diabetes – this can damage small and large blood vessels.
- having atrial fibrillation
- having coronary heart disease
Vascular dementia can sometimes run in families. One rare genetic condition, CADASIL, affects younger people.
Symptoms of vascular dementia
Vascular dementia symptoms vary from person to person. They often depend on which part of the brain is affected. The condition can occur in stages.
The first signs of vascular dementia may include:
- personality and mood changes, often noticed by family and friends
- problems with thinking, planning and concentration
- difficulty solving problems or taking in information
- struggling to remember how to use familiar equipment
- finding it more difficult to manage finances
The memory problems usually happen later on as the condition gets worse. Vascular dementia can also cause depression and anxiety. And some people become agitated or aggressive at times.
Other symptoms of vascular dementia include:
- loss of interest and enthusiasm
- falls due to unsteadiness when walking
- fits (seizures)
- loss of bladder control (incontinence)
People with vascular dementia find it increasingly difficult to cope and will need more help over time. They may eventually need residential care.
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Treatment of vascular dementia
There’s no cure for vascular dementia. But certain medicines can slow down the condition. Other vascular dementia treatments and therapies can improve people’s daily life.
Medicines to slow vascular dementia
Treating the underlying cause of vascular dementia may help to slow down how quickly the symptoms get worse. A doctor may prescribe medicines to:
- treat any underlying high blood pressure or diabetes
- reduce the risk of having another stroke – these medicines include statins and a small daily dose of aspirin or clopidogrel
- treating atrial fibrillation – these medicines include anticoagulants to stop blood clotting as well as other treatments
For mixed dementia, doctors may prescribe a medicine for Alzheimer’s disease. This may also be suggested for vascular dementia with Parkinson’s disease dementia or dementia with Lewy bodies.
Medicines to manage other difficulties
Depression is common in vascular dementia. If this is one of the symptoms, a doctor may prescribe anti-depressants.
Doctors can prescribe medicines that calm people down if they’re aggressive and agitated. But these medicines can make other dementia symptoms worse and may increase the risk of stroke. So doctors only prescribe these medicines for a short time when other ways of calming the situation have failed.
Other therapies for vascular dementia
Other ways to improve life for people with vascular dementia and their families include:
- physiotherapy and occupational therapy to keep the person with dementia mobile and to avoid falls
- complementary therapies such as massage and aromatherapy for people who are unsettled, agitated or depressed
- talking therapies such as cognitive behavioural therapy (CBT) to help manage mood changes
- social activities such as gardening to reduce apathy or depression
It may help to reduce agitation if carers explain what they’re going to do in advance. Using calendars, clocks, and charts can help people with dementia stay oriented to time and place.
Exercise and activity-based therapies may also be helpful, including music therapy or dance.
Outlook of vascular dementia
Being diagnosed with vascular dementia is upsetting. There’s also a lot to think about. If you or a loved one has been given a vascular dementia diagnosis, it’s important to know you’re not alone. You can get support from specialist dementia support workers, counsellors, and support groups.
Knowing what to expect can help with planning ahead and finding ways to cope. Someone with vascular dementia is likely to need a lot of care as their condition gets worse. They may eventually need residential care.
How long someone may live with vascular dementia differs from person to person and is difficult to predict.
Prevention of vascular dementia
If you’re at a high risk of vascular dementia, you can take steps to reduce your risk of developing the condition. Even after diagnosis, you can still make changes to help slow down the condition and stop it getting worse. It may help to:
- stop smoking
- eat a healthy diet
- keep to a healthy weight for your height
- exercise regularly
- have your blood pressure checked and treated if it’s high
- cut down on alcohol
Dementia symptoms include problems with memory and thinking. These symptoms gradually get worse over time. Vascular dementia is the second most common type of dementia.
For more information, see our section: About vascular dementia.
Vascular dementia affects people in different ways. Common symptoms include personality changes, poor concentration, finding it hard to make decisions, and difficulty walking. People with vascular dementia gradually need more help with everyday tasks. They may eventually need residential care.
For more information, see our section on symptoms of vascular dementia.
Vascular dementia symptoms can come on suddenly, especially after a stroke. But this varies from person to person. If the symptoms are caused by a series of small strokes, there may be stable periods in between the strokes.
For more information, see our section: About vascular dementia.
How long people live with vascular dementia varies and is hard to predict. The symptoms get worse gradually over time.
For more information, see our sections on symptoms of vascular dementia and outlook of vascular dementia.
Vascular dementia symptoms gradually get worse over time. Early signs include problems with thinking, concentration, planning, and organising. Memory loss, mood changes, and problems with behaviour usually happen later on.
For more information, see our section on symptoms of vascular dementia.
Stroke
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- Vascular dementia. Patient. patient.info, last updated July 2021
- Dementia. NICE British National Formulary. bnf.nice.org.uk, last updated March 2024
- Vascular cognitive impairment and dementia. MSD Manuals. msdmanuals.com, reviewed/revised February 2023
- Dementia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2024
- Jolly AA, Nannoni S, Edwards H, et al. Prevalence and predictors of vascular cognitive impairment in patients with CADASIL. Neurology 2022 Aug 1; 99(5):e453-e461. doi: 10.1212/WNL.0000000000200607.
- After receiving a dementia diagnosis. Alzheimer’s Society. www.alzheimers.org.uk, accessed May 2024
- Transient ischaemic attacks. Patient. patient.info, last updated June 2024
- Transient ischemic attacks (TIAs). MSD Manuals. msdmanuals.com, reviewed/revised July 2023
- Viticchi G, Falsetti L, Burattini M, et al. Atrial fibrillation on patients with vascular dementia: A fundamental target for correct management. Brain Sci 2020 Jul 2; 10(7):420. doi: 10.3390/brainsci10070420.
- Atrial fibrillation. patient.info, last updated May 2021 https://patient.info/doctor/atrial-fibrillation-pro
- Personal communication by Dr Nick Clarke, Consultant in Old Age Psychiatry, October 2024
- Victoria Goldman, Freelance Health Editor
