Symptoms And Disease Course
Symptoms differ depending on what part and how much of the brain is affected, and can overlap with those of other types of dementia. Symptoms are likely to be more gradual and less dramatic in multi-infarct than in post-stroke dementia. For example, in multi-infarct dementia a gradual decline in some aspects of speech and language may be noticed, whereas immediately following a stroke there can be a sudden change in speech.
Vascular dementia does generally progress, but the speed and pattern of cognitive decline, motor skills slowing, and mood changes can vary. Some individuals may experience memory loss, whereas others may exhibit changes primarily in mood and behavior.
Like all dementias, individuals in later stages will show overall cognitive changes and will depend on others for care. Symptoms common in both post-stroke and multi-infarct type dementia can include:
- confusion and difficulty problem-solving
- changes in mood including loss of interest in regular activities
- trouble finding the right word
- motor symptoms including clumsiness and slow or unsteady gait disturbance.
Family caregivers may find it difficult to know how to provide help when symptoms are so variable. Getting a definitive diagnosis will make it easier to provide care now and in the future.
What Are The Symptoms Of Vascular Dementia
The symptoms of vascular dementia depend on the location and amount of brain tissue involved. Vascular dementia symptoms may appear suddenly after a stroke, or gradually over time. Symptoms may get worse after another stroke, a heart attack, or major surgery. These are signs and symptoms of vascular dementia
- Increased trouble carrying out normal daily activities because of problems with concentration, communication, or inability to carry out instructions
- Memory problems, although short-term memory may not be affected
- Confusion, which may increase at night
- Stroke symptoms, such as sudden weakness and trouble;with speech
- Personality changes
- Mood changes, such as depression or irritability
- Stride changes when walking too fast, shuffling steps
- Problems with movement and/or balance
- Urinary problems, such as urgency or incontinence
Are There Medicines To Treat Vascular Dementia
Though there is no cure for vascular dementia yet, there are medications that can help manage the symptoms. Sometimes medications used to treat memory problems in Alzheimers disease may be helpful for vascular dementia. Sometimes, people with vascular dementia can have mood changes, such as depression or irritability. These can be managed by medications like the ones used for depression or anxiety.
Diffuse Subcortical Small Vessel Disease
This is damage to the small subcortical vessels that supply deep grey matter and white matter. The vessels affected are small arteries and arterioles that branch from proximal parts of the major cerebral arteries to supply the basal ganglia and thalamus, and penetrating arterioles from the pial surface that reach through the cerebral cortex to supply the white matter. The perivascular VirchowRobin spaces around these vessels are frequently widened, a process referred to as cribriform change. The tissue supplied by these small vessels may suffer from lacunar infarction or hypoperfusion of blood that renders it damaged but not dead. Radiological changes of small vessel disease are very commonly seen in scans of older people, and small vessel disease may even account for the largest proportion of vascular dementia . Reference Erkinjuntti, Inzitari and PantoniErkinjuntti et al have proposed specific radiological criteria for subcortical ischaemic vascular dementia.
An unusual form of subcortical small vessel disease occurs in the rare inherited condition of CADASIL in which a mutation in the Notch3 gene results in deposition of granular material in the walls of small arteries and arterioles, narrowing of vessel lumens and destruction of smooth muscle cells in their walls.
Causes Of Vascular Dementia
Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells.;
This can;happen as a result of:
- narrowing and blockage of;the small blood vessels inside the brain
- a single;stroke, where the blood supply to part of the brain is suddenly cut off
- lots of “mini strokes” that cause tiny but widespread damage to the brain
Tackling these might reduce your risk of vascular dementia in later life, although;it’s not yet clear exactly how much your risk of dementia can be reduced.
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Symptoms Of Vascular Dementia
Symptoms of vascular dementia depend on what part of the brain is affected and to what extent. Like Alzheimer’s disease, the symptoms of vascular dementia are often mild for a long time. They may include:
- Problems with short-term memory
- Wandering or getting lost in familiar surroundings
- Laughing or crying at inappropriate times
- Trouble concentrating, planning, or following through on activities
- Trouble managing money
- Hallucinations or delusions
Symptoms that suddenly get worse often signal a stroke. Doctors look for symptoms that progress in noticeable stages to diagnose vascular dementia. Alzheimer’s, by comparison, progresses at a slow, steady pace. Another clue is impaired coordination or balance. In vascular dementia, problems walking or balancing can happen early. With Alzheimer’s, these symptoms usually occur late in the disease.
Is Cerebrovascular Disease The Same As Vascular Dementia
a series of tiny strokes, abstract = Cerebrovascular disease is an important cause of psychiatric disability in the elderly, global, Dementia is chronic, 66 The presence of cerebrovascular disease in patients with dementia and concomitant AD will tend to produce a more severe dementia , with respective frequencies of 70% and 15% of all dementias, It is clear that there are no easy categorical distinctions between the 2 diseases.Cited by: 79Vascular dementia is dementia caused by problems in the supply of blood to the brain, The term refers to a syndrome consisting of a complex interaction of cerebrovascular disease and risk factors that lead to changes in the brain structures due to strokes and lesions, Vascular dementia is a common form of dementia that affects more than 138, Damage to blood vessels can occur as a result of a major stroke, there are also important differences which people should be aware of.
Types Of Stroke And Treatment
Ischemic stroke is by far the most common type of stroke, accounting for a large majority of strokes. There are two types of ischemic stroke: thrombotic and embolic. A thrombotic stroke occurs when a blood clot, called a thrombus, blocks an artery to the brain and stops blood flow. An embolic stroke occurs when a piece of plaque or thrombus travels from its original site and blocks an artery downstream. The material that has moved is called an embolus. How much of the brain is damaged or affected depends on exactly how far downstream in the artery the blockage occurs.
In most cases, the carotid or vertebral arteries do not become completely blocked and a small stream of blood trickles to the brain. The reduced blood flow to the brain starves the cells of nutrients and quickly leads to a malfunctioning of the cells. As a part of the brain stops functioning, symptoms of a stroke occur. During a stroke, there is a core area where blood is almost completely cut off and the cells die within five minutes. However, there is a much larger area known as the ischemic penumbra that surrounds the core of dead cells. The ischemic penumbra consists of cells that are impaired and cannot function, but are still alive. These cells are called idling cells, and they can survive in this state for about three hours.
Transient Ischemic Attack
Signs And Symptoms Of Vascular Dementia
Symptoms of VD often begin suddenly and worsen in astepwise, episodic progression of intellectual decline, althoughsymptoms can develop gradually and thus may be easily confused withAlzheimers disease.3,4 Decline appears to be gradual when associated with small-vessel ischemic damage due to small incremental deficits.3 In some cases of VD, symptom manifestation can be followed by modest recovery.3 Motor and focal neurologic deficits frequently develop and occur early in the course of VD as compared withAlzheimers disease, in which they develop late in the disease.3;
One of the first symptoms of VD manifests as a decline inthe ability to organize thoughts or actions .4While loss of short-term memory is usually the first sign in otherdementias, short-term memory may be less affected in VD, with memoryproblems usually developing later in the course of disease.3,4Depression may be more common in VD compared with other dementias dueto the patients awareness of disease-related deficits .3
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What Are The Causes Of Cerebrovascular Disease
Conditions that fall under the heading of cerebrovascular disease include:
- Stroke: The most common type of cerebrovascular disease. The hallmark of a stroke is the permanent loss of sensation or motor function. The two general categories of strokes are hemorrhagic or ischemic .
- Transient ischemic attack : This is similar to a stroke, but the symptoms completely resolve within 24 hours. TIA is sometimes referred to as a mini stroke.
- Aneurysms of blood vessels supplying the brain: An aneurysm is caused by a weakening of the artery wall, resulting in a bulge in the blood vessel.
- Vascular malformations: This refers to abnormalities present in arteries or veins.
- Vascular dementia: Cognitive impairment that is usually permanent.
- Subarachnoid hemorrhage: This term is used to describe blood leaking out of a blood vessel onto the brains surface.
What Is Vascular Dementia
If you are worried about vascular dementia or know someone who is, this guide can help you understand what you need to do. It explains what vascular dementia is and how it is linked to stroke. It also explains what you can do if you or someone you know is diagnosed with vascular dementia.
Its aimed at people who’ve had a stroke or who think they may have vascular dementia, but there is information for family and friends as well. If you have a question that is not answered in this guide call our Stroke Helpline.
The information on this page can be accessed in the following formats:
- ;as a pdf or large print Word document.
- To request a braille copy, email;.
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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.1516 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.17 This may help to identify new therapeutic targets to prevent cognitive impairment, including protection of the glio-neuro-vascular unit .14
How Is Vascular Dementia Treated
Vascular dementia can’t be cured. The main goal is to treat the underlying conditions that affect the blood flow to the brain. This can help cut;the risk of further damage to brain tissue.
Such treatments may include:
- Medicines;to manage blood pressure, cholesterol, triglycerides, diabetes, and problems with blood clotting
- Lifestyle changes, such as following a healthy diet, getting physical activity, quitting smoking, and quitting or decreasing alcohol consumption
- Procedures to improve blood flow to the brain, such as carotid endarterectomy, angioplasty, and;stenting; the carotid arteries are located in the neck and provide blood flow from the heart to the brain
- Medicines, such as cholinesterase inhibitors to treat the symptoms;of dementia or antidepressants to help with depression or other symptoms
What Happens In Vascular Dementia
Vascular dementia can cause different symptoms depending on where the blood vessels are damaged in the brain. For example, a person who had a stroke may have sudden problems with memory, balance, or speech. However, a person can have several strokes that may be unnoticeably small, but the damage can add up over time.
Many people with vascular dementia have trouble with memory. Others may have difficulty with organization and solving complex problems, slowed thinking, or being easily distracted. People with vascular dementia may also have changes in mood or behavior, such as irritability, loss of interest, or depression.
Sometimes, people with vascular dementia have trouble with balance and movement. This might include weakness on one side of the body, and the symptoms may get worse over time.
Caring For Someone With Dementia
Caring for a person with dementia can be physically and emotionally demanding. Anger, guilt, frustration, discouragement, worry, grief and social isolation are common.
Learn as much about vascular dementia as you can. Ask the primary care doctor or neurologist about good sources of information. Your local librarian also can help you find good resources.
Take care of yourself. See your doctors on schedule, eat healthy and exercise.
Seek support. People with dementia and their families benefit from counseling or local support services. Contact your Alzheimers Association local affiliate to connect with support groups, resources, referrals, home care agencies, residential care facilities, telephone help lines and educational seminars.
Encourage. You can help a person cope with vascular dementia by listening, reassuring them that life can be enjoyed and helping them retain dignity and self-respect.
Provide a calm environment. It can reduce worry and agitation. Establish a daily routine that includes comfortable activities for the person with vascular dementia.
New situations, excess noise, large groups of people, being rushed to remember or being asked to do complicated tasks can cause anxiety. As a person with dementia becomes upset, the ability to think clearly declines even more.
Paying attention to your needs and well-being is one of the most important things you can do for yourself and the person in your care.
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Dementia Terms You May Hear
- Alzheimers disease: the most common type of dementia, caused by clumps of proteins building up in the brain.
- Mild cognitive impairment: this can happen after a stroke. This is when someone has memory and thinking problems but they are not severe enough to interfere with their day-to-day activities.
- Other types of dementia: you may hear about dementia with Lewy bodies, frontotemporal dementia and young-onset dementia, as well as other rarer types.
- Small vessel disease: damage to the blood vessels deep inside the brain, often caused by high blood pressure.
- Vascular cognitive impairment: this describes all memory and thinking problems associated with stroke. It includes vascular dementia and mild cognitive impairment.
- Vascular dementia: problems with memory and thinking due to reduced blood flow in your brain.
Small Vessel Disease And Vascular Cognitive Impairment
Vascular dementia can also be caused by small vessel disease. This is when the small blood vessels deep within your brain become narrow and clogged up. The damage stops blood from getting to parts of your brain. The damage can build up over time and may cause signs of vascular cognitive impairment. This can eventually lead to vascular dementia.
Many of the things that increase your risk of small vessel disease, such as high blood pressure and diabetes, also increase your risk of stroke.;
You can read more about how to reduce your risk of stroke and small vessel disease.
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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.12 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.11 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 .11 Clarification of these questions may facilitate identification of potential therapeutic targets to improve brain function after cerebrovascular diseases.14
Mixed Or Multiple Forms Of Vascular Pathology
It is commonly the case that in an elderly brain there is more than one of these forms of vascular pathology and it can be difficult to define the exact component of mixed pathology that contributes most to vascular dementia or vascular cognitive impairment. In the unselected community-based population of elderly participants that contributed to the Medical Research Council Cognitive Function and Ageing Study, it was only in cases that had more than one form of vascular pathology that vascular disease contributed to dementia . However, it is noteworthy that in almost all cases one form of vascular pathology was small vessel disease. Thus, there is good reason to believe that small vessel disease, including lacunes that it gives rise to, is a particularly important contributor to vascular dementia/vascular cognitive impairment.
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