After Alzheimer’s disease, vascular dementia is the second most frequently experienced type of dementia. Vascular dementia is the consequence of damaged blood vessels in the brain. This causes a decrease in blood flow to brain tissue, resulting in inadequate oxygen and nutrition supply, which damages brain tissue. Inadequate blood flow harms and can ultimately kill cells in any part of the body, but the risk to the brain is more significant. It differs from other forms of dementia as declines are usually sudden, occurring in a step-like progression versus gradually.
At NursePartners, we understand that dementia can pose many changes that require expertise, personalized care, and compassion. We specialize in helping care for people affected by dementia and offer an option for providing support to individuals as they age in place.
In this article, we’ll cover what you need to know about vascular dementia and what is believed to cause the condition.
What is Vascular Dementia?
Vascular dementia is characterized by alterations in cognitive abilities, which can manifest suddenly after a stroke that obstructs the primary blood vessels in the brain.
Cognitive challenges may also emerge as mild changes that progressively worsen due to multiple minor strokes or another condition affecting smaller blood vessels, resulting in extensive damage. An increasing number of specialists favor the term “vascular cognitive impairment” (VCI) over “vascular dementia” as it more accurately represents the spectrum of vascular cognitive changes, which can range from mild to severe.
Changes associated with vascular dementia often co-occur with those related to other forms of dementia, such as Alzheimer’s disease and dementia with Lewy bodies. Some studies have discovered that vascular alterations and other brain anomalies may interact to heighten the probability of a dementia diagnosis.
Approximately 5% to 10% of individuals with dementia suffer from vascular dementia exclusively. However, it is more prevalent as a component of mixed dementia. Numerous experts contend that vascular dementia is still underdiagnosed (like Alzheimer’s disease) even though it is acknowledged as a common condition.
What are the Symptoms of Vascular Dementia?
The consequences of vascular issues on cognitive abilities can differ significantly, contingent on the extent of blood vessel damage and the brain region affected. Memory loss may or may not be a prominent symptom, depending on which specific brain areas experience reduced blood flow.
Vascular damage originating in brain regions responsible for information storage and retrieval might result in memory loss closely resembling Alzheimer’s disease. Symptoms might be most noticeable when they occur shortly after a significant stroke.
Sudden changes in cognition and perception following a stroke may include:
- Challenges in maintaining focus and concentration
- Decreased capacity to structure thoughts or actions
- Deterioration in the ability to assess a situation, devise an efficient strategy, and communicate with others
- Issues with organization
- Struggles in determining the next course of action
- Memory issues
- Restlessness and agitation
- Unstable walking patterns
- Sudden or recurrent need to urinate or incapacity to control urination
- Apathy or depression
If cognitive and reasoning changes appear closely associated with a stroke, the condition is occasionally called post-stroke dementia.
At times, a distinct pattern of vascular dementia symptoms follows a series of strokes or mini-strokes. Cognitive changes are observed in noticeable downward steps from one’s prior functional level, contrasting with the steady, gradual decline typical of Alzheimer’s disease dementia.
However, vascular dementia can also manifest progressively, similar to Alzheimer’s disease dementia. Moreover, vascular disease and Alzheimer’s disease often coexist. Research indicates that numerous individuals with dementia and signs of brain vascular disease also have Alzheimer’s disease.
Types of Vascular Dementia
There are several types of vascular dementia, all caused by blood supply issues to specific parts of the brain:
This occurs when tiny blood vessels deep within the brain develop thick walls, stiffening and becoming twisted, thereby preventing a regular blood flow. Protein build-up in small blood vessels occurs over time.
As the patient ages, cerebral amyloid angiopathy, or weakening of the blood vessels can also result. When the vessels cease to operate, the brain cells they supply are starved of nutrients and oxygen and will die. High blood pressure, diabetes, infection, autoimmune disorders, and abnormal aging of blood vessels – known as atherosclerosis – are all factors that can cause the narrowing of the blood vessels.
Stroke-related Dementia or Infarction
An artery in the brain is blocked by a clot that could have formed either in the brain or the heart and may have moved to the brain. A brain hemorrhage may also see high blood pressure weakening a blood vessel and causing it to rupture. There will then be bleeding into the brain, which can cause damage to the brain. This is not as likely as a clot occurring.
Since health issues that caused the initial stroke may still exist, a further clot could result in more strokes which progressively diminish overall brain function. After a major stroke, symptoms are usually the most apparent. A step downward in thought processes may become noticeable compared to previous levels.
This occurs after small blockages repeatedly affect blood flow to a specific brain region. As more strokes take place over time, whether apparent or silent, vascular dementia increases. The individual effects of blockages may not be obvious, but in time, the symptoms of impairment become increasingly noticeable.
This condition occurs when symptoms of both vascular dementia and Alzheimer’s exist. Of those diagnosed with dementia, around 5% to 10% have vascular dementia alone, but generally, it presents with mixed dementia. Experts see vascular dementia as a common problem but say it often goes undiagnosed in the same way Alzheimer’s disease does.
Common Risk Factors for Vascular Dementia
Vascular dementia is not common before age 65. This risk increases as patients approach their 90s.
Previous cardiac events
Brain damage associated with a stroke, mini-stroke (transient ischemic attack), or a heart attack can increase the risk of developing dementia.
High levels of low-density lipoprotein (LDL) and triglyceride are associated with a heightened risk of developing vascular dementia. Deposits of cholesterol and plaques building up in the arteries and narrow blood vessels reduce nutrient-rich blood to the brain.
High blood pressure
Extra strain on blood vessels everywhere in the body increases the risk of vascular problems in the brain.
High levels can damage blood vessels and cause blood clots and heart disease.
High glucose levels tend to destroy blood vessels.
This habit damages the blood vessels, increasing the risk of atherosclerosis.
Obesity and lack of physical activity
Being overweight is a commonly recognized risk factor for vascular diseases.
The condition known as atrial fibrillation is when the heart’s upper chambers beat irregularly and are rapidly out of sync with its lower chambersion. AF can cause blood clots to form in the heart that can travel to the blood vessels in the brain.
Cerebral autosomal dominant arteriopathy (CADASIL) with subcortical infarcts and leukoencephalopathy is a genetic disorder that often leads to vascular dementia. A parent with the gene for CADASIL can pass it on to a child – the disorder affects blood vessels in the brain’s white matter. Symptoms include depression, migraine headaches, seizures, and severe depression. This tends to begin when the patient is in their 30s.
Differentiating Vascular Dementia from Other Types of Dementia
Vascular dementia and other similar conditions are difficult to distinguish since they share common signs and symptoms. Depending on the individual, the location, and the size of the area impacted by blood flow impairment, vascular dementia symptoms vary. If vascular changes occur in brain regions where information is stored and retrieved, memory loss may present like that associated with Alzheimer’s disease.
If only a tiny zone in a part of the brain that controls memory is affected, the patient might seem forgetful, but this does not necessarily alter their ability to carry out normal functions, whereas if a larger area is affected, they might have difficulty thinking and solving problems. Memory problems might actually be severe enough to reduce their ability to do tasks they previously had no problem completing.
In the case of vascular dementia, problem-solving and the speed at which thinking occurs are usually most affected, whereas memory loss tends to be more commonly associated with Alzheimer’s disease.
How is Vascular Dementia Diagnosed?
Since vascular dementia does often go unrecognized, cognitive screening by a qualified professional is advised for high-risk candidates, including patients who have suffered a stroke or transient ischemic attack (TIA) or whose heart or blood vessels may be at risk. Depression is also a factor that those with vascular disease should be screened for since it is possible that this, too, may contribute to cognitive impairment.
Early diagnosis is beneficial since treatment can help prevent further deterioration. It is essential that those who commonly experience issues with their thinking and/or memory chat with their doctor, who will usually refer their patients to a specialist for testing.
Neurocognitive testing is used to evaluate skills like problem-solving, reasoning, memory, and judgment. This requires hours of written or computerized tests and can help distinguish vascular dementia from other types of dementia and Alzheimer’s. A Neuropsychiatric evaluation may also be done to eliminate a psychiatric condition that resembles dementia.
Besides a physical exam and medical history, the doctor may decide to run the following imaging tests:
This technology uses X-rays and a computer to make detailed axial images or “slices” of the brain.
- Magnetic Resonance Imaging (MRI)
This brain imaging machine uses large magnets, radio frequencies, and computer technology to create detailed images of the brain, and can indicate whether there has been a recent stroke or other vascular brain alterations, the severity of which might be in keeping with impairments noted during the above mentioned neurocognitive testing. A CT or MRI could reveal evidence of a recent stroke or other brain abnormalities and can also assist in detecting a build-up of fluid in the brain or tumor.
This brain scan lights up regions of the brain using a tracer.
- Electroencephalogram (EEG)
Electrical activity is measured in the brain using an EEG.
Reducing the Risk of Vascular Dementia
Improving heart health can help limit the risk of vascular dementia.
This can be achieved by:
- Giving up smoking
- Limiting alcohol consumption
- Maintaining a healthy weight
- Doing regular exercise
- Ensuring blood pressure, cholesterol, and blood sugar are kept within recommended limits
- Eating a healthy, low-fat diet
- Taking prescribed cholesterol-lowering medications (when necessary) to reduce the risk of strokes and heart attacks that could lead to vascular dementia. (The aim is to limit plaque deposits inside the brain’s arteries.)
How is Vascular Dementia Treated?
Working with a doctor to tailor a treatment plan to the patient’s circumstances is ideal. Evidence points to the fact that lifestyle changes, like a healthy diet and exercise and giving up smoking and alcohol, all improve outcomes and can also aid in postponing or preventing further health issues.
Depending on the effects of the stroke, rehabilitation could aid in improving compromised speech, movement, strength, and general living skills for a quicker return to independence. Mobility training, range of motion therapy, motor skill exercises, as well as therapy for communication and cognitive disorders might be employed, among other forms of treatment, to assist the patient.
Drugs have not been approved by The U.S. Food and Drug Administration (FDA) for the treatment of the symptoms of vascular dementia, but clinical trials indicate that people with vascular dementia might gain some benefit from drugs approved for the treatment of Alzheimer’s symptoms.
Treatment works mainly on underlying diseases such as hyperlipidemia, hypertension, blood clotting problems, or diabetes mellitus to prevent worsening symptoms of vascular dementia. Medicines, such as cholinesterase inhibitors, are also used to treat dementia symptoms, and antidepressants can assist with depression.
Blood flow to the brain can be improved by surgeries, such as stents, angioplasty, and carotid endarterectomy.
Living with Vascular Dementia
NursePartners’ approach to caring for dementia patients is rooted in Teepa Snow’s GEMS™: Brain Change Model, which categorizes dementia stages by likening them to the unique characteristics of six different gemstones. This approach helps understand and meet the needs of individuals affected by dementia.
Like gemstones, people benefit from different care and settings to shine at full capacity, so rather than focusing on what has been lost, individuals are looked at as precious, unique, and capable. Knowing what has changed and what is still possible, communication and care for the individual become more effective.
The GEMS™ Brain Change Model Classification System Categorizes Stages of Dementia as follows:
In response to the aging process, Sapphires may feel “blue” despite no significant changes in cognition or signs of dementia.
This initial stage of dementia occurs with the first signs that something is “off.” Diamonds are “clear and sharp,” they have established routines and enjoy feeling competent, valued, and in control. This stage sees them being nudged from their comfort zone. Diamonds can function as they have in the past, but they tend to become territorial, and boundaries are blurred.
Green emeralds are “on the go.” They may be flawed and a little vague, getting lost in their past. Communication and comprehension can be issues, with emeralds often asking who, what, where, and when questions. These gems are most comfortable when doing familiar tasks. They like to engage and feel helpful so that they have a purpose.
Ambers are directed towards sensations and their wants and needs. They tend to live in moments and like to touch, gather and manipulate objects. This exploratory urge can land them in trouble as they have little safety awareness. They have trouble understanding and struggle to express their needs, so activities should be familiar and preferably stimulate the senses.
Rubies experience changes in depth perception, and their fine motor skills are almost non-existent. Sensory changes mean that assistance is often necessary when it comes to using utensils, brushing hair, dressing, and moving about. Hand-under-hand assistance helps rubies feel the “safety and security” they crave.
Layered and hidden in an outwardly unattractive shell, pearls tend towards introversion. There is often an inability to move or respond. With a reduced awareness of the world, pearls enjoy pleasant sounds and voices they are familiar with, and they cling to moments of connection.
A fundamental respect for these stages allows the care partner to better understand their client’s needs. Once an in-home assessment has been carried out, NursePartners creates a care plan to help the individual live in the comfort of their home. Activity lists are devised, and communication techniques are developed to aid patients in the various stages.
Professional Help for Late-Stage Dementia Available in Philadelphia, Montgomery, Chester, and Delaware Counties
At NursePartners, we train all CarePartners in the GEMTM methodology engaging with clients, focusing on what they still can do, and letting go of what they cannot.
Even at the most advanced stage of dementia, you can find new ways to make the person feel valued and with purpose.
To learn more about how we can engage your loved one with Vascular dementia, Alzheimer’s disease, or another form of dementia, call us at 610-323-9800.