Vascular Dementia

Vascular dementia is a decline in thinking skills caused by conditions that block or
reduce blood flow to various regions of the brain, depriving them of oxygen and
nutrients.

About vascular dementia

body, but the brain is especially vulnerable.

In vascular dementia, changes in thinking skills sometimes occur suddenly after a stroke, which blocks major blood vessels in the brain. Thinking difficulties may also begin as mild changes that gradually worsen as a result of multiple minor strokes or another condition that affects smaller blood vessels, leading to widespread damage. A growing number of experts prefer the term “vascular cognitive impairment” (VCI) to “vascular dementia” because they feel it better expresses the concept that vascular thinking changes can range from mild to severe.

Vascular brain changes often coexist with changes linked to other types of dementia, including Alzheimer's disease and Lewy body dementia. Several studies have found that vascular changes and other brain abnormalities may interact in ways that increase the likelihood of dementia diagnosis. Sign up for our e-news to receive updates about Alzheimer’s and dementia care and research.

Vascular dementia is widely considered the second most common cause of dementia after Alzheimer's disease, accounting for 5% to 10% of cases. Many experts believe that vascular dementia remains underdiagnosed — like Alzheimer's disease — even though it's recognized as common.

Learn more: Key Types of Dementia, Mixed Dementia

Symptoms

The impact of vascular conditions on thinking skills varies widely, depending on the
severity of the blood vessel damage and the part of the brain it affects. Memory loss
may or may not be a significant symptom depending on the specific brain areas where
blood flow is reduced. Vascular damage that starts in the brain areas that play a key
role in storing and retrieving information may cause memory loss that is very similar
to Alzheimer’s disease.

Symptoms may be most obvious when they happen soon after a major stroke. Sudden post-stroke changes in thinking and perception may include:

• Confusion
• Disorientation
• Trouble speaking or understanding speech
• Physical stroke symptoms, such as a
  sudden headache
• Difficulty walking
• Poor balance
• Numbness or paralysis on one side of the face or the body

Multiple small strokes or other conditions that affect blood vessels and nerve fibers deep inside the brain may cause more gradual thinking changes as damage accumulates. Common early signs of widespread small vessel disease include impaired planning and judgment, uncontrolled laughing and crying, declining ability to pay attention, impaired function in social situations, and difficulty finding the right words.

Learn more: Warning Signs from the American Stroke Association

Diagnosis

Diagnostic guidelines for vascular dementia have used a range of definitions for dementia and various approaches to diagnosis. In 2011, the American Heart Association and American Stroke Association issued a joint scientific statement on vascular contributions to mild cognitive impairment (MCI) and dementia. The Alzheimer’s Association participated in developing the statement, which is also endorsed by the American Academy of Neurology. The goals of the statement, which include practice recommendations, are to raise awareness of the importance of vascular factors in cognitive change, increase diagnostic consistency and accelerate research.

Under the diagnostic approach recommended in the 2011 statement, the following criteria suggest the greatest likelihoodof mild cognitive impairment (MCI) or dementia is caused by vascular changes: 

1. The diagnosis of dementia or mild cognitive impairment is confirmed by neurocognitive testing, which involves several hours of written or computerized tests that provide detailed evaluation of specific thinking skills such as judgment, planning, problem-solving, reasoning and memory.
2. There is brain imaging evidence, usually with magnetic resonance imaging (MRI), confirming:
   • A recent stroke, or
   • Other vascular brain changes whose severity and pattern of affected
     tissue are consistent with the types of impairment documented in
     cognitive testing.
3. There is no evidence that nonvascular factors may be contributing to
   cognitive decline.

The statement also details variations in these criteria that may suggest a possibility
rather than a strong likelihood that cognitive change is due to vascular factors.

Because vascular dementia often goes unrecognized, many experts recommend
professional cognitive screening for everyone considered to be at high risk, including
those who have had a stroke or a transient ischemic attack (TIA), also known as a
ministroke, or who have risk factors for heart or blood vessel disease. Professional
screening for depression is also recommended for high-risk groups. Depression
commonly coexists with brain vascular disease and can contribute to cognitive
impairment.

Learn more: AHA/ASA Scientific Statement: Vascular Contributions to Cognitive Impairment and Dementia, Mixed Dementia

Causes and risks

Any condition that damages blood vessels anywhere in the body can cause brain
changes linked to vascular dementia. As with Alzheimer’s disease, advancing age is a
major risk factor.

Additional risk factors for vascular dementia coincide with those that increase risk for
heart disease, stroke and other conditions affecting blood vessels. Many of these
factors are also linked to increased risk of Alzheimer’s.

The following strategies may reduce the risk of developing diseases that affect the heart and blood vessels — and may help protect the brain:

• Don't smoke.
• Keep your blood pressure, cholesterol and blood sugar within recommended limits.
• Eat a healthy, balanced diet.
• Exercise.
• Maintain a healthy weight.
• Limit alcohol consumption.

Learn more: Brain Health

Treatment and outcomes

The U.S. Food and Drug Administration (FDA) has not approved any drugs
specifically to treat symptoms of vascular dementia, but there is evidence from
clinical trials that drugs approved to treat Alzheimer’s symptoms may also offer a
modest benefit in people with vascular dementia. Treatment primarily works to prevent the worsening of vascular dementia by treating the underlying disease, such as hypertension, hyperlipidemia or diabetes mellitus.

Controlling risk factors that may increase the likelihood of further damage to the
brain’s blood vessels is an important treatment strategy. There’s substantial evidence
that treatment of risk factors may improve outcomes and help postpone or prevent
further decline.

Individuals should work with their physicians to develop the best treatment plan for
their symptoms and circumstances.

Like other types of dementia, vascular dementia shortens life span. Some data suggest
that those who develop dementia following a stroke survive an average of three years.
As with other stroke symptoms, cognitive changes may sometimes improve during
recovery and rehabilitation from the acute phase of a stroke as the brain generates
new blood vessels and brain cells outside the damaged region take on new roles.

Learn more: Clinical Studies for Dementia