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Vascular dementia
Expert reviewers, Dr Pravir Sharma, Consultant in Mental Health Care and Old Age Psychiatry and Dr Adrian Raby, General Practitioner
Next review due December 2024
Vascular dementia happens when there’s a problem with the supply of blood to the brain. It is the second most common type of dementia. Dementia is a term used to describe a set of symptoms that include problems with memory and thinking. Vascular dementia sometimes happens after a stroke or a series of mini-strokes.
About vascular dementia
Vascular dementia is a type of dementia that’s caused by problems with the small blood vessels in the brain. Around one in five people with dementia have vascular dementia. The biggest thing that increases your risk of getting vascular dementia is age. People don’t usually develop it until after they reach 70. Vascular dementia is more common in men than in women.
Symptoms of vascular dementia can come on more suddenly than other types of dementia. Symptoms may show up after a stroke. A person’s personality may change before they develop other symptoms more commonly linked to dementia, such as memory loss and confusion. Depression and anxiety are also common.
Vascular dementia does get worse over time. But because it’s often caused by a series of small strokes, this tends to happen in steps, rather than gradually. There are usually periods in between when the condition is stable.
Some people with vascular dementia have Alzheimer’s disease as well. This combination of vascular dementia and Alzheimer's disease is called mixed dementia.
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Help when you need itCauses of vascular dementia
Doctors understand the causes of vascular dementia better than some of the other types of dementia. Blood is delivered to the brain through a series of vessels called the vascular system. If these vessels are damaged (if they leak or get blocked), blood cannot reach the brain cells and eventually these cells will die. This can cause vascular dementia symptoms.
Brain cells may die after the blood supply is cut off in a stroke. It may also happen following a series of mini-strokes, some of which a person might not be aware they’ve had. You may hear this called multi-infarct dementia.
As well as stroke, there are other reasons for a lack of blood supply to the brain that can cause vascular dementia. These include the following.
- A bleed in the brain (haemorrhage) can interrupt the blood supply to the brain. A bleed may be small or large. Small bleeds that cause vascular dementia may happen if protein deposits collect on the walls of small arteries. These deposits weaken the arteries. The protein in these deposits is called beta-amyloid, and it is also linked to Alzheimer’s disease.
- There may be a lack of blood supply to small blood vessels deep in the brain – this causes the rarer type of vascular dementia called subcortical vascular dementia. The progression of dementia symptoms may be more gradual with this type.
Things that increase your risk of a stroke in turn increase your chances of vascular dementia. These include smoking, being very overweight and having high blood pressure. Diabetes can damage small and large blood vessels so may contribute to vascular dementia too.
Rarely, vascular dementia may be caused by genetics. One rare genetic condition is called CADASIL and affects people at a younger age.
Symptoms of vascular dementia
Vascular dementia symptoms differ from person to person. The symptoms depend on which part of the brain is affected.
Signs of vascular dementia may include:
- difficulty solving problems or taking in information
- loss of inhibitions (people may speak or behave inappropriately)
- loss of interest and enthusiasm
- depression and anxiety
- memory loss
- emotional symptoms, such as becoming easily upset or angry
- fits (seizures)
- unsteadiness, which can lead to falls
- loss of bladder control (incontinence)
- delusions (false beliefs)
Other symptoms of strokes that may happen with vascular dementia can include:
- changes to a person’s personality
- poor attention and concentration
- difficulties walking
- problems with sight
- paralysis on one side of the body
- difficulty swallowing and slurred speech
- problems with movement, such as tremors, muscle spasms, and involuntary movements
How vascular dementia develops
Unlike other forms of dementia, vascular dementia can come on suddenly. Vascular dementia often develops after a stroke or series of mini-strokes. Dementia that starts within three months of having a stroke is a strong sign to a doctor that a person might have vascular dementia.
As with other types of dementia, vascular dementia is a progressive condition that will get worse over time. But the dementia symptoms tend to get worse in stages, with periods in between when it’s quite stable. Vascular dementia is split into early and longer-term stages.
Early stages
The first sign of vascular dementia may be changes to a person’s personality. This is often noticed by people closest to the person with vascular dementia. Problems with memory and reasoning usually come on later in a person with vascular dementia, as the condition gets worse. A person’s ability to think, plan and concentrate are usually more affected than their memory.
Longer term
Over time, people with vascular dementia may become more confused.
Depression is common in people with vascular dementia. This can be because people with vascular dementia are more aware of their condition compared with other types of dementia. They may realise that they have dementia symptoms.
Around two out of every 10 people diagnosed with vascular dementia become agitated or aggressive at times, which can be upsetting for those close to them. Falls may be more likely, particularly in people who have become unsteady when they walk.
As with other types of dementia, people with vascular dementia will find it increasingly difficult to live independently and will need more help over time. They may eventually need residential care.
If you care for someone with vascular dementia, it’s important to recognise that this can be very stressful. It’s therefore important to look after yourself as a dementia carer. You may need help at home and periods of respite care, particularly if your relative is disabled from a stroke, as well as having vascular dementia.
Treatment of vascular dementia
There’s no cure for vascular dementia. But there are medicines that can slow down its development, and other therapies that can improve quality of life.
Medicines to slow down vascular dementia
Treatment of vascular dementia involves treating the underlying causes, which will help to slow down its development. A doctor may prescribe anti-hypertensive medicines to treat high blood pressure, for example. If a person has diabetes, their doctor will make sure it’s well controlled.
Statins may help to reduce the risk of stroke. Or a doctor may prescribe a small dose of aspirin a day if vascular dementia is caused by strokes. This may help to slow down the development of more serious vascular dementia symptoms by preventing further strokes. If a person can’t take aspirin, another medicine called clopidogrel may be used to prevent strokes.
For people with mixed dementia, doctors may prescribe a medicine for Alzheimer’s disease. This may also be an option for people with vascular dementia and Parkinson's disease dementia, or dementia with Lewy bodies.
If you’re caring for someone with dementia, it can be hard remembering what medicines they need to take, when. You may find it helpful to download our medicines planner for dementia carers (PDF, 0.8MB).
Medicines to manage other difficulties
As depression is common in vascular dementia, a doctor may prescribe antidepressants. Depending on how well the person is able to communicate and understand, doctors may suggest talking therapies as a way to help them emotionally.
People with vascular dementia can sometimes be aggressive and agitated. There are medicines that can calm people down, but these may make symptoms of vascular dementia worse or increase the risk of stroke. Because of this, doctors will only use them for a short time when other ways of trying to calm the situation haven’t worked.
Other therapies for vascular dementia
There are several other ways to improve life for people with vascular dementia and their families. Physiotherapy and occupational therapy can help to keep the person with dementia mobile and avoid falls.
People who are unsettled, agitated or depressed may find complementary therapies such as aromatherapy helpful. Other things that may help to reduce agitation include carers explaining what they are going to do in advance. It can also help to use calendars, clocks, and charts to help people with vascular dementia stay oriented to the time and place. Exercise and activity-based therapies may also be helpful, including music therapy or dance.
Support for carers
If you care for somebody with vascular dementia, it may help to learn how the condition is likely to affect them. It can make it easier to prevent problems and cope with them when they arise. Caring for someone with dementia can be particularly demanding and stressful so it’s important you look after yourself.
Outlook of vascular dementia
It can be upsetting to read but being prepared for what to expect can help with planning ahead. Someone with vascular dementia is likely to need a lot of care as the condition progresses. How long someone may live varies from person to person and is difficult to predict. On average, people live for around five years after their diagnosis, but this does vary a great deal.
There is lots of support and advice available to help those affected by dementia. See our Other helpful websites for details of organisations that can help.
Preventing vascular dementia
Vascular dementia is one type of dementia where you can take definite steps to reduce your risk of developing it. Even after you’re diagnosed, you can still make some changes to your lifestyle 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
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Is dementia different from vascular dementia?
Dementia is a term used to describe a set of symptoms that include problems with memory, thinking and behaviour, and these get worse over time. There are different types of dementia. The most common type is Alzheimer’s disease, and the next is vascular dementia. Vascular dementia differs from other types of dementia in that the symptoms usually progress in steps, rather than gradually.
For more information, see our section: About vascular dementia
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What happens to someone with vascular dementia?
Vascular dementia can affect people in different ways. Symptoms of vascular dementia can include changes to a person’s personality, a lack of concentration and difficulties walking. Like other types of dementia, people with vascular dementia will find it increasingly difficult to live independently and will need more help over time. They may eventually need residential care.
For more information, see our section: How vascular dementia develops.
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Does vascular dementia progress quickly?
Symptoms of vascular dementia can come on more suddenly than other types of dementia if it happens after a stroke. Since vascular dementia is often caused by a series of small strokes, symptoms of vascular dementia usually get worse in steps, rather than gradually. There are usually periods in between when the condition is stable.
For more information, see our section: About vascular dementia.
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Related information
Dementia explained
An overview of what dementia is, the different types and how it develops.
Diagnosing dementia
Here you can find information about dementia symptoms, how it's diagnosed and what happens afterwards.
Caring for someone with dementia at home
Here you can find tips about caring for a loved one who has dementia.
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Other helpful websites
- Alzheimer's Society
0333 150 3456
www.alzheimers.org.uk - Carers UK
0808 808 7777
www.carersuk.org - Age UK
0800 678 1602
www.ageuk.org.uk
Discover other helpful health information websites.
- Alzheimer's Society
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Sources
- Dementia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised May 2021
- Vascular dementia. Patient. patient.info, last edited 21 July 2021
- Vascular dementia. MSD Manuals. msdmanuals.com, last full review/revision March 2021
- Vascular dementia. BMJ Best Practice. bestpractice.bmj.com, last reviewed 1 October 2021
- Cerebrovascular disease. American Association of Neurological Surgeons. www.aans.org, accessed 1 November 2021
- Diabetic cardiovascular disease. BMJ Best Practice. bestpractice.bmj.com, last reviewed 1 October 2021
- Dementia. World Health Organization. www.who.int, published 2 September 2021
- Dementia. NICE British National Formulary. bnf.nice.org.uk, last updated 6 October 2021
- Personal communication, Dr Pravir Sharma, Consultant in Mental Health Care and Old Age Psychiatry, 5 December 2021
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Author information
Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, December 2021
Expert reviewers, Dr Pravir Sharma, Consultant in Mental Health Care and Old Age Psychiatry and Dr Adrian Raby, General Practitioner
Next review due December 2024
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