Vascular dementia (VaD), sometimes referred to as Vascular Cognitive Impairment (VCI), is a brain disorder characterized by memory loss and difficulty thinking. Individuals with this disease find solving problems and making decisions much harder. VaD is caused by reduced or blocked blood flow, resulting in the brain cells receiving insufficient nutrients and oxygen. High blood pressure and diabetes are among the risk factors for VaD.
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. Vascular disease is the second-most-common type of dementia, affecting about 200,000 Americans. On this page, we will cover its causes, symptoms, and the difference between VaD and other types of dementia.
The most common type of vascular dementia develops after a stroke or multiple small strokes. This is sometimes called Multi-Infarct Dementia (MID). The stroke causes parts of the brain to die, which breaks down communication between cells that allows our brains to think and control our bodies.
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 is subcortical vascular dementia, also known asBinswanger’s Disease. This is caused by a narrowing of the blood vessels called atherosclerosis, which is the same buildup 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 of vascular dementia include:
• High blood pressure (hypertension): Accounts for approximately half of VaD cases. High blood pressure may cause subcortical vascular dementia.
• High cholesterol
• Family history of heart problems
• Heart rhythm abnormalities
• Being overweight
• 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 erythematosus, temporal arteritis), certain inherited (genetic) diseases, infections of the heart (endocarditis), brain hemorrhage, and profoundly low blood pressure.
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.
Vascular dementia, or vascular cognitive impairment, on its own can have different symptoms than Alzheimer’s. Whereas memory loss is a key warning sign of Alzheimer’s, some people with VaD will see changes to their personalities and/or ability to make decisions while their memories remain intact. This is because the effect of the disease depends on which parts of the brains are having problems with blood flow.
Put simply: Alzheimer’s disease is caused by a breakdown of the ability to communicate between brain cells (neurons) because of plaques and tangles that build up between them; vascular disease comes from a reduction in blood supply to a vital region of the brain.
According to the Alzheimer’s Association (2021), vascular dementia is the second most common type of dementia after Alzheimer’s disease. Approximately 5-10% 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 80s and 90s. Additionally, individuals are much more likely to develop vascular dementia following a stroke than at other times.
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 problems organizing 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
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.
It may be difficult to tell if someone has had multiple small strokes that could also lead to symptoms of VaD. Difficulty making decisions and uncontrollable laughing and crying are signs that someone is having problems with blood flow deep inside their brain.
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, before symptoms 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.
Whereas someone with Alzheimer’s disease typically lives for 8 to 10 years after diagnosis, those with vascular dementia have a shorter average life expectancy: A person typically lives another 5 years after VaD diagnosis.
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.
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.
Broadly, these are ways you can help care for someone who has vascular dementia:
– Create a more structured routine, with meals, getting dressed, and other activities of living occuring at about the same time every day.
– Simplify tasks as much as possible.
– Subtle reminders to do things like go to the bathroom can be enough to help ease daily difficulties.
Unfortunately, dementia gets worse over time. Respite care and adult day care programs can be useful for helpful supervision of a loved one who is losing independence, but eventually a move into assisted living with memory care will become necessary. Be sure to communicate regularly with doctors who can help you be prepared for what’s coming. If you need help finding memory care that fits your family’s budget and needs, click here.