Monday, June 27, 2022
HomeHealthCan Vascular Dementia Be Prevented

Can Vascular Dementia Be Prevented

Whats Next With Dementia Prevention Research

Vascular Dementia: Causes & Prevention

More research is needed to find ways to help prevent Alzheimers and related dementias. Future research may determine that specific interventions are needed to prevent or delay the disease in some people, but others may need a combination of treatments based on their individual risk factors. Understanding risk factors and choices you can make now is important for both your present and future health. In addition to this website, consider the resources listed below to learn more.

You can also help researchers learn more about preventing dementia by participating in clinical trials and studies. Search the Alzheimers.gov Clinical Trials Finder to find studies that need volunteers.

Can Diet Prevent Or Slow Down Dementia

We hear so much from the media about what we should or should not eat. One day blueberries are the new so-called superfood that will reduce our risk of developing dementia, the next it is the humble plum.

But what information can we rely on to be accurate? Can the food we eat really reduce our risk of developing dementia? If a person has dementia, can their diet or use of supplements influence how they experience dementia or its progression?

Knowing what and what not to eat is so confusing, the messages seem to change daily!

Person with dementia

The brain requires a regular supply of nutrients in our diet to function and remain healthy. There is growing recognition that what we eat affects the way our brains work and our mental health, as well as our physical health.

Traditionally research undertaken to investigate the connection between diet, cognitive function and risk of dementia has primarily focused on the impact of individual nutrients on brain health. Those nutrients commonly researched include: vitamins B6, B12, C, E and folic acid, as well as omega 3 essential fatty acids. The outcome of such research has been inconclusive and thus guidelines to advise on specific nutrient intakes have not been developed. In this feature well explore some of the ongoing research on this topic.

What Causes Vascular Dementia

Vascular dementia is caused by a lack of blood flow to a part of the brain. Blood flow may be decreased or interrupted by:

  • Blood clots
  • Bleeding because of a ruptured blood vessel
  • Damage to a blood vessel from atherosclerosis, infection, high blood pressure, or other causes, such as an autoimmune disorder

CADASIL is a genetic disorder that generally leads to dementia of the vascular type. One parent with the gene for CADASIL passes it on to a child, which makes it an autosomal-dominant inheritance disorder. It affects the blood vessels in the white matter of the brain. Symptoms, such as migraine headaches, seizures, and severe depression, generally start when a person is in his or her mid-30s; but, symptoms may not appear until later in life.

Vascular Dementia: An Umbrella Term

Vascular dementia is considered the second most common cause of dementia, following Alzheimers disease, according to the Alzheimers Association. But its also an umbrella term that encompasses a lot of different conditions, and is a bit difficult to categorize.

Vascular dementia is caused by an impairment in the circulatory system, which encompasses the vessels that carry blood throughout the body, like veins and arteries.

When the blood vessels in the brain stiffen or are damaged, they can lead to the development of vascular dementia or vascular cognitive impairment, according to Alzheimers Research UK. The resulting reduced blood flow to the braincan lead to cell death in the brain.

Its often tough to diagnose vascular dementia because more and more, scientists are realizing just how much overlap can occur between different types of dementia and Alzheimers disease, says Stanford Health Care neurocritical care specialist Dr. Marion Buckwalter.

Classically, vascular dementia has been diagnosed in people that dont really fit the pattern of other dementias like Alzheimers disease or Lewy body dementia, and have signs of ischemia in their brains, Buckwalter said in an interview with Being Patient. But more recently, people have realized theres a lot of overlap.

Treatment Of Major Depressive Disorder To Prevent Cognitive Decline

Vascular Dementia

Antidepressant and mood-stabilizing strategies have also been examined in patients who already have some degree of cognitive impairment. In a group of healthy subjects, 60 mg of citalopram given in divided doses of 30 mg reduced production by 38% compared with placebo. In a group of 45 patients with MCI treated with lithium versus placebo, treatment with lithium titrated to a blood level of 0.250.5 mEq/l for a year slowed down cognitive deterioration compared with placebo, as measured with the Alzheimers Disease Assessment Scale-Cognitive subscale. Lithium also decreased the level of phosphorylated tau in patients with MCI. In a study examining the association between amyloid pathology and remission of depressive symptoms with electroconvulsive therapy , remitters showed significantly lower A40/A42 than nonremitters. In a group of patients with MDD receiving ECT, there were changes in levels of CSF A1-42, the isoform with highest amyloidogenic potential. RCTs examining dementia prevention as a result of ECT are lacking; however, evidence points to an increase in hippocampal volume with ECT,, thus providing a pathophysiological basis for the potential role of severe MDD treatment in dementia prevention.,

The role of pharmacological and nonpharmacological antidepressant strategies in preventing dementia onset and progression warrants further examination by future studies.

How Can Vascular Dementia Be Prevented

In a 44-year longitudinal population study of Swedish women, researchers found that a high cardiovascular fitness in midlife was associated with a decreased risk of subsequent dementia. Data show women with high fitness levels had an 88% lower risk of developing dementia compared with women who were moderately fit in midlife. Additionally, when the highly fit women did develop dementia, they developed the disease an average of 11 years later than women who were moderately fit.

Heavy drinking is the strongest potentially modifiable risk factor for dementia, according to a retrospective analysis involving 30 million people in France. Data from the study show that those with a history of alcohol use disorders had a threefold increased risk for dementia and that over half those with early-onset dementia had a history of alcohol problems. Of 57,000 patients who had developed dementia under the age of 65 years, 57% had a history of alcohol use disorders .

References
  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders . Washington, DC: American Psychiatric Association; 2013.

  • Zhang-Nunes SX, Maat-Schieman ML, van Duinen SG, Roos RA, Frosch MP, Greenberg SM. The cerebral beta-amyloid angiopathies: hereditary and sporadic. Brain Pathol. 2006 Jan. 16:30-9. .

  • Schmidtke K, Hull M. Cerebral small vessel disease: how does it progress?. J Neurol Sci. 2005 Mar 15. 229-230:13-20. .

  • Preventing Dementia By Preventing Cerebrovascular Diseases

    Screening for cognitive impairment using scales such as the Montreal Cognitive Assessment is easy. However, although the US Food and Drug Administration recently accepted an application for the first biological treatment of Alzheimers disease, treatment of the disease is still disappointing owing to the failure of most recent trials targeting clearance of amyloid and selective inhibition of tau protein aggregation to improve cognition in Alzheimers disease. Increasing evidence points to a failure of clearance of amyloid and tau rather than overproduction as a main problem in Alzheimers disease, and this failure is related to hypertension and other vascular risk factors through functional alteration of perivascular space clearance, implicating new directions to prevent dementia by preventing cerebrovascular diseases. This may help to identify new therapeutic targets to prevent cognitive impairment, including protection of the glio-neuro-vascular unit .

    Heart Health And Dementia

    Heart disease is often linked to Alzheimers disease and vascular dementia, and atherosclerosis is the leading cause of heart disease. Its also closely related to vascular dementia. 

    Vascular dementia develops when plaque builds up in your arteries and obstructs blood flow, which can damage the blood vessels that deliver blood to your brain. Maintaining healthy cholesterol levels can ward off your chances of developing atherosclerosis and vascular dementia after that.

    High Blood Pressure And Dementia Risk

    Emerging risk factors for preventing dementia

    High blood pressure can cause blood clots in arteries, blocking blood flow to the brain. Stroke and the loss of brain cells may follow, and the brain could subsequently shrink. 

    People with high blood pressure in midlife are more likely to develop dementia later in life . 

    Heres what you can do:Make sure you know your blood pressure if you are 40, Livingston said. The Lancet team recommended aiming for a systolic blood pressure the pressure of the blood against artery walls as the heart beats of 130mm Hg or less in midlife, though Larson cautioned against reaching an overly low blood pressure. 

    Experts say managing stress and sleeping well, maintaining a stable weight and eating a healthy diet of less sugary foods, exercising regularly and refraining from smoking can help control blood pressure. 

    Read more about past research on the link between hypertension and dementia, and insights on how hypertensive treatment may reduce risk of cognitive decline 

    Control Your Blood Pressure

    Hypertension or high blood pressure is strongly associated with an increased risk of dementia. High blood pressure can damage tiny blood vessels in the parts of the brain responsible for cognition and memory. The latest American Heart Association guidelines class blood pressure readings of 130/80 mm Hg and above as the start of high blood pressure.

    Check your blood pressure at home. A study in the Netherlands found that a large variation in blood pressure readings over a period of years was associated with an increased risk of dementia. Inexpensive monitors that wrap around your upper arm can help you keep track of your blood pressure throughout the day and pick up on any variations. Some devices even send the results to your phone so you can easily track your readings or share them with your doctor.

    The Link Between Air Pollution And Dementia

    Air pollution isnt just harmful for our respiratory health: Emerging evidence shows that people who are exposed to air pollution are at a higher risk of dementia. In fact, people who live close to major roads and freeways, have higher odds of developing dementia. And some scientists have suggested that exposure to air pollution can lead to brain inflammation. 

    Heres what you can do: Avoid the outdoors when air pollution levels are high, Larson said, such as instances of wildfires. Meanwhile, researchers urge policy makers to consider increasing peoples access to green spaces, reducing traffic and the number of highways in residential areas. 

    Read more about past research on the link between heart disease, Alzheimers, and air pollution 

    Give Your Brain Sleep

    A study by Maiken Nedergaard found that sleep is when your brain cleans up. During sleep, your brain clears amyloid-beta protein, which contributes to the plaque that is often found in the brains of people with dementia. Without adequate amounts of sleep, your brain may start to suffer from toxic buildup.

    Action Strategy: Make a date with sleep. Figure out when your best sleep hours are in a 24-hour period and commit to being in bed for those times. Get yourself ready for sleep an hour before you meet your pillow. Promote high-quality sleep by:

    • Turning off electronics
    • Having a relaxing shower or bath
    • Practicing meditation or light reading

    Recent Studies And Ongoing Trials

    Vascular dementia: Five ways to prevent signs and symptoms ...

    Recent studies have also coupled physical exercise with other interventions. The Life Randomized Trial recruited 1635 community-living participants at risk for cognitive impairment at eight US centers from February 2010 until December 2011. The interventions comprised either a structured, moderate-intensity physical activity program, which included walking, resistance training, and flexibility exercises, or a health education program of educational workshops and upper-extremity stretching. No differences in executive function were observed between the two interventions over a period of 24 months when comparing adults over 80 years of age or those with lower baseline physical activity performance who did benefit with the physical activity intervention.

    Education And Cognitive Health

    Receiving more education in early life mayreduce risk of dementia. According to Lon Schneider, an author of the report and professor of psychiatry, neurology, and gerontology at the University of Southern California, the more we learn, the more cognitive reserve we build up. While connections between brain cells, also known as synapses, may falter due to aging and sickness, You have more reserves to start with, so youre more resilient against illnesses, said Schneider.

    Heres what you can do: Engaging in intellectual activities later in life can potentially help maintain cognitive abilities. One study in China which found people older than the age of 65 who read, played games or bet more frequently were less likely to develop dementia. Another study showed that people who participated in intellectual, physical and social activities in midlife were more likely to have better cognition in old age.

    Read more about past research on the link between early childhood education and Alzheimers disease, the most common form of dementia.  

    Dementia Prevention: 5 Steps To Take Now

    While forgetfulness and problems thinking most often show up in people age 60 or older, medical research is discovering that the disease starts making changes in the brain many years before that.

    In a 2017 article in JAMA Neurology, the authors looked at data from 15,744 people from all over the country to see the relationship between smoking, diabetes and elevated blood pressure and the chance of developing dementia over 25 years.

    People with high blood pressure in middle age increased their risk of having dementia over the next 25 years by 40%. And in the case of diabetes, that risk goes up by 80%. Thats almost as much of an increased risk as having a genetic vulnerability for Alzheimers.

    Healthy choices and lifestyle changes in your 40s may make a difference in your dementia risk. Talk to your doctor about strategies to guard against plaque buildup and narrowing of your arteries:

    Hearing Loss And Dementia Risk

    People with hearing loss in midlife are at a higher risk of dementia. Older adults with hearing problems also have higher odds of dementia except for those who use hearing aids. socially isolating, Larson said. Social isolation and inability to engage with others in speech and listening has a detrimental effect on maintaining brain reserve. 

    Heres what you can do:To prevent hearing loss, Larson urged people to avoid excessive noise. Those who have hearing difficulties should seek testing and, if appropriate, use a hearing aid. 

    Read more about past research on the link between hearing loss and cognitive decline 

    How To Prevent Dementia 10 Strategies To Reduce Your Risk

    Dementia Free Preventing Alzheimers

    According to the Center for Disease Control and Prevention, there are ways to decrease your risk of dementia. Studies are showing us that healthy lifestyle choices can prevent many forms of cancer, diabetes and heart disease. A healthy lifestyle can also improve your cognitive function. While there is no definitive way to prevent dementia, these 10 healthy lifestyle strategies may help you reduce your risk.

    Lifestyle Changes To Improve Vascular Dementia Symptoms

    A diagnosis of dementia is scary. But its important to remember that many people with dementia can lead healthy, fulfilling lives for years after the diagnosis. Dont give up on life! As much as possible, continue to look after your physical and emotional health, do the things you love to do, and spend time with family and friends.

    The same strategies used to keep your brain healthy as you age and prevent the onset of dementia can also be used to improve symptoms.

    Find new ways to get moving. Research suggests that even a leisurely 30-minute walk every day may reduce the risk of vascular dementia and help slow its progression. Regular exercise can also help control your weight, relieve stress, and boost your overall health and happiness.

    Create a network of support. Seeking help and encouragement from friends, family, health care experts, and support groups can improve your outlook and your health. And its never to late to make new friends and expand your network.

    Eat for heart health. Heart disease and stroke share many of the same risk factors, such as high LDL cholesterol , low HDL cholesterol , and high blood pressure. Adopting a heart-healthy diet may help to improve or slow down your dementia symptoms.

    Make it a point to have more fun.Laughing, playing, and enjoying yourself are great ways to reduce stress and worry. Joy can energize you and inspire lifestyle changes that may prevent further strokes and compensate for memory and cognitive losses.

    Cognitive Impairment In Cerebrovascular Diseases

    Cerebrovascular diseases include a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. These include conditions that may cause acute interruption of cerebral circulation and subsequent acute neuronal damage, such as ischaemic or haemorrhagic stroke, and disorders that may cause chronic pathological changes in small vessels and neurological dysfunction, such as cerebral small vessel diseases. Patients with cerebrovascular diseases, both acute and chronic, usually have multidimensional functional impairments to the brain and an increased risk of cognitive impairment and dementia.

    The cognitive consequences of cerebrovascular disease may substantially affect patients quality of life and cause a considerable disease burden for patients and their families. Compared with other brain dysfunctions such as movement disorders, cognitive impairment and dementia due to cerebrovascular diseases are neglected by both patients and physicians in all countries, but especially in low income and developing countries such as China.

    Vascular Dementia Vs Alzheimers

    Vascular dementia and Alzheimers are not the same disease, but its possible to have both at the same time.

    In fact, the most common form of mixed dementia is vascular dementia and Alzheimers.

    When that happens, the person could have symptoms of both types of dementia.

    Heres how theyre different.

    Vascular dementia:

    • Is caused by stroke or
    • Symptoms usually progress in noticeable stages
    • Impaired coordination or balance usually happens early on
    • Related to vascular problems like high cholesterol and high blood pressure

    Alzheimers:

    Is Dementia Hereditary And Can It Be Prevented

    Complications of vascular dementia

    Medically Reviewed By: Wendy Boring-Bray, DBH, LPC

    Beingdiagnosedwithdementiacanbeverysurreal.Youdon’twanttobelievethatitistruebecausesufferingfromadiseaselikethisisveryhorrifying.Theideathatyourmemoriesandyourconceptofrealitycouldbestolenfromyoubyamedicalconditioniscompletelyfrightening,andyouwouldn’tbeblamedforfeelingdepressedafterreceivingthisnews.Itisn’tsomethingthatyouwanttohavehappened,butyouhavetodealwithitanyway.

    Manypeoplewonderexactlyhowsomeonecontractsadiseasesuchasdementia.Commonpeopledon’tknowalotaboutthisconditionoutsideofthefactthatitcanchangeyourperspectiveandalteryourmind.Manypeopleaskquestionssuchas,”isdementiahereditary?”Afterexaminingthefacts,theinformationthatyoufindoutmightsurpriseyou.

    Folic Acid Vitamin B6 And B12

    Deficiencies in folic acid, vitamin B6 and vitamin B12 can cause an amino acid in our body, called homocysteine, to rise. Higher than normal levels are considered to be a risk factor for a number of disease states including cardiovascular disease and dementia, and are thought to contribute to poor cognition.

    However, there are no guidelines to consuming supplements of B6, B12, or folic acid individually merely to reduce the risk of dementia . Again the advice is to ensure that foods rich in B6, B12, and folate are present in the diet.

    Other Treatment And Support

    Supporting a person with vascular dementia to live well includes treatment for symptoms, support to cope with lost abilities, and help to keep up enjoyable activities. For someone who has had a stroke or has physical difficulties, treatment will also include rehabilitation.

    The drugs that are routinely prescribed for Alzheimer’s disease do not have benefits for vascular dementia, and are not recommended for it. These drugs may, however, be prescribed to treat mixed dementia .

    If someone is depressed or anxious, talking therapies or drug treatments may also be tried. Counselling may also help the person adjust to the diagnosis.

    Talking therapies for people with dementia

    Talking therapies give people the chance to speak in confidence to a trained professional about problems or issues that are causing them concern.

    Mechanisms Of Cognitive Impairment In Cerebrovascular Diseases

    Given the high prevalence of cognitive impairment, understanding the mechanisms of cognitive impairment in cerebrovascular diseases is pivotal. Understanding impairment of brain function due to neuronal damage after stroke is not difficult. A recent study suggested that multiple infarcts in one hemisphere; involvement of strategic regions such as the middle and inferior frontal gyri, parietal region, and middle temporal gyrus; larger stroke lesion volume; and lesions on the left hemisphere were associated with a higher risk of dementia after stroke. Further studies are needed in large populations to confirm these findings and enable application of a personalised approach in the clinic.

    Recent progress in imaging techniques has provided potential breakthroughs in our understanding of the mechanism of cognitive impairment. Clinical studies have shown endothelial dysfunction in cerebral microvessels in cerebral small vessel disease, including blood-brain barrier dysfunction, dysfunctional blood flow, impaired interstitial fluid drainage, and white matter rarefaction. However, challenges still exist to determine what types of vascular dysfunction initiate or propagate small vessel disease pathogenesis, which abnormalities are reversible, and why lesion progression and symptomatology are so variable . Clarification of these questions may facilitate identification of potential therapeutic targets to improve brain function after cerebrovascular diseases.

    Vascular Dementia Signs And Symptoms

    Why is dementia so hard to treat?

    Vascular dementia affects different people in different ways and the speed of the progression also varies from person to person. Some symptoms may be similar to those of other types of dementia and usually reflect increasing difficulty to perform everyday activities like eating, dressing, or shopping.

    Behavioral and physical symptoms can come on dramatically or very gradually, although it appears that a prolonged period of TIAsthe mini-strokes discussed aboveleads to a gradual decline in memory, whereas a bigger stroke can produce profound symptoms immediately. Regardless of the rate of appearance, vascular dementia typically progresses in a stepwise fashion, where lapses in memory and reasoning abilities are followed by periods of stability, only to give way to further decline.

    Common Signs and Symptoms of Vascular Dementia
    Mental and Emotional Signs and Symptoms
    • Slowed thinking
    • Language problems, such as difficulty finding the right words for things
    • Getting lost in familiar surroundings
    • Laughing or crying inappropriately
    • Difficulty planning, organizing, or following instructions
    • Difficulty doing things that used to come easily
    • Reduced ability to function in daily life

    Cognitive Retraining And Dementia

    Cognitive interventions for dementia syndromes encompass a wide range of modalities, including cognitive training that targets one domain and increasing task difficulty as expertise develops, cognitive stimulation targeting multiple domains with emphasis on social interaction, and cognitive rehabilitation tailored at improving activities of daily living. These interventions aim at enhancing cognitive reserve, that is, the structural and dynamic capacities of brain circuits that compensate when one or more brain regions do not function adequately, thus increasing resilience against the neuropathological changes of dementia., Several long-term follow-up studies have looked at trajectories of cognitive impairment and the effect of cognitive stimulation, including the German Interdisciplinary Longitudinal Study on Adult Development and Aging Study, the Minority Aging Research Study, the Memory and Ageing Project, the Chicago Health and Ageing Project, and the Betula prospective cohort study. The PACE study was an RCT designed to study the effect of cognitive interventions on the progression of MCI. The intervention group received supervised education on cognitive retraining strategies. Over a period of 2 years, there was no significant effect on progression to dementia; however, a limitation of the trial was the lack of active supervised task engagement for the participants of the intervention group beyond the 5-week intervention period.

    How Diabetes Drives Dementia Risk

    Diabetes is linked to the degeneration of small blood vessels as well as strokes which are in turn risk factors of dementia. It is possible beta-amyloid plaques and tau tangles, the biomarkers of Alzheimers, play a role in high blood sugar levels, Larson said. But more research is needed to pinpoint biological mechanisms linking diabetes and dementia beyond those related to blood flow. 

    Most people have type 2 diabetes, which leads to a two-fold increased risk of developing Alzheimers. As cells fail to respond to insulin the hormone that manages blood sugar levels the body produces more insulin, which in turn, leads to overly high levels of blood sugar. 

    Heres what you can do: Researchers warn that type 2 diabetes and Alzheimers are reaching epidemic proportions, as they urge people to manage their stress, get a good nights sleep, maintain a balanced weight, eat a healthy diet with less sugary beverages, stay active and exercise regularly. 

    Read more about past research on the link between the brains metabolic function, diabetes and dementia  

    RELATED ARTICLES

    Most Popular