Vascular Dementia - Signs, Symptoms, Prevention, and Treatment
Vascular dementia is the second most common form of dementia, accounting for up to 40 percent of dementia cases in older adults. Vascular dementia is caused by reduced blood flow to the brain–usually from a stroke or series of strokes. While the strokes may be unnoticeably small, the damage can add up over time, leading to memory loss, confusion, and other signs of dementia. With these guidelines, however, it may be possible to prevent further blockages and compensate for brain damage that has already occurred.
What is vascular dementia?
Vascular dementia refers to a subtle, progressive decline in memory and cognitive functioning. It occurs when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system. If blood supply is blocked for longer than a few seconds, brain cells can die, causing damage to the cortex of the brain—the area associated with learning, memory, and language.
Depending on the person, and the severity of the stroke or strokes, vascular dementia may come on gradually or suddenly. Currently, there is no known cure, but the good news is that making certain lifestyle changes and using practical strategies may help prevent strokes, compensate for cognitive loses, and slow its development.
Multi-infarct dementia: The most common type of vascular dementia
The most common type of vascular dementia is multi-infarct dementia (MID), which is caused by a series of small strokes, or “mini-strokes,” that often go unnoticed. These mini-strokes, also referred to as transient ischemic attacks (TIAs), result in only temporary, partial blockages of blood supply and brief impairments in consciousness or sight. Over time, however, as more areas of the brain become damaged, the symptoms of vascular dementia begin to appear.
Signs and symptoms of vascular dementia
Vascular dementia affects different people in different ways and the speed of the progression varies from person to person. Some symptoms may be similar to those of other types of dementia and usually reflect increasing difficulty to perform everyday activities like eating, dressing, or shopping.
Behavioural and physical symptoms can come on dramatically or very gradually, although it appears that a prolonged period of TIAs—the mini-strokes discussed above—leads to a gradual decline in memory, whereas a bigger stroke can produce profound symptoms immediately. Regardless of the rate of appearance, vascular dementia typically progresses in a stepwise fashion, where lapses in memory and reasoning abilities are followed by periods of stability, only to give way to further decline.
Common mental and emotional signs and symptoms of vascular dementia
Memory problems; general forgetfulness
Unusual mood changes (e.g. depression, irritability)
Hallucinations and delusions
Confusion, which may get worse at night
Personality changes and loss of social skills
Common physical signs and symptoms of vascular dementia
Leg or arm weakness
Moving with rapid, shuffling steps
Loss of bladder or bowel control
Common behavioural signs and symptoms of vascular dementia
Language problems, such as difficulty finding the right words for things
Getting lost in familiar surroundings
Laughing or crying inappropriately
Difficulty planning, organizing, or following instructions
Difficulty doing things that used to come easily (e.g. paying bills or playing a favourite card game)
Reduced ability to function in daily life
Causes of vascular dementia
Stroke, small vessel disease, or a mixture of the two can cause vascular dementia. Most commonly there is a blockage of small blood vessels somewhere in the vast system of arteries that feeds the brain and enters through the base of the skull. Blockages may be caused by plaque build-up on the inside of the artery wall, or by blood clots which have broken loose and clogged a tributary further downstream. Clots can form as a result of abnormal heart rhythms, or other heart abnormalities. Also, a weak patch on an artery wall can balloon outward and form an aneurysm, which can burst and deprive the brain cells of oxygen.
It is estimated that about 50 percent of the cases of vascular dementia result from hypertension, or high blood pressure. Less common causes of vascular dementia are associated with autoimmune inflammatory diseases of the arteries such as lupus and temporal arteritis, which are treatable with drugs that suppress the immune system.
Know the symptoms of stroke
Call 999 immediately if you experience any of the following symptoms, which may indicate you’ve had a stroke or a transient ischemic attack (TIA), or mini-stroke.
Numbness, paralysis, or weakness on one side of your body or face.
Trouble speaking (e.g. slurring your words, inability to repeat a simple sentence).
Loss of vision or seeing double.
Loss of balance and coordination (e.g. dizziness, trouble walking).
Sudden, severe headache (may include a stiff neck, vomiting, or pain between your eyes).
Vascular dementia prevention and treatment
There is not yet a known cure for vascular dementia, so prevention is important. The best way to prevent vascular dementia is to lower your risk of stroke. This means getting high blood pressure under control, avoiding cigarettes, and controlling cholesterol levels and diabetes.
But even if you or a loved one have already been diagnosed with vascular dementia, it’s not too late to do anything about it. If you treat the risk factors that led to vascular dementia, you may be able to slow the progression of the disease and possibly reverse some of the symptoms. The most important thing is minimize your risk of having another stroke and making the dementia worse.
While there are not yet any approved medications for the treatment of vascular dementia, a number of medications used to treat the cognitive symptoms of Alzheimer’s disease appear to work for vascular dementia, too.
Prevent and treat vascular dementia by reducing your risk for stroke
Know your blood pressure. If high, work with your doctor to lower it.
Find out from your doctor if you have atrial fibrillation.
If you smoke, stop.
If you drink alcohol, do so in moderation.
Find out if you have high cholesterol. If so, work with your doctor to control it.
If you are diabetic, follow your doctor's recommendations carefully to control your diabetes.
Include exercise in the activities you enjoy in your daily routine.
Enjoy a lower sodium (salt), lower fat diet.
Source: National Stroke Association
Living with vascular dementia
A diagnosis of dementia is scary. But it’s important to remember that many people with dementia lead healthy, fulfilling lives for years after the diagnosis. Don’t give up on life! As much as possible, continue to look after your physical and emotional health, do the things you love to do, and spend time with family and friends.
Stay active as much as possible. Research suggests that even a leisurely 30-minute walk a day may reduce the risk of vascular dementia and help slow its progression. It will also boost your overall health and happiness.
Create a network of support. Seeking help and encouragement from friends, family, health care experts, and support groups can improve your outlook and your health.
Eat for heart health. Heart disease and stroke share many of the same risk factors, such as high LDL cholesterol (bad cholesterol), low HDL cholesterol (good cholesterol), and high blood pressure. Adopting a more heart-healthy diet may improve or slow down your dementia symptoms.
Make it a point to have more fun. Laughing, playing and enjoying yourself are great ways to reduce stress and worry. Joy energizes and inspires lifestyle changes that prevent further strokes and blockages and compensate for memory and cognitive losses.
Learn how to relax and manage stress. Stress is a major contributor to high blood pressure and heart disease, so it’s helpful to practice relaxation techniques, such as yoga, meditation, deep breathing, or rhythmic exercise, and know how to quickly reduce stress in the moment by employing one or more of your senses.
Challenge your brain. Your brain remains capable of change throughout your life, so you may be able to improve your ability to retain and retrieve memories. Set aside some time in the evening to recall the day’s events, which can build memory capacity. Learning new skills, such as a foreign language or how to paint, can also help build brain capacity if done consistently.
Managing symptoms of vascular dementia
Managing the symptoms of vascular dementia means learning practical ways to manage memory loss, while staying as optimistic and realistic as possible. Although you may not be able to bring back what’s lost, you can still find ways to make a challenging situation easier.
Follow a routine. A regular, daily routine can stimulate your memory and help you feel more balanced and in control. Keep important items in the same place so they’re easier to find.
Carry a notepad. Take some pressure off your memory by writing down names, dates, appointment times, and a to-do list of errands. You can also post important phone numbers and reminders in a prominent place.
Be upfront about your condition. Tell the people you’re around that you’ve had a stroke. This way, they know what to expect and you can alleviate or prevent misunderstandings.
Communicate your needs. Ask people to speak slowly or repeat things when necessary. Ask for a message broken into smaller parts, and repeat what you heard back to them.
Remove distractions. When attempting to understand long messages or instructions, take away distractions such as TV or radio so that you can better concentrate and take notes.
Avoid rushing into new tasks. Be deliberate and stop to think and plan before beginning a task, whether it’s taking out the garbage or conducting a meeting.
Be patient with yourself. Getting angry only makes it more difficult to remember. Learning relaxation techniques can help you cope with changes.
Allow those close to you to help you. It’s not easy to admit you need help, but letting those who care about you lend support is important to your independence.
Helping someone with vascular dementia
Caring for a person with vascular dementia can be very stressful for both you and your loved one. You can make the situation easier by providing a stable and supportive environment.
A stable environment starts with a stable, healthy you. It’s easy to lose sight of your own needs when your loved one is dealing with dementia. But taking care of yourself isn’t optional. Stress and burnout are common in carers—and that isn’t a good thing for you or the person you’re caring for. Nurturing and protecting your own emotional and physical health isn’t selfish. It’s the best thing you can do for the person you love.
Tips for caring for a loved one with vascular dementia
Avoid changing things. Your loved one will feel more comfortable and less frightened or agitated when he or she is on a regular routine and in familiar surroundings.
Use calendars and clocks. Place large calendars and clocks around your loved one’s living area. They can help people with dementia reorient if they've forgotten the date or time.
Keep your loved one busy. Encourage your loved one to continue physical and social activities as long as possible. Whether it’s going for a walk or spending time at the local senior centre, it’s important that he or she has regular activities to participate in.
Provide plenty of stimulation. Make sure your loved one’s room is colourful and inviting. Do they have a nice view outside? If not, you can bring the outdoors in with some flowers or a plant. Also make sure they have a TV, radio, or other things to look at and do.
Tell your loved one what you’re doing, and why. If it’s time for dinner, say so. Don’t just lead them into the kitchen without explaining what’s going on. Be sure to communicate, even if you’re not sure your loved one understands. Even if he or she doesn’t understand your words, your tone of voice and body language can provide reassurance.