Vascular Dementia- Causes and Symptoms.

Vascular dementia is not caused by a specific disease, rather it is the result of blood supply restriction to the brain. Progressive deterioration in a step-like manner is common, and surprisingly there may be noticeable improvement between each step. Read on to find out why this occurs. 

Vascular is one of the few types of dementia which is preventable. Know the health risk factors and take steps to reduce them. Early diagnosis and detection are critical in reducing further decline.

Vascular dementia -  the second most common type of dementia. 

  • Vascular dementia affects 10-20% of people with dementia, making it the second most common type of dementia after Alzheimer’s disease. It affects more men than women, mostly occurring between the ages of 60 to 75.
  • Vascular dementia is not a disease, rather it is a health condition for which the risk factors are well known. Some of the risk factors are uncontrollable, such as age, gender and race. However most of the known risk factors are controllable. These include high blood pressure, high cholesterol, diabetes, smoking and excessive alcohol consumption. If these risk factors are reduced, the risk of vascular dementia will also be reduced.
  • Vascular dementia is caused by a reduction of oxygen and nutrients to the brain. Blockages or narrowing of blood vessels deprive the brain of oxygen and nutrient-rich blood, causing brain cell damage and cell death. A stroke or mini-stroke will also starve the brain of oxygen. It is thought that up to one-third of strokes result in some degree of dementia.

The Causes of Vascular Dementia

Restriction of blood supply caused by mini-strokes is the most common cause of vascular dementia. Initially no symptoms may be present, as mini-strokes can be undetectable. However brain cell damage increases with each successive mini-stroke, until the symptoms of dementia are visible. People may appear to improve slightly, then deteriorate in steps, following each mini-stroke.

Other causes of vascular dementia include blood vessel narrowing, hardening, or lesions. Blood vessel damage can also be the result of an infection or bacterial inflammation of the brain.

Controllable risk factors for Vascular Dementia include high blood pressure, high cholesterol, diabetes, cardiovascular disease, smoking and excessive alcohol consumption. Diet and lifestyle changes can control and reduce these underlying risk factors.

Vascular dementia is also known by various other names, including:

  • Multi-infarct dementia (MID) - used to describe vascular dementia caused by mini-strokes.
  • Subcortical vascular dementia - used when hardening or narrowing of the arteries is the cause.
  • Vascular cognitive impairment (VCI) – another name for vascular dementia, used when the resulting symptoms are primarily a decline in cognitive abilities.

The Stages and Symptoms of Vascular Dementia

Vascular dementia often occurs in conjunction with Alzheimer’s disease, making diagnosis difficult.

The symptoms of vascular dementia may occur suddenly following a major stroke. However mini-strokes are often “silent”, and may go undiagnosed for years. A person might experience multiple unrecognized mini-strokes before the symptoms are apparent enough to warrant a doctor’s diagnosis and intervention.

Symptoms due to the hardening and narrowing of the arteries will similarly be slow to develop, making a diagnosis difficult and delayed.

Depending on the area of the brain damaged, the symptoms of vascular dementia can vary widely from person to person. Memory loss, although common, is not always the first sign of vascular. Cognitive impairment may be patchy or temporary, following each mini-stroke. This may be apparent initially as intermittent loss of attention or fluency of speech.

Mild or Early Stage Vascular Dementia

The first symptoms of vascular dementia, and the progression of these symptoms, largely depends on the underlying cause. Unlike other types of dementia, it is typical for vascular dementia symptoms to worsen in steps, stabilizing between each step, and worsening following another stroke or mini-stroke. It is also possible for some people to show some improvement, should their underlying condition stabilize or improve. However most symptoms will deteriorate with time.

Medical intervention and changes in lifestyle can reduce the underlying risks and lessen the chances of future strokes.

During the early stages of vascular dementia, most people can still function independently. However some signs of dementia will gradually appear. Confusion and disorientation are among the earliest signs, and a detailed medical consultation will confirm a dementia diagnosis.

Reduced muscle strength and muscle control can be apparent in some people, depending on the area of the brain that has been damaged. This may show up as clumsiness, difficulty with coordination, or as one-sided weakness.

Vascular caused by a major stroke will often skip this early stage, demonstrating symptoms of the moderate stage immediately following the stroke.

Moderate Stage Vascular Dementia

During this stage, decreased muscle control and increased cognitive problems will significantly impact daily tasks. As the disease progresses, people will become more reliant on carers for their daily tasks such as bathing and feeding. Memory loss similar to other types of dementia will also begin to show.

The symptoms of vascular dementia which become apparent during the moderate stage include:

  • Disorientation, unable to recognize familiar locations or routes home.
  • Confusion, vagueness, or inability to find the correct word when conversing, often making speech and writing mistakes.
  • Difficulty with concentration, and with processing information, instructions or questions.
  • Difficulty in performing routine tasks, difficulty in multi-tasking or planning complex activities.
  • Memory loss- especially of recent events, or well-know people or places, forgetting where things have been put, forgetting appointments or getting lost easily.
  • Poor judgement in decision making, or assessing situations or risks.
  • Difficulty with fine motor control, for tasks such as writing or feeding.
  • Muscular difficulties resulting in incontinence, or affecting speaking, balance, walking, or one-sided numbness or paralysis.
  • Deterioration of vision.
  • Unpredictable behaviour or emotions, including mood swings, depression, apathy, and social withdrawal.

Severe Stage Vascular Dementia

During the severe stage a person will need full time assistance with even basic day to day activities. People become wheelchair dependent or bedridden as their muscles and brain “forget” how to walk. Severe stage symptoms include:

  • Inability to carry out basic daily living activities.
  • Inability to control basic bodily functions, resulting in complete incontinence, inability to stand, walk, talk or swallow.
  • Severe or total memory loss.
  • Unresponsive and withdrawn.
  • Inability to converse rationally, leading to not speaking at all.

At the end of this stage, death most often occurs following a fatal stroke or heart attack.

* For more detailed medical and scientific analysis, refer to: Cleveland Clinic- subcortical vascular dementia

* See also: emedicine - vascular overview 

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