Most people have heard of the term “dementia,” usually associated with aging parents or grandparents. Dementia describes a group of symptoms affecting memory, thinking and social abilities. There are different types of dementia, which vary depending on the cause. In this post we will discuss vascular dementia, the second most common form of dementia next to Alzheimer Disease. We will learn its cause, presentation, treatment, and what to expect when living with the disease.
The word vascular means blood vessels, in this case, of the brain. Blood carries vital nutrients and oxygen to the brain tissues. When there are issues with blood flow to the brain, a person can develop vascular dementia. There are several different disease processes of the blood vessels of the brain that can lead to dementia. The most common are: stroke (single and multiple infarct), hypertension (high blood pressure), and small blood vessel disease. There are other, rarer, syndromes that affect the blood vessels that could also lead to vascular dementia.
Stroke: When a person has vascular dementia, they may experience either focal or diffuse effects on the brain and cognitive decline. When a person has a stroke (blood vessel blocked by a blood clot), blood flow to the brain is impaired. Usually, just the part of the brain where the clot was lodged is affected; this is called “focal cerebrovascular disease.” If that person develops a resulting vascular dementia it may only affect that certain part of the brain as well. Although, this is not always the case.
Hypertension: High blood pressure is the major cause of “diffuse disease” or vascular dementia that affects many parts of the brain. Diffuse means to spread widely through a tissue. Although in many patients, both focal and diffuse disease are observed together. This could be because many people who have a history of stroke also have history of high blood pressure.
Small vessel disease: This disease affects all the small vessels of the brain and produces two major syndromes: Binswanger disease and lacunar state. Small blood vessel disease results in changes in the walls of the blood vessels. This affects how blood reaches the brain and can cause vascular dementia.
Vascular dementia and Alzheimer dementia can also exist together, and this is called “mixed dementia”. There have been several studies suggesting that the risk of developing Alzheimer disease is increased when a patient has vascular risk factors such as high blood pressure, diabetes, peripheral arterial disease, and smoking. It has been suggested that the vascular processes in both disorders may mutually induce each other. But that does not mean that a person with vascular dementia will develop Alzheimer disease.
It is common for people with vascular dementia to have mood and behavioral changes. These changes may be seen before severe memory loss in the early stages. Another early sign of vascular dementia is apathy. Severe depression is more common in vascular dementia than in Alzheimer’s. Some signs of depression are being socially withdrawn, decreased psychomotor activity, passive wishes to die, and feeling that life is not worth living. Depending on the part of the brain that was affected, there may be other changes such as balance and gait problems and/or urinary incontinence. Doctors will reach a diagnosis by observing signs of cognitive decline, problem solving and social functioning as well as physical exam, positive neuro imaging studies (CT or MRI of the brain), and screening tools such as the Folstein Mini-Mental State Exam. As is the case with most dementias, it is usually not diagnosed until the symptoms are severe enough to interfere with daily life.
Living with vascular dementia can be very difficult, especially when it affects mood and interactions with others. Family members may notice that their loved one is impatient and challenging to deal with at times. Understanding the disease will help you to better cope with these changes. It may also be helpful to see a geriatric psychiatrist for assistance with the emotional aspects of the disease. Treatment of vascular dementia may include medications to slow the progression of memory loss. It is also important to prevent further damage by treating underlying diseases such as high blood pressure, diabetes, and prevention of stroke and reducing risks factors such as high cholesterol and smoking. Studies have shown that reducing stress, keeping active socially, exercise, healthy eating and limited alcohol consumption can improve the quality of life in people with vascular dementia and improve cardiovascular health.
Alagiakrishnan, Kannayiram, MD, MBBS, MPH, MHA; chief editor Xiong, Glen, MD “2018/3/26” emedicine.medscape.com