Onset and Progression of Vascular Dementia and Commonly Seen Symptoms

Last Updated: September 19, 2018

Vascular dementia (VaD), sometimes referred to as Vascular Cognitive Impairment (VCI), is a brain disorder that is characterized by memory loss and difficulty thinking, such as solving problems and making decisions. It is caused by problems with the blood vessels that feed the brain. In simple terms, blood flow is reduced or blocked, resulting in the brain cells receiving insufficient nutrients and oxygen. While VaD is a type of dementia, it’s important to note that the causes, risk factors, and symptoms are somewhat different from Alzheimer’s Disease and the other forms of dementia.

 There are many types of dementia in addition to Vascular Dementia. Watch a short video that describes the different types (1 minute 45 seconds long). 


Causes of Vascular Dementia

Many people develop vascular dementia after suffering a stroke or multiple small strokes. This is the most common type of vascular dementia and is sometimes called Multi-Infarct Dementia (MID). The stroke causes parts of the brain to die, which is what leads to dementia. Strokes often cause physical symptoms, depending upon what part of the brain is affected, but mini-strokes may happen without obvious external symptoms. Vascular dementia most commonly develops when the stroke occurs on the left side of the brain or when it involves the memory center of the brain, the hippocampus. About one-third of people who had no dementia symptoms before the stroke will develop vascular dementia afterwards, usually within a year.

Another common subtype, subcortical vascular dementia, has also been called Binswanger’s Disease. This is the type that is caused by narrowing of the blood vessels called atherosclerosis, which is the same build up of fatty material in blood vessels that can lead to heart attacks. Therefore, the factors associated with heart disease are also associated with vascular dementia.

Risk factors include:

  • High blood pressure (hypertension): Accounts for approximately half of VaD cases. High blood pressure may cause subcortical vascular dementia.
  • Diabetes
  • High cholesterol
  • Family history of heart problems
  • Heart rhythm abnormalities
  • Being overweight
  • Smoking
  • None to little physical exercise
  • Unhealthy diet
  • High alcohol consumption
  • Increasing age

Other causes: Vascular dementia can also be caused by other conditions that reduce blood flow to the brain, including certain autoimmune diseases (e.g., lupus eythematosus, temporal arteritis), certain inherited (genetic) diseases, infections of the heart (endocarditis), brain hemorrhage, and profoundly low blood pressure.


Relationship Between VaD and Alzheimer’s Disease

Many people have a combination of vascular dementia and Alzheimer’s disease. This is called mixed dementia. In fact, having a combination of strokes and Alzheimer’s disease is more common than having either Alzheimer’s alone or having vascular dementia alone.


How Common is Vascular Dementia?

According to the Alzheimer’s Association (2018), vascular dementia is the second most common type of dementia after Alzheimer’s disease. Approximately 10% of all people with dementia show signs of only vascular dementia in their brains. However, brain changes associated with VaD are found in about 40% of individuals with dementia. Vascular dementia is most common in people after age 65, and the risk of developing vascular dementia is significantly higher for individuals who are in their 80’s and 90’s. Additionally, individuals are much more likely to develop vascular dementia following a stroke than at other times.


Symptoms of Vascular Dementia

Symptoms of vascular dementia vary depending on what part of the brain is affected and the cause of the vascular dementia. A common early symptom of vascular dementia is a decline in the ability to organize thoughts or actions. Often the most noticeable initial symptoms of vascular dementia are impaired planning, judgment, and ability to make decisions. Memory loss, such as with Alzheimer’s disease, may or may not be a noteworthy symptom. Other symptoms of VaD include the following:

  • Confusion and disorientation
  • Unsteady walking
  • Difficulty “finding” words
  • Increased urinary frequency, urgency, or incontinence
  • Mood problems or changes in behavior (loss of interest, depression, agitation, etc.)
  • Difficulty concentrating / solving problems


Symptoms Related to Stroke or Mini-Stroke

People with vascular dementia may also have other (physical) signs of a stroke or mini-strokes. There may be a localized area of the body, such as a hand or the facial muscles, that is weakened or the person may have a numb area somewhere on their body.

Onset and Progression of Symptoms

Symptoms of vascular dementia may have a sudden onset if they are related to a stroke or mini-stroke. People with this type of VaD, sometimes called multi-infarct dementia, have a so-called “stepwise” progression of their symptoms, meaning that their symptoms stay the same for a while and then suddenly get worse. This can be a challenge for caregivers.

Caregivers may find that their loved ones are doing “fine” for a period of time, or that they may even seem to be getting somewhat better, then their symptoms may suddenly worsen overnight. Usually this happens when the person suffers from another stroke, sometimes one so small that it is physically undetectable.

People with other forms of vascular dementia will have a gradual increase in symptoms, and the disease will slowly get worse over time. This is similar to the progression of Alzheimer’s disease.


Diagnosis and Treatment of Vascular Dementia

Although there are no medications currently approved for the treatment of vascular dementia specifically, cholinergic medications used in the treatment of Alzheimer’s disease appear to work well for persons with vascular dementia. In addition, if an individual is suffering from mood issues related to VaD, medications can be taken to treat these symptoms.

Approaches to diagnosis and treatment of vascular dementia are similar to those for other forms of dementia. For instance, a doctor may recommend scans of the brain — computerized tomography (CT) or magnetic resonance imaging (MRI). Click on the links below to learn more about diagnosing and treating dementia.

Diagnosing Dementia
Treating Dementia


Providing Care for Someone with Vascular Dementia

Caring for someone with vascular dementia is challenging. Understanding the disease and knowing what to expect is the best thing that caregivers can do to be prepared. Because so many cases of VaD result from stroke, caregivers may also have to assist their loved ones with physical tasks if they are impaired following the stroke.

Please visit our caregiving section for a comprehensive guide to providing care for dementia.