Vascular dementia

Your health experts: Dr Pravir Sharma, Consultant in Mental Health Care and Old Age Psychiatry and Dr Adrian Raby, General Practitioner
Content editor review by Rachael Mayfield-Blake, December 2021
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 set of symptoms including 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. Around one in five people with dementia have this type. The main risk factor is age – 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.

Symptoms can come on suddenly and may start after a stroke. Personality changes are often the first sign, before other symptoms more commonly linked to dementia, such as loss of memory and confusion. Depression and anxiety are also common.

Vascular dementia does get worse over time. It tends to worsen in steps (rather than gradually), because it’s often caused by a series of small strokes. In between, the condition is stable.

Causes of vascular dementia

Doctors understand the causes of vascular dementia better than some other dementias. If blood vessels supplying the brain leak or get blocked, brain cells eventually die. This causes the symptoms.

Brain cells may die after the blood supply is cut off in a stroke or after a series of ‘mini-strokes’, which the person may not be aware of. This is called multi-infarct dementia.

Lack of blood to the brain may also be caused by a bleed (haemorrhage). Small bleeds may happen if protein deposits collect on the walls of small arteries and weaken them. These beta-amyloid proteins are also linked to Alzheimer’s.

There may be a lack of blood to small vessels deep in the brain. This causes a rarer type of vascular dementia, called subcortical vascular dementia, which develops more gradually.

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.
  • Although rare, vascular dementia can run in families. One rare genetic condition, CADASIL, affects younger people.

Symptoms of vascular dementia

Vascular dementia symptoms vary. The symptoms depend on which part of the brain is affected.

The first sign may be personality change, often noticed by family and friends. Thinking, planning and concentration are usually more affected than memory problems, which usually come on later. They may have difficulty solving problems or taking in information.

Over time, confusion may develop. Depression and anxiety are common. People with vascular dementia are more aware of their condition than with other dementias, so notice their symptoms.

Around two out of every 10 people diagnosed become agitated or aggressive at times. They may become easily upset or angry and speak or behave inappropriately. Other symptoms include:

  • loss of interest and enthusiasm
  • falls if they’re unsteady when walking
  • fits (seizures)
  • loss of bladder control (incontinence)
  • delusions (false beliefs)

As with other types of dementia, people with vascular dementia find it increasingly difficult to cope and will need more help over time. They may eventually need residential care.

Help when you need it

Arranging care can be a little overwhelming at first. Our helpful, understanding care advisors offer free advice on anything from funding to finding just the right home.

Call a customer care advisor on 0370 218 4495

Treatment of vascular dementia

There’s no cure for vascular dementia. But there are medicines that can slow it down. Other therapies can improve life for people.

Medicines to slow vascular dementia

Treating the underlying cause helps to slow down vascular dementia. A doctor may prescribe medicines for high blood pressure, for example. Controlling diabetes will also help.

Statins and a small daily dose of aspirin may help to reduce risk of stroke. Preventing further strokes helps to slow development of more serious dementia symptoms. If a person can’t take aspirin, another medicine used to prevent stroke is called clopidogrel.

For mixed dementia, doctors may prescribe a medicine for Alzheimer’s. This may also be suggested for vascular dementia with Parkinson's disease dementia, or dementia with Lewy bodies.

Medicines to manage other difficulties

As depression is common in vascular dementia, a doctor may prescribe anti-depressants. Depending on someone’s ability to communicate and understand, doctors may suggest talking therapies, to help them emotionally.

There are medicines that calm people down if they are aggressive and agitated. But these can worsen other dementia symptoms or increase risk of stroke. So doctors only use them 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. These 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.

It may help to reduce agitation if carers explain what they are going to do in advance. Using calendars, clocks, and charts 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

It is upsetting, but knowing what to expect can help with planning ahead. Someone with vascular dementia is likely to need a lot of care as their condition worsens. They may eventually need residential care.

How long someone may live varies and is difficult to predict. On average people live for around five years after their diagnosis, but this does vary a great deal.

Prevention of vascular dementia

Vascular dementia is one type where you can take definite steps to reduce your risk . Even after diagnosis, you can still make changes to help slow down the condition and stop it getting worse. It may help to:

Dementia describes a set of symptoms, including problems with memory, thinking and behaviour. These get worse over time. There are different types of dementia – the most common is Alzheimer’s disease, followed by vascular dementia. Vascular dementia differs to other types as the symptoms usually progress in steps, rather than gradually.

See our section: About vascular dementia above for more information.

Vascular dementia can affect people in different ways. Symptoms include personality changes, poor concentration and difficulty walking. Like other types of dementia, people find it increasingly difficult to live independently and need more help over time. They may eventually need residential care.

See our section: Vascular dementia symptoms above for more information.

Symptoms can come on more suddenly than other types of dementia, if it starts after a stroke. Vascular dementia is often caused by a series of small strokes and symptoms usually get worse in steps, rather than gradually. There are usually stable periods in between.

See our section: About vascular dementia above for more information.

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  • Personal communication, Dr Pravir Sharma, Consultant in Mental Health Care and Old Age Psychiatry, 5 December 2021
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