Vascular Neurocognitive Disorder (Vascular Dementia)

What is vascular dementia?

Dementia is an umbrella term that refers to conditions that cause cognitive decline and an impairment in daily functioning. Vascular dementia is the second most common form of dementia, falling behind Alzheimer’s disease as the most prevalent form of this condition ^[1].

Cases of vascular dementia are caused by a lack of blood and oxygen flow to the brain. This lack of blood flow can be a result of blood clots or fatty deposits that block the blood vessels. Vascular dementia is more likely to affect older adults. Additional risk factors include cigarette use, diabetes, high blood pressure, and high cholesterol ^[1].

Vascular dementia, sometimes also referred to as multi-infarct dementia, causes cognitive decline, which can lead to difficulties with attention, memory, language use, and overall executive functioning, which is the ability to plan tasks and use logical reasoning ^[1].

Symptoms of vascular dementia

When a person has vascular dementia, symptoms may occur suddenly, or they may appear gradually. Common symptoms of the condition are as follows ^[2]:

• Difficulty with daily tasks like paying bills
• Struggling to learn new routines
• Appearing forgetful of past events
• Losing important items
• Getting lost when going to familiar places
• Having a hard time with finding the right word to say during conversations
• Poor judgment
• Changed sleeping habits
• Struggling to read and write
• Experiencing hallucinations and delusions
• Showing changes in personality
• Becoming more depressed or agitated than usual

While the list above provides general symptoms of vascular dementia, it’s also helpful to know that dementia can occur in stages. Sometimes, symptoms appear suddenly, but in other cases, a person has a gradual onset of symptoms, and they decline over time.

Stages of vascular dementia

Mild stage

One symptom of mild dementia includes episodes of forgetfulness, which a person may try to cover up because they are aware that they are becoming forgetful. A person with mild dementia can generally communicate well and perform daily tasks, but others may notice changes to their behavior. The person may experience signs of depression, because they recognize that their cognitive capacities are beginning to decline ^[3].

Moderate stage

As vascular dementia progresses to the moderate stage, a person experiences more evident signs of cognitive decline. They may stop caring for themselves, and it can be difficult for them to perform daily activities without assistance. A person with moderate dementia symptoms will begin to struggle with communication, and they may become frustrated when they cannot think of the correct word to say in conversation ^[3].

Advanced stage

Finally, in the advanced stage of dementia, a person becomes dependent on other people for their daily care, and they may not communicate verbally at all. A person with advanced vascular dementia will need someone to assist them with all daily activities; they may experience difficulty with mobility and feeding themselves. ^[3].

Causes of vascular dementia

Vascular dementia is ultimately the result of a lack of blood and oxygen flow to the brain. This can occur for a number of reasons. Some medical conditions that increase the risk of vascular dementia include ^[4]:

• Stroke
• Narrowing of the arteries
• High blood pressure
• Heart rhythm abnormalities
• Diabetes
• High cholesterol
• Sleep apnea ^[5]

Beyond these specific health conditions, certain lifestyle factors can increase the risk of developing vascular dementia. For example, smoking and obesity have both been identified as risk factors for vascular dementia ^[6].

Healthy lifestyle habits, such as eating a nutritious diet, limiting alcohol intake, avoiding smoking, getting plenty of exercise, and managing stress, can all reduce the risk of vascular dementia ^[4].

Diagnosing vascular dementia

When making a diagnosis of vascular dementia, a physician begins by taking the patient’s history. The physician will ask about the nature of cognitive deficits and problems with daily functioning and gather information about when the symptoms began, as well as how they have progressed. When gathering historical information from a patient, a physician may also speak to family members who have knowledge of the patient’s functioning ^[1].

If it appears that a patient may be experiencing vascular dementia, it is also common for medical providers to conduct cognitive testing to determine the degree of a patient’s impairment. A physician must also rule out alternative diagnoses, such as depression, infections, thyroid problems, or alcohol misuse, that may be contributing to cognitive decline. To rule out these conditions, a physician may order blood work to test levels of thyroid hormone and other blood markers related to metabolic functioning ^[1].

A physician may also order an magnetic resonance imaging (MRI) scan to evaluate neurological deficits in specific areas of the brain ^[1].

Once gathering all materials for a diagnosis, a physician will diagnose vascular dementia utilizing the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5). This manual refers to vascular dementia with the term, “major or mild vascular neurocognitive disorder.” The diagnostic criteria for this condition are as follows ^[7]:

• The person meets diagnostic criteria for a mild or major neurocognitive disorder. Mild neurocognitive disorder is diagnosed when a person shows cognitive decline in at least one area, like attention, learning, memory, or language, and the person or someone in their life (ie: a spouse) is concerned about the impairment. Mild neurocognitive disorder requires evidence of moderate cognitive impairment, which is typically assessed via a standardized test.

While mild neurocognitive disorder does represent a state of cognitive decline, a person is still able to be independent in daily life. In major neurocognitive disorder, cognitive decline does interfere with independence, and a person requires assistance with daily tasks like paying bills, because cognitive impairment is substantial.

• The onset of symptoms of cognitive decline is related to a cerebrovascular event, such as a stroke, OR a person shows declines in attention or executive functioning. Declines in attention and executive functioning can look like difficulty processing information efficiently, inability to organize and prioritize tasks, and struggling with impulse control.

• The person has evidence of cerebral vascular disease, based upon history, physical exam, or neuroimaging.

• There is not another brain disease or systemic disorder that better explains the person’s cognitive decline.

Prevention of vascular dementia

Vascular dementia can be prevented by modifying risk factors for the disease. For example, keeping blood pressure within a healthy range can reduce the risk of vascular dementia. If you have high blood pressure, it’s important to take steps to control the condition, as uncontrolled high blood pressure can cause damage to the brain ^[8].

Other strategies that can reduce the risk of vascular dementia are as follows ^[8]:

• Getting plenty of physical activity
• Staying mentally active, such as by playing cards or solving word puzzles
• Remaining socially engaged
• Eating a healthy diet, especially one that is rich in antioxidants
• Avoiding smoking
• Keeping body weight within a healthy range
• Taking steps to keep cholesterol and blood sugar at an acceptable level

Treatment for vascular dementia

While there is no cure for vascular dementia, the goal of treatment is to slow the progression of brain damage from the disease. This is achieved by treating not only vascular dementia, but also any co-occurring conditions, such as diabetes, that can lead to worsening of the disease ^[1].

Vascular dementia treatment often involves the use of one or more of the following medications ^[1]:

• Cholinesterase inhibitors, such as galantamine or donepezil, which can slow cognitive decline but may not be the first choice due to the potential for significant side effects
• Memantine, which can improve functioning in cases of moderate to severe cognitive decline
• Blood thinners, which can reduce the risk of further brain damage from strokes ^[4]
• Medications to reduce high blood pressure or high cholesterol ^[4]

In addition to prescribing medication, a doctor treating a patient for vascular dementia will likely recommend lifestyle changes, which can reduce the risk of further brain damage. For example, a doctor will often recommend that patients with vascular dementia give up smoking and reduce their alcohol intake ^[1].

Self-care for vascular dementia

If you have vascular dementia, it’s important for you to take steps to care for yourself; lead a healthier lifestyle, cut down on unhealthy food, and train your body and mind, and you can help slow the progression of the condition. With healthy lifestyle habits, you can preserve your cognitive functioning and slow the rate of decline from vascular dementia. Some common self-care tips recommended for people who live with vascular dementia include:

• Giving up smoking. Smoking leads to blood vessel damage that can cause vascular dementia to progress more quickly. Giving up smoking is an important way to slow the progression of the disease ^[1].
• Get an adequate amount of exercise. Experts recommend that patients with dementia engage in physical activity ^[8], as this can reduce risk factors like high blood pressure, high cholesterol, and excess body weight. Moderate activity, such as a 30-minute walk most days of the week, can be beneficial.
• Train your brain. It’s also important to exercise your brain. You can stimulate mental activity with word puzzles and card games to keep your brain functioning ^[8].
• Stay socially connected. Being socially engaged has been found to reduce the risk of complications from vascular dementia ^[8]. Staying in touch with friends and participating in social activities such as clubs and church groups can keep your mind sharp.
• Follow a healthy diet. A healthy diet that provides the body with plenty of nutrients, including antioxidants, can preserve brain functioning. If you drink, it’s also important to reduce or limit alcohol intake, as excessive alcohol consumption can be harmful ^[8].

Helping someone with vascular dementia

If a loved one lives with vascular dementia, there are things you can do to help. Consider the following strategies for caring for your loved one:

• Offer support. While people with vascular dementia may be fully capable of living independently, they may still require support. For instance, tasks like paying the bills may become more complicated. You can offer support by validating their experience and being patient with them. It may take them more time to complete daily tasks, so being patient with them can go a long way.
• Encourage them to seek treatment. A person who is in the early stages of cognitive decline may recognize that there is a problem, but they may be embarrassed or fearful of seeking treatment. Encouraging them to see a doctor can increase their chances of receiving medical care to reduce the progression of vascular dementia. It may be helpful for you to attend appointments with your loved one as a sign of your support.
• Invite them to participate in activities. People who are living with symptoms of vascular dementia may socially withdraw from others. They may be embarrassed or fearful of being a burden to those around them. However, staying socially engaged is beneficial. Be sure to include your loved one in outings and family gatherings. You might even offer to do activities with them, such as going to see a movie or taking a walk together.

FAQs about vascular dementia

How common is vascular dementia?

Recent estimates show that in people aged 50 and above, there are 116 cases of vascular dementia per 10,000 individuals. The condition is more common among females compared to males, and it is also more prevalent in North America and Europe when compared to Asia, Africa, and South America. The risk of vascular dementia increases with age ^[9].

What is the outlook for people with vascular dementia?

While vascular dementia can be managed to slow the progression of the disease, individuals with this condition do have a shortened life expectancy. In patients who have had a cerebrovascular accident, such as a stroke, the 5-year survival rate is 39%. Given the link between high cholesterol and vascular dementia, heart disease is a common cause of death among patients with vascular dementia ^[1].