Overview

Vascular dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes caused by brain damage from impaired blood flow to your brain.

You can develop vascular dementia after a stroke blocks an artery in your brain, but strokes don't always cause vascular dementia. Whether a stroke affects your thinking and reasoning depends on your stroke's severity and location. Vascular dementia can also result from other conditions that damage blood vessels and reduce circulation, depriving your brain of vital oxygen and nutrients.

Factors that increase your risk of heart disease and stroke — including diabetes, high blood pressure, high cholesterol and smoking — also raise your vascular dementia risk. Controlling these factors may help lower your chances of developing vascular dementia.

Source: http://www.mayoclinic.com

Symptoms

Vascular dementia symptoms vary, depending on the part of your brain where blood flow is impaired. Symptoms often overlap with those of other types of dementia, especially Alzheimer's disease dementia.

Vascular dementia signs and symptoms include:

• Confusion
• Trouble paying attention and concentrating
• Reduced ability to organize thoughts or actions
• Decline in ability to analyze a situation, develop an effective plan and communicate that plan to others
• Difficulty deciding what to do next
• Problems with memory
• Restlessness and agitation
• Unsteady gait
• Sudden or frequent urge to urinate or inability to control passing urine
• Depression or apathy

Vascular dementia symptoms may be most clear-cut when they occur suddenly following a stroke. When changes in your thinking and reasoning seem clearly linked to a stroke, this condition is sometimes called post-stroke dementia.

Sometimes a characteristic pattern of vascular dementia symptoms follows a series of strokes or ministrokes. Changes in your thought processes occur in noticeable steps downward from your previous level of function, unlike the gradual, steady decline that typically occurs in Alzheimer's disease dementia.

But vascular dementia can also develop very gradually, just like Alzheimer's disease dementia. What's more, vascular disease and Alzheimer's disease often occur together.

Studies show that many people with dementia and evidence of brain vascular disease also have Alzheimer's disease.

Source: http://www.mayoclinic.com

Causes

Vascular dementia results from conditions that damage your brain's blood vessels, reducing their ability to supply your brain with the amounts of nutrition and oxygen it needs to perform thought processes effectively.

Common conditions that may lead to vascular dementia include:

• Stroke (infarction) blocking a brain artery. Strokes that block a brain artery usually cause a range of symptoms that may include vascular dementia. But some strokes don't cause any noticeable symptoms. These silent strokes still increase dementia risk.

  With both silent and apparent strokes, the risk of vascular dementia increases with the number of strokes that occur over time. One type of vascular dementia involving many strokes is called multi-infarct dementia.

• Narrowed or chronically damaged brain blood vessels. Conditions that narrow or inflict long-term damage on your brain blood vessels also can lead to vascular dementia. These conditions include the wear and tear associated with aging, high blood pressure, abnormal aging of blood vessels (atherosclerosis), diabetes, and brain hemorrhage.

Source: http://www.mayoclinic.com

Diagnosis

Doctors can nearly always determine that you have dementia, but there's no specific test that confirms you have vascular dementia. Your doctor will make a judgment about whether vascular dementia is the most likely cause of your symptoms based on the information you provide, your medical history for stroke or disorders of the heart and blood vessels, and results of tests that may help clarify your diagnosis.

Lab tests

If your medical record doesn't include recent values for key indicators of the health of your heart and blood vessels, your doctor will test your:

• Blood pressure
• Cholesterol
• Blood sugar

He or she may also order tests to rule out other potential causes of memory loss and confusion, such as:

• Thyroid disorders
• Vitamin deficiencies

Neurological exam

Your doctor is likely to check your overall neurological health by testing your:

• Reflexes
• Muscle tone and strength, and how strength on one side of your body compares with the other side
• Ability to get up from a chair and walk across the room
• Sense of touch and sight
• Coordination
• Balance

Brain imaging

Images of your brain can pinpoint visible abnormalities caused by strokes, blood vessel diseases, tumors or trauma that may cause changes in thinking and reasoning. A brain-imaging study can help your doctor zero in on more likely causes for your symptoms and rule out other causes.

Brain-imaging procedures your doctor may recommend to help diagnose vascular dementia include:

• Computerized tomography (CT) scan. For a CT scan, you'll lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles, and a computer uses this information to create detailed cross-sectional images (slices) of your brain.

  A CT scan can provide information about your brain's structure; tell whether any regions show shrinkage; and detect evidence of strokes, ministrokes (transient ischemic attacks), blood vessel changes or tumors. Sometimes you'll receive an intravenous (IV) injection of a contrast agent that will help highlight certain brain tissues.

• Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into a tube-shaped MRI machine, which makes loud banging noises while it produces images.

  MRIs are painless, but some people feel claustrophobic inside the machine and are disturbed by the noise. MRIs are generally the preferred imaging test because MRI can provide even more detail than CT scans about strokes, ministrokes and blood vessel abnormalities.

Carotid ultrasound

This procedure uses high-frequency sound waves to determine whether your carotid arteries — which run up through either side of your neck to supply blood to the brain — show signs of narrowing as a result of plaque deposits or structural problems. Your test may include a Doppler ultrasound, which shows the movement of blood through your arteries in addition to structural features.

Neuropsychological tests

This type of exam assesses your ability to:

• Speak, write and understand language
• Work with numbers
• Learn and remember information
• Develop a plan of attack and solve a problem
• Respond effectively to hypothetical situations

Neuropsychological tests sometimes show characteristic results for people with different types of dementia. People with vascular dementia may have an exceptionally hard time analyzing a problem and developing an effective solution.

They may be less likely to have trouble learning new information and remembering than are people with dementia due to Alzheimer's disease unless their blood vessel problems affect specific brain regions important for memory. However, there's often a lot of overlap in exam results for people with vascular dementia and people who also have the brain changes of Alzheimer's disease.

Source: http://www.mayoclinic.com

Prevention

The health of your brain's blood vessels is closely linked to your overall heart health. Taking these steps to keep your heart healthy may also help reduce your risk of vascular dementia:

• Maintain a healthy blood pressure. Keeping your blood pressure in the normal range may help prevent both vascular dementia and Alzheimer's disease.
• Prevent or control diabetes. Avoiding the onset of type 2 diabetes, with diet and exercise, is another possible way to decrease your risk of dementia. If you already have diabetes, controlling your glucose levels may help protect your brain blood vessels from damage.
• Quit smoking. Smoking tobacco damages blood vessels everywhere in your body.
• Get physical exercise. Regular physical activity should be a key part of everyone's wellness plan. In addition to all of its other benefits, exercise may help you avoid vascular dementia.
• Keep your cholesterol in check. A healthy, low-fat diet and cholesterol-lowering medications if you need them may reduce your risk of strokes and heart attacks that could lead to vascular dementia, probably by reducing the amount of plaque deposits building up inside your brain's arteries.

Lifestyle and home remedies

Though these haven't been proved to alter the course of vascular dementia, your doctor will likely recommend that you:

• Participate in regular physical activity
• Eat healthy
• Try to maintain a normal weight
• Engage in social activities
• Challenge your brain with games, puzzles and new activities, such as an art class or listening to new music

Source: http://www.mayoclinic.com

Coping and support

People with any type of dementia and their caregivers — whether it's vascular dementia or Alzheimer's disease — experience a mixture of emotions, including confusion, frustration, anger, fear, uncertainty, grief and depression.

Caring for someone with dementia

• Seek out support. Many people with dementia and their families benefit from counseling or local support services. Contact your local Alzheimer's Association affiliate to connect with support groups, resources and referrals, home care agencies, residential care facilities, a telephone help line, and educational seminars.
• Plan for the future. While your loved one is in the earlier stages of the disease, talk with a lawyer about the types of legal documents you'll need in the future, such as power of attorney, health care proxy and an advanced directive.
• Give encouragement. Caregivers can help a person cope with vascular dementia by being there to listen, reassuring the person that life can still be enjoyed, providing encouragement, and doing their best to help the person retain dignity and self-respect.
• Provide a calm environment. A calm and predictable environment can help reduce worry and agitation. Establish a daily routine that includes enjoyable activities well within the comfort zone of the person with vascular dementia.
• Do activities together. Instead of dwelling on what's to come, try to find activities you both like to do, such as a painting class or a long walk.
• Respect independence as often as is safe. It may be a long time before your loved one has to give up living alone or driving. The early stages of dementia can last years, and your loved one may still be capable of doing many things on his or her own. If you and your loved one can't agree on when it's time to stop certain activities, such as driving, ask your loved one's doctor for his or her advice.

Caring for the caregiver

Providing care for a person with dementia is physically and emotionally demanding. Feelings of anger and guilt, frustration and discouragement, worry and grief, and social isolation are common. But paying attention to your own needs and well-being is one of the most important things you can do for yourself and for the person in your care.

If you're a caregiver:

• Learn as much about the disease as you can. Ask your primary care doctor or neurologist about good sources of information. Your local librarian also can help you find good resources.
• Ask questions of doctors, social workers and others involved in the care of your loved one.
• Call on friends and family members for help when you need it.
• Take a break every day.
• Take care of your health by seeing your own doctors on schedule, eating healthy meals and getting exercise.
• Make time for friends, and consider joining a support group.

Source: http://www.mayoclinic.com

Risk factors

In general, the risk factors for vascular dementia are the same as those for heart disease and stroke. Risk factors for vascular dementia include:

• Increasing age. Your risk of vascular dementia rises as you grow older. The disorder is rare before age 65, and the risk rises substantially by your 90s.
• History of heart attack, strokes or ministrokes. If you've had a heart attack, you may be at increased risk of having blood vessel problems in your brain. The brain damage that occurs with a stroke or a ministroke (transient ischemic attack) may increase your risk of developing dementia.
• Abnormal aging of blood vessels (atherosclerosis). This condition occurs when deposits of cholesterol and other substances (plaques) build up in your arteries and narrow your blood vessels. Atherosclerosis can increase your risk of vascular dementia by reducing the flow of blood that nourishes your brain.
• High cholesterol. Elevated levels of low-density lipoprotein (LDL), the "bad" cholesterol, are associated with an increased risk of vascular dementia.
• High blood pressure. When your blood pressure's too high, it puts extra stress on blood vessels everywhere in your body, including your brain. This increases the risk of vascular problems in the brain.
• Diabetes. High glucose levels damage blood vessels throughout your body. Damage in brain blood vessels can increase your risk of stroke and vascular dementia.
• Smoking. Smoking directly damages your blood vessels, increasing your risk of atherosclerosis and other circulatory diseases, including vascular dementia.
• Obesity. Being overweight is a well-known risk factor for vascular diseases in general, and therefore, presumably increases your risk of vascular dementia.
• Atrial fibrillation. In this abnormal heart rhythm, the upper chambers of your heart begin to beat rapidly and irregularly, out of coordination with your heart's lower chambers. Atrial fibrillation increases your risk of stroke because it causes blood clots to form in the heart that can break off and go to the brain blood vessels.

Source: http://www.mayoclinic.com