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What Are The Effects Of Vascular Dementia

What Can You Do

Testing new treatments for vascular dementia | Prof Hugh Markus | Alzheimer’s Research UK

A healthy lifestyle is important to help reduce risk factors of vascular dementia. This includes eating well, limiting alcohol, not smoking, exercising, and managing stress.

If you are concerned about vascular dementia symptoms, talk with your doctor. If you or someone you know has recently been diagnosed, explore the resources on this website and linked below to find out more about the disease, care, support, and research.

Clinical Definitions And Epidemiology

Vascular dementia represents a clinical syndrome that includes a wide spectrum of cognitive dysfunctions resulting from brain tissue death due to ischemia caused by vascular disease. A number of excellent reviews have been written on the topics of its diagnosis, pathogenesis, and epidemiology . It is believed that vascular dementia is a distinct clinical and pathological entity from Alzheimers dementia, Lewy body dementia, or fronto-temporal dementia, although elements of vascular disease may be present in all of these conditions. Treatment of vascular dementia has also received extensive coverage . The prevailing conclusion of these reports is that most vascular dementia trials have produced disappointing results. It is important to note that so far no drug has been approved by regulatory agencies to treat vascular dementia . Epidemiologically, vascular dementia is considered the second most prevalent type of dementia after Alzheimers disease although this point of view maybe brought to doubt by our increasing understanding of Lewy body disease . From a clinicians point of view, vascular dementia represents a major source of frustration because of its relatively high prevalence and lack of effective treatment options.

Vascular Dementia Vs Alzheimers

Alzheimers disease, like vascular dementia, is a form of dementia. In fact, it is the most common type. Some people use the terms interchangeably. However, Alzheimers is a type of dementia, not dementia itself.

Unlike vascular dementia, Alzheimers disease isnt caused by stroke. There is no known cause of Alzheimers, and your risk of developing it increases with age. The Alzheimers Association estimates that it makes up 80 percent of all dementia diagnoses, which is why the two terms are often confused. Vascular problems, such as stroke, high cholesterol, and hypertension, arent related to Alzheimers disease, as they are with vascular dementia.

While Alzheimers can cause memory issues, some of the first signs are not memory related. Adults in the early stages of the disease might have vision, word finding, and spatial difficulties. It can also cause poor judgement in everyday tasks. This differs a bit with vascular dementia, which usually causes memory problems in the earliest stages.

Although vascular dementia and Alzheimers are not the same disease, it is possible to have both. In fact, according to the Alzheimers Society, about 10 percent of people who have dementia have a form called mixed dementia. Most of these cases include both vascular dementia and Alzheimers disease. A person in this situation could exhibit symptoms of both of these types of dementia.

Several conditions and factors can damage blood vessels. They include:

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Sudden And Frequent Headaches

Based on the underlying cause and also each individual case from one person to the next, vascular dementia symptoms vary significantly.

However, experiencing sudden and frequent headaches is amongst the earliest signs that someone is suffering from the condition. Headaches can strike any time, meaning, they appear unexpectedly.

When experienced frequently following a medical event like suffering from a stroke is highly likely to have a connection with the onset of vascular dementia.

Vascular dementia comes about when there is inadequate blood flow going to the brain. It could also be the result of damaged blood vessels in the brain and these initial changes manifest as headaches.

How Long Can Person With Vascular Dementia Care For Themselves

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A person with vascular dementia will need help with at least some aspects of daily function, such as managing medications, paying bills or preparing food. You or your family member with vascular dementia may be able to do many things for themselves although, it may not be safe for them to live alone, depending on what abilities are affected. For some people with vascular dementia, more specialized care may be required from facilities that care specifically for people with dementia.

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Types Of Vascular Dementia

Vascular dementia can be divided into two types: post-stroke dementia and multi-infarct dementia .

POST-STROKE DEMENTIASymptoms are most obvious when they arise suddenly following a stroke, resulting in the blood supply to the brain being suddenly interrupted due to a blocked artery. This disruption can lead to damage or death of brain tissue. Not all stroke victims develop dementia it is estimated that approximately 20% of stroke patients develop post-stroke dementia within six months. Post-stroke dementia can result in physical symptoms and/or problems with vision or speech. Symptoms depend on what area and how much of the brain is affected.

MULTI-INFARCT DEMENTIAThis type of dementia results from a series of mini-strokes in vessels located deep within the brain . These mini-strokes may not lead to any sudden obvious onset of symptoms however, even these âsilent brain infarctionsâ still increase the risk of dementia, a result of disease of the brainâs blood vessels. Over time, the effects of this damage can result in dementia. Progression is referred to as âstep-wiseâ because symptoms worsen after any additional mini-strokes and then remain the same for a time. Symptoms that may develop include changes in reasoning and other thinking skills such as memory, as well as mood and behavior problems, including depression and apathy.

How Is Vascular Dementia Linked To Stroke

When you have a stroke, the blood supply to part of your brain is cut off, killing brain cells. The damage from a stroke can cause problems with memory and thinking. For many people, these problems improve over time. If the problems dont improve or get worse this may be a sign of vascular dementia.

Vascular dementia can also be caused by a series of small strokes. These result in lots of small areas of damage in your brain. Often, these strokes can be so small that you don’t know you are having them. These are known as silent strokes.

Sometimes symptoms of vascular dementia can be confused with the effects of stroke. Both stroke and vascular dementia can cause problems with memory, thinking and mood. Strokes happen suddenly while the symptoms of vascular dementia often get worse over time. The difference is that vascular dementia gets worse over time. If youre unsure, go to see your GP.

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Morphological Alterations Across The Cerebral Vasculature

Intracranial atherosclerosis.

String vessels and capillary rarefaction.

Aging leads to reduced cerebral microvascular density, a process known as vascular rarefaction . In advanced AD, this process is exacerbated, and autopsy studies have shown a large number of string vessels, consisting of remnants of micro-vessels that become acellular and collapse . These microvascular alterations occur in 90% of AD brains and are exacerbated in ApoE4 carriers and in the presence of amyloid plaques . Multiple factors may contribute to vascular rarefaction in AD, including A toxicity to vascular cells and vascular risk factors such as hypertension .

Cerebral amyloid angiopathy.

Amyloid deposition into the walls of cerebral arteries and capillaries gives rise to the so-called cerebral amyloid angiopathy . CAA occurs in 85% to 95% of patients with AD, has a significant impact on vessel health, and is an important contributor to cerebrovascular pathology in AD. CAA starts with A deposits in the adventitia and media of the arteries and in the basement membrane of capillaries, probably due to impaired A clearance . In more advanced cases, this vascular accumulation of A progresses until vascular cells degenerate. CAA, therefore, weakens the vessel wall, reduces resting cerebral blood flow and cerebrovascular reactivity, compromises the integrity of the blood-brain-barrier , and leads to microinfarcts and microbleeds, factors that contribute to cognitive impairment .

Helping Someone With Vascular Dementia

What is vascular dementia?

Caring for a person with vascular dementia can be very stressful for both you and your loved one. You can make the situation easier by providing a stable and supportive environment.

  • Modify the caregiving environment to reduce potential stressors that can create agitation and disorientation in a dementia patient.
  • Avoid loud or unidentifiable noises, shadowy lighting, mirrors or other reflecting surfaces, garish or highly contrasting colors, and patterned wallpaper.
  • Use calming music or play the persons favorite type of music as a way to relax the patient when agitated.

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Signs Of Vascular Dementia

If you or the people around you notice any of the signs below, you should visit your GP:

  • Not being able to understand or respond to things very quickly.
  • Not being able to remember things.
  • Finding it difficult to concentrate.
  • Not being able to find the right word when youre speaking.
  • Struggling to plan ahead for everyday tasks.
  • Difficulty in learning new tasks
  • Seeming down or depressed.

At a later stage, signs may include:

  • Becoming confused.
  • Behaving differently, especially if youre being aggressive or behaving inappropriately.
  • Lacking motivation.
  • Not being able to control your emotions.
  • Finding it difficult to walk and keep your balance.
  • Having problems controlling your bladder.

Psychological And Psychosocial Therapies

Psychological therapies for dementia include some limited evidence for reminiscence therapy , some benefit for cognitive reframing for caretakers, unclear evidence for validation therapy and tentative evidence for mental exercises, such as cognitive stimulation programs for people with mild to moderate dementia. Offering personally tailored activities may help reduce challenging behavior and may improve quality of life. It is not clear if personally tailored activities have an impact on affect or improve for the quality of life for the caregiver.

Adult daycare centers as well as special care units in nursing homes often provide specialized care for dementia patients. Daycare centers offer supervision, recreation, meals, and limited health care to participants, as well as providing respite for caregivers. In addition, home care can provide one-to-one support and care in the home allowing for more individualized attention that is needed as the disorder progresses. Psychiatric nurses can make a distinctive contribution to people’s mental health.

Some London hospitals found that using color, designs, pictures and lights helped people with dementia adjust to being at the hospital. These adjustments to the layout of the dementia wings at these hospitals helped patients by preventing confusion.

Cognitive training

Personally tailored activities

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What Is Vascular Dementia

Vascular dementia is the second most common form of dementia after Alzheimer’s disease. It’s caused when decreased blood flow damages brain tissue. Blood flow to brain tissue may be reduced by a partial blockage or completely blocked by a blood clot.

Symptoms of vascular dementia may develop gradually, or may become apparent after a stroke or major surgery, such as heart bypass surgery or abdominal surgery.

Dementia and other related diseases and conditions are hard to tell apart because they share similar signs and symptoms. Although vascular dementia is caused by problems with blood flow to the brain, this blood flow problem can develop in different ways. Examples of vascular dementia include:

  • Mixed dementia. This type occurs when symptoms of both vascular dementia and Alzheimer’s exist.
  • Multi-infarct dementia. This occurs after repeated small, often “silent,” blockages affect blood flow to a certain part of the brain. The changes that occur after each blockage may not be apparent, but over time, the combined effect starts to cause symptoms of impairment. Multi-infarct dementia is also called vascular cognitive impairment.

Researchers think that vascular dementia will become more common in the next few decades because:

When To See Your Gp

PPT

See your GP if you think you have early symptoms of dementia, especially if you’re over 65.

If it’s found at an early stage, treatment may be able to stop vascular dementia getting worse, or at least slow it down.

If you’re worried about someone else, encourage them to see their GP. You could suggest that you go with them.

Your GP can do some simple checks to try to find the cause of your symptoms. They can refer you to a memory assessment service or a specialist for further tests if needed.

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Vascular Dementia Clinical Trials

Memantine

Memantine belongs to the aminoadamantane chemical class and is structurally similar to amantadine, an antiparkinson and antiviral drug. It was initially developed to treat Parkinsons disease and was first tested in Europe in the 1990s, and later in the US, as a neuroprotective compound. In addition to its propensity to release dopamine from dopaminergic terminals, memantine is a weak, noncompetitive, open channel antagonist of the glutamate NMDA receptor . Since NMDA receptor-mediated excitotoxic nerve cell death is considered of paramount importance in ischemic nerve cell damage, NMDA antagonist properties make memantine an attractive neuroprotective compound. On the other hand, NMDA receptor antagonists have been well known to cause hallucinations and impair cognition, attributes which have seriously hampered their clinical development.

Galantamine

Donepezil

Rivastigmine

Rivastigmine is a nonspecific inhibitor of two enzymes: acetylcholinesterase and butyrylcholinesterase . Rivastigmines efficacy in in vascular dementia has been studied insufficiently to draw any meaningful conclusions. One study conducted on 16 patients with vascular dementia showed some benefits of rivastigmine on executive function and behavior . More studies are needed to understand if rivastigmine could be used for treatment of vascular dementia.

Hydergine

Nicergoline

Nimodipine

Blood pressure-lowering therapies

CDP-choline

Folic acid

Validation therapy

How Vascular Dementia Develops

Symptoms of vascular dementia can appear suddenly if they are caused by a single stroke, or if they are caused by silent strokes they may appear gradually over time. Vascular dementia sometimes develops in steps, so that symptoms will stay the same for a while and then suddenly get worse. These steps are usually due to new strokes.

You can read more about treatments to slow down the progression of dementia.

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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.

Who Is At Risk For Vascular Dementia

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Some risk factors for vascular dementia can be managed others, like age and gender, cannot. Among all factors, high blood pressure carries the greatest risk vascular dementia almost never occurs without it.

Likewise, a high risk of stroke goes hand in hand with risk for vascular dementia. One-quarter to one-third of strokes are thought to result in some degree of dementia. People who smoke, consume excessive amounts of alcohol, have diabetes, or heart disease also have a higher rate of the condition.

Vascular dementia most commonly occurs in people between the ages of 60 and 75. Men seem to be more vulnerable than women, and the condition affects African-Americans more often than other races. People whose age, sex, or race puts them at increased risk of vascular dementia have that much more reason to manage risk factors within their control.

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Research Into The Cause Of Vascular Dementia

Vascular dementia is the second most commonly diagnosed type of dementia, and may account for 15 – 20% of all cases. Vascular dementia is caused by chronic reduced blood flow to the brain, usually as a result of a stroke or series of strokes. It can often coexist with Alzheimer’s disease.

Stroke, small vessel disease, or a mixture of the two can cause vascular dementia. Most commonly there is a blockage of small blood vessels somewhere in the network of arteries that feeds the brain. Blockages may be caused by plaque build up on the inside of the artery wall, or by blood clots which have broken loose. Clots can form as a result of abnormal heart rhythms, or other heart abnormalities. Also, a weak patch on an artery wall can balloon outward and form an aneurysm, which can burst and deprive brain cells of oxygen.

It is estimated that about 50% of cases of vascular dementia result from high blood pressure, which can lead to a major stroke or a series of strokes and a build up of brain damage over time. Less common causes of vascular dementia are associated with autoimmune inflammatory diseases of the arteries such as lupus and temporal arteritis, which are treatable with drugs that suppress the immune system.

An inherited form of vascular dementia known as CADASIL is caused by a mutation on the Notch3 gene. This is a very rare form of dementia and only affects families carrying the Notch3 gene mutation.

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.

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