Vascular dementia

Expert reviewer, Professor Graham Stokes, psychologist and dementia specialist
Next review due December 2019

Vascular dementia is the second most common type of dementia. Between one in five and one in six cases diagnosed are this type. The cause of vascular dementia is a lack of blood supply to areas of the brain. Sometimes this happens after a stroke. Sometimes it’s after a series of ‘mini-strokes’ (‘multi-infarct dementia’).

About vascular dementia

The biggest risk factor for vascular dementia is age. This type of dementia is most common in those between 60 and 70. Other common risk factors for stroke are also important, including smoking, being very overweight and having high blood pressure. Unlike Alzheimer’s disease, vascular dementia is more common in men than women.

Symptoms of vascular dementia tend to come on more suddenly than with other types of dementia and may show up after a stroke. People may have personality changes before developing 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. But because of the cause, deterioration tends to happen in ‘steps’ (rather than steadily), with periods in between when the condition is stable.

Symptoms of vascular dementia

Vascular dementia symptoms differ from person to person. The symptoms depend on which part of the brain is affected by the lack of blood supply that causes vascular dementia. The doctor will look for specific symptoms that may show that a particular part of the brain has been affected.

The symptoms of vascular dementia can include:

• specific problems with sight, such as loss of a particular area of vision in one or both eyes
• difficulty speaking
• paralysis in part of the body, for example on one side only
• movement disorders, such as tremors, muscle spasms, involuntary movements or not being able to keep still

Other signs of vascular dementia may include:

• difficulty problem-solving or taking in information
• loss of inhibitions (people may speak or behave inappropriately)
• apathy
• loss of concentration and difficulty focusing
• depression and anxiety
• memory loss
• emotional symptoms, such as becoming easily upset or angry
• fits (seizures)
• unsteadiness and tendency to fall
• loss of bladder control

How vascular dementia develops

Vascular dementia usually comes on more suddenly than other types of dementia. This is one of the main differences between vascular dementia and Alzheimer's disease, for example. Vascular dementia often follows a stroke or series of ‘mini-strokes’. In fact, dementia that starts within three months of having a stroke is a strong indication to a doctor that dementia may be vascular.

As with other types of dementia, vascular dementia is a progressive condition and will worsen over time. The dementia symptoms tend to get worse in ‘steps’, with periods in between when it is quite stable. Generally, vascular dementia tends to have a shorter course than Alzheimer’s disease. On average someone lives for around five years after diagnosis, but this does vary a lot between people, so it can’t be taken as a ‘guide’.

The first sign of vascular dementia may be personality changes. Often, this is noticed by the people close to the person with vascular dementia. It is quite common after a major stroke for someone’s emotions to be triggered more easily and this can be a sign of damage to particular parts of the brain.

This is one difference between vascular dementia and Alzheimer's disease. With Alzheimer's disease, memory problems are often the first sign of dementia. 

As the condition worsens, people may then develop problems with memory and reasoning. These may be worse at some times than at others. Generally, thinking, planning and concentrating are more affected than memory when it comes to vascular dementia. Over time, people may become slower and confused, and develop depression. About one in 10 people develop fits.

As with many long-term illnesses, there can be complications with vascular dementia. Depression is very common, affecting between two and five out of every 10 people. This can be because people with vascular dementia have greater and longer-lasting insight into their condition than with other types of dementia. They realise that they are experiencing vascular dementia symptoms.

Around two out of every 10 people diagnosed with vascular dementia become agitated or aggressive at times, although doctors don’t fully understand why this is. Falls may be more likely, particularly in people who have become unsteady when walking.

As with other types of dementia, people with vascular dementia will have increasing difficulty living independently and will need more help over time. They may eventually need looking after in residential care. If you’re caring for someone with vascular dementia, you may need help at home and periods of respite care, particularly if your relative is disabled after having a stroke as well as having vascular dementia.

Causes of vascular dementia

Unlike other types of dementia, doctors fully understand the cause of vascular dementia. Parts of the brain become damaged because there is a problem with the blood supply. This lack of blood supply causes vascular dementia symptoms. Blood brings oxygen and nutrients to all parts of the body, including the brain. So if there is no ready flow of blood to brain cells, they will not be able to work properly and will eventually die.

There are several sub-types of vascular dementia.

• The damage that causes vascular dementia may be due to a large stroke.
• It could also be caused by a series of ‘mini-strokes’. These are known as infarcts, so this specific type of dementia is ‘multi-infarct dementia’.
• It may be due to small arteries ‘furring up’ (known as atherosclerosis or arteriosclerosis) in a similar way to the blocking of the coronary arteries in a heart attack. High blood pressure can lead to stroke and arteriosclerosis.
• A bleed in the brain (haemorrhage) will also interrupt the blood supply. Large bleeds are generally caused by high blood pressure. Small bleeds that cause vascular dementia may be due to protein deposits collecting on the walls of small arteries and weakening them. These are deposits of a protein called beta-amyloid, which is also associated with Alzheimer’s disease.
• There is a rarer type of dementia called ‘subcortical vascular dementia’, affecting small blood vessels deep in the brain. Here, the progression of dementia symptoms may be more gradual.

Diabetes can cause damage to small and large blood vessels and can be a contributing cause of vascular dementia. It isn’t unusual for people with vascular dementia to have Alzheimer’s disease as well. This combination of vascular dementia and Alzheimer's disease is called mixed dementia.

Medicines for vascular dementia

There is sadly no cure for vascular dementia, and there are no medicines that can specifically treat the symptoms of vascular dementia. The medicines available for Alzheimer’s disease have not been shown to work in vascular dementia and are not recommended for use outside clinical trials. However, someone with mixed dementia may be prescribed one of these medicines.

Find out more about the medicines available for Alzheimer’s disease.

Treatment of vascular dementia involves treating any underlying causes, which will help to slow down the development of vascular dementia. This means what the doctor prescribes will vary, depending on other medical conditions. They may suggest anti-hypertensives to treat high blood pressure, for example.

Some doctors 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. Some people can’t take aspirin, if they’ve had a stomach ulcer, for example.

Other medicines that may be used in vascular dementia

As depression is common in vascular dementia, the doctor may prescribe a course of anti-depressants.

People with vascular dementia can sometimes have episodes of aggression and agitation. There are medicines available that can calm people down, but these may make symptoms of vascular dementia worse, or increase the risk of stroke. So doctors will only use them for a short time if other ways of trying to calm the situation have failed.