Vascular Dementia

Vascular Dementia

Vascular dementia is the second most common cause of dementia after Alzheimer’s disease.

What is vascular dementia?

Vascular dementia is the broad term for dementia associated with problems of circulation of blood to the brain. Vascular dementia occurs when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system. Vascular dementia generally affects people between the ages of 60 and 75.

Vascular dementia occurs when blood vessels in the brain narrow, reducing the amount of blood flowing to the brain. In some cases, a blood vessel may be completely blocked, causing a stroke and vascular dementia. However, not all strokes cause vascular dementia. The severity of the stroke and the location are the most important factors.

Vascular dementia often presents with symptoms similar to Alzheimer’s disease. This usually happens after a series of very small strokes, or infarcts, that block small blood vessels. Often these small strokes are not noticeable. Eventually a cumulative effect takes place that results in vascular dementia.

There is no cure for vascular dementia.

The prevalence of vascular dementia ranges from 1 to 4 percent in people over the age of 65. There are no drugs currently approved by the U.S. Food and Drug Administration (FDA) to treat vascular dementia.

Persons with high blood pressure, high cholesterol, hardening of the arteries, diabetes, or other risk factors for heart disease are at high risk for vascular dementia. Monitoring of blood pressure, weight, blood sugar, and cholesterol are essential to avoid vascular dementia, or to lessen the chances of suffering from vascular dementia. Healthy eating, exercise, and taking medication as prescribed are important.

Are there different types of vascular dementia?

There are a number of different types of Vascular dementia. Two of the most common are Multi-infarct dementia and Binswanger’s disease.

Multi-infarct dementia

This is probably the most common form of Vascular dementia. Multi-infarct dementia is caused by a number of small strokes, called mini-strokes or Transient Ischaemic Attacks (TIA). The strokes cause damage to the cortex of the brain, the area associated with learning, memory and language. A person with Multiinfarct dementia is likely to have better insight in the early stages than people with Alzheimer’s disease, and parts of their personality may remain relatively intact for longer. Symptoms may include severe depression, mood swings and epilepsy.

Binswanger’s disease (also known as Subcortical vascular dementia)

This was thought to be rare, but is now being reassessed, and may in fact be relatively common. As with other Vascular dementias, it is associated with stroke-related changes. It is the “white matter” deep within the brain that is affected. It is caused by high blood pressure, thickening of the arteries and inadequate blood flow. Symptoms often include slowness and lethargy, difficulty walking, emotional ups and downs and lack of bladder control early in the course of the disease. Most people with Binswanger’s disease have, or have had, high blood pressure.

One single large stroke can sometimes cause Vascular dementia depending on the size and location of the stroke. Risk factors that make strokes more likely to lead to Vascular dementia include:

  • Untreated high blood pressure (hypertension)
  • Atrial fibrillation
  • Other irregular heart rhythms which raise the risk of clots and atherosclerosis (fatty deposits in blood vessels) which causes damage to the arteries of the brain.

How is vascular dementia diagnosed?

Vascular dementia is usually diagnosed through a range of brain scanning techniques. However, as is the case with Alzheimer’s disease, a definite diagnosis of Vascular dementia can only be made by examining the brain after death. Vascular dementia can be very difficult to distinguish from other forms of dementia. Some people have both Alzheimer’s disease and Vascular dementia.

You can expect any or all of these tests.

  • Computerized tomography
  • Magnetic resonance imaging (MRI).
  • Positron emission tomography (PET).
  • Doppler ultrasound.
  • Neuropsychological tests.

Neuropsychological tests assess orientation, learning, recall, attention, calculation and language.

Exam results for people with vascular dementia typically show the same types of cognitive deficits as the exam results of people who have Alzheimer’s disease.

One major difference, however, is in memory function. Most people with vascular dementia don’t experience memory problems until later in the course of the disease unless there is a stroke in the exact area of the brain that controls memory.

Who gets vascular dementia?

Anyone can be affected by Vascular dementia, but several factors increase the risk. These include:

  • High blood pressure
  • Smoking
  • Diabetes
  • High cholesterol
  • History of mild warning strokes
  • Evidence of disease in arteries elsewhere
  • Heart rhythm abnormalities.

Vascular dementia is slightly more common in men than women.

How does vascular dementia progress?

Vascular dementia usually progresses gradually in a step-wise fashion in which a person’s abilities deteriorate after a stroke, and then stabilise until the next stroke. If further strokes do not occur, the abilities of people with Vascular dementia may not continue to decline, or in some cases, may improve. However, these improvements may not last. Sometimes the steps are so small that the decline appears gradual. On average though, people with Vascular dementia decline more rapidly than people with Alzheimer’s disease. Often they die from a heart attack or major stroke.

Vascular Dementia Symptoms

  • Problems with memory or forgetfulness
  • Confusion, agitation and sudden mood swings
  • Difficulty concentrating, planning, and communicating
  • Unsteady gait, poor balance, or shuffling feet
  • Urinary urgency or Incontinence
  • Night wandering or getting lost in familiar surroundings
  • Depression
  • A decline in the ability to organize thoughts
  • Trouble communicating details
  • Sudden weakness and difficulty speaking

 Is there treatment available?

While no treatment can reverse damage that has already been done, treatment to prevent additional strokes is very important. To prevent strokes, medicines to control high blood pressure, high cholesterol, heart disease and diabetes can be prescribed. A healthy diet, exercise and avoidance of smoking and excessive alcohol also lessen the risk of further strokes. Sometimes aspirin or other drugs are prescribed to prevent clots from forming in the small blood vessels.

Drugs can also be prescribed to relieve restlessness or depression or to help the person with dementia to sleep better. In some cases surgery known as carotid endarterectomy may be recommended to remove blockage in the carotid artery, the main blood vessel to the brain. Recent research suggests that cholinesterase inhibitor medications such as Donepezil (Aricept) and Galantamine (Reminyl), which are helpful for some people with Alzheimer’s disease, may also be of some benefit to some people with Vascular dementia. However, the evidence is not yet as clear or compelling as that for the use of these medications with Alzheimer’s disease.

 Additionally, if you treat the risk factors that may have contributed to vascular dementia, you may be able to slow the progression of dementia. This means controlling your blood pressure, cholesterol levels,  diabetes, and quitting smoking.

Doctors may also prescribe medications to help you control these conditions, along with aspirin or an anti-platelet aggregator medication, such as ticlopidine (Ticlid) and clopidogrel (Plavix), to help keep your arteries clear. None of these measures, however, can restore lost cognitive function.

Sources:                 http://www.fightdementia.org.au/

http://www.alzheimersreadingroom.com/

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