What Is Vascular Dementia?
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Medically reviewed by Smita Patel, DO
Vascular dementia is a condition where memory, thinking, and behavior are impacted by damage to the blood vessels of the brain. When blood flow to the brain's neurons (nerve cells) is reduced or stopped, these cells start to die when they can't get the nutrients they need. As a result, the brain tissue begins to shrink.
Risk factors for vascular dementia include having a history of heart disease or stroke, cigarette smoking, and genetics. Symptoms of vascular dementia can include changes in personality and behavior and difficulty with tasks that were once easy. While there may be brief moments of improvement, symptoms can worsen as the condition progresses.
Vascular dementia is the second most frequent type of dementia after Alzheimer's disease. It makes up at least 20% of all dementia cases. Vascular dementia can happen on its own or alongside other types of memory problems or types of dementia.
Research shows there are racial differences in dementia diagnoses. Non-Hispanic Black individuals are about 1.5 to 2 times more likely to develop dementia compared to non-Hispanic white individuals.
Vascular Dementia Symptoms
Symptoms of vascular dementia may begin with subtle changes, and become more noticeable over time. Below are some early symptoms and more advanced (or late) symptoms.
Early Signs
Early signs and symptoms of vascular dementia include:
Having a challenging time with familiar tasks that used to be easy
Getting lost on routes that are usually familiar, like to the grocery store or to work
Having trouble with language, like finding the right words for common objects
Losing interest in activities you used to enjoy
Feeling less emotional
Misplacing things often
Changes in personality, social skills, and behavior
Late Signs
Later signs and symptoms of vascular dementia include:
Changes in sleeping patterns, such as waking up often during the night
Difficulty with basic tasks like cooking or driving
Forgetting recent events and personal history, or losing a sense of identity
Experiencing false beliefs (delusions), depression, or restlessness
Seeing or hearing things that aren't there (hallucinations), arguing, or showing aggressive behavior
More trouble than usual with reading or writing
Poor judgment and not recognizing potential dangers
Pronouncing or using words incorrectly, or speaking in confusing ways
Pulling back from social interactions
As dementia progresses, the symptoms can worsen and the ability to look after oneself decreases.
What Causes Vascular Dementia?
The most common cause of vascular dementia is multiple small strokes, often linked with high blood pressure (hypertension). However, not everyone who experiences a stroke will develop vascular dementia.
A stroke usually presents as sudden episodes that can cause symptoms like muscle weakness, slowness in movement, speech difficulties, dysphagia (trouble swallowing), a shuffling walk, overactive reflexive response (hyperactive reflexes), and specific reactions in the feet when stimulated. You may notice these physical symptoms by the time a decline in mental abilities happens.
The risk of vascular dementia after a stroke depends on the size and number of strokes, as well as which parts of the brain are affected. A brain scan of someone with vascular dementia may show thicker blood vessel walls and thinning of white matter, a network of nerve fibers that send messages to different areas of the brain.
Vascular dementia can also be caused by other conditions that reduce blood and oxygen flow to the brain, like intracranial stenosis, or the narrowing of the brain's arteries. Risk factors like high blood pressure, irregular heartbeat, diabetes, metabolic syndrome, and high cholesterol can increase your likelihood of developing vascular dementia.
Structural Inequities in Communities of Color
A study from 2016 found the incidence of a vascular dementia diagnosis among adults ages 65 and older was highest among Black adults compared to other races.
Black adults also have higher rates of high blood pressure and obesity, while Hispanic adults are more likely to have diabetes. Studies have found that the inflammation in the brain that occurs in someone with obesity can also worsen other neurological disorders like dementia.
These factors are often highly impacted by accessibility to healthy foods in low income and predominantly Black and Brown communities. Eating ultra-processed foods and dairy have also been shown to potentially increase rates of hypertension (high blood pressure) and obesity. Hypertension makes it more difficult for your heart to deliver the right amount of blood and oxygen to your brain, which is a contributing factor to many cases of vascular dementia.
Structural inequities also contribute to delayed diagnoses due to reduced access to care. Black people are more likely to be diagnosed with vascular dementia as well as other coexisting neurological conditions later in life than white people. Delayed diagnoses of conditions that coexist with dementia can increase your likelihood of developing vascular dementia earlier in life. For example, a 2018 study indicated that after a stroke, Black adults were almost twice as likely as white adults to develop vascular dementia.
How Is Vascular Dementia Diagnosed?
To determine if someone has vascular dementia, a neurologist (a medical doctor who specializes in conditions affecting the brain and spinal cord) will typically ask about difficulties with everyday tasks, perform tests to check memory and cognitive skills, and talk to someone close to the person to understand if there are signs of dementia. They will also look at the person's medical history and lifestyle.
They may also perform a range of blood tests. These include a complete blood count, called a CBC (a panel that checks various components in the blood), tests for thyroid function, and vitamin B12 levels.
They may also assess use a questionnaire to assess for depression. If there are specific neurological symptoms, brain imaging tests may be performed. For instance, magnetic resonance imaging (MRI) is often preferred if the person shows specific signs of brain or nerve issues.
Diagnosing vascular dementia accurately can be challenging. There's some difficulty in standardizing tests and assessments, particularly when there are a number of brain changes or diseases involved.
Treatments for Vascular Dementia
While there's no way to undo the brain damage caused by vascular dementia, it's important to manage symptoms and reduce risk factors to prevent the disease. Here's what can help:
Eat healthy foods that are low in saturated fat and free of trans fats
Limit alcohol to 1 or 2 drinks per day or fewer
Manage your blood pressure
Get control of your LDL (or 'bad') cholesterol
Avoid tobacco use
Your healthcare provider might also recommend blood thinners like aspirin to prevent blood clots and reduce your risk of strokes.
When caring for someone with dementia at home, focus on:
Managing ongoing behavior changes
Removing hazards from the home
Supporting family members and other caregivers
Sometimes, medication is needed to control aggressive or dangerous behaviors.
Diversity in Clinical Trials
There have been advancements in how different types of dementia can be treated. Leqembi (lecanemab) and Donanema (N3pG) are the first drugs to be used to treat Alzheimer's disease. These drugs target a build-up of amyloid in the brain. Amyloid is an amino acid that is thought to build-up in the brains of people with Alzheimer's. However, a significant portion of Black individuals with vascular dementia do not have the amount of amyloid build-up needed for the drugs to be effective.
For example, despite Black people being more likely to develop Alzheimer's, Leqembi and Donanema were not extensively studied in Black people. Researchers said this is because Black people did not have enough beta amyloid to qualify for the study, and that the lack of beta amyloid may be because Black people have a different form of dementia and not Alzheimer’s disease.
Black people have historically been excluded from and experienced discrimination in healthcare settings. This includes but is not limited to discriminatory beliefs in medicine about pain tolerance among Black individuals and past predatory clinical trials. The lack of diversity in clinical trial settings contributes to the continued lack of resources in treatment for people of color.
An increase in inclusion efforts in research are needed to create more diversity in research on dementia to better serve Black and Brown communities.
How to Prevent Vascular Dementia
For people who are already showing early signs of cognitive decline, research suggests that there are methods can help slow down the progression of the disease. These methods include stroke prevention treatments like surgery to clear blocked carotid arteries (which send blood to your brain), medications to prevent blood clots, and regular physical exercise.
Risk of developing vascular dementia can often be reduced, and possibly prevented, by managing existing condition like diabetes, high blood pressure, and high cholesterol, as well as incorporating lifestyle factors such as not smoking. It's also crucial to properly manage other conditions like coronary artery disease and atrial fibrillation (A-Fib). Research studies have found that using medications to lower blood pressure can reduce your risk of developing vascular dementia.
Related Conditions
Conditions or complication related to vascular dementia include:
Delusions, paranoia, or distorted thoughts
Aspiration pneumonia, which is a condition where food or fluid is accidentally inhaled into the lungs instead of being swallowed.
Depression
History of falls
Difficulties with walking
Pressure sores and ulcers, which are especially common in people who also have type 2 diabetes
Recurrent hospitalizations
Living With Vascular Dementia
Living with vascular dementia presents challenges, but there are reasons to remain hopeful. Medical advancements and proactive lifestyle changes can greatly enhance the quality of life and may even extend it.
Actively managing heart health through diet, exercise, and regular medical check-ups is important. Staying physically and mentally active, as well as engaging in activities like walking, puzzles, and social interactions, can also have a positive impact. Early and consistent medical attention for any changes in physical or mental health can lead to better management of the condition. All these efforts combined can make a significant difference for those living with and at risk for vascular dementia.
Additionally, more research is needed to examine differences in clinical presentations of dementia in Black and Brown people. This can help with addressing inequities in research.
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