Dec 14, 2013

What is Vascular Dementia?

Vascular dementia (VD) is a degenerative cerebrovascular disease that leads to a progressive decline in memory and cognitive functioning.

Vascular dementia occurs when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system. Vascular dementia generally affects people between the ages of 60 and 75.

By Bob DeMarco
Alzheimer's Reading Room

Vascular dementia is a degenerative cerebrovascular disease that leads to a progressive decline in memory

Vascular dementia is considered the second most common type of dementia.

Vascular dementia occurs when blood vessels in the brain narrow, reducing the amount of blood flowing to the brain. In some cases, a blood vessel may be completely blocked, causing a stroke and vascular dementia. However, not all strokes cause vascular dementia. The severity of the stroke and the location are the most important factors.

Vascular dementia often presents with symptoms similar to Alzheimer’s disease. This usually happens after a series of very small strokes, or infarcts, that block small blood vessels. Often these small strokes are not noticeable. Eventually a cumulative effect takes place that results in vascular dementia.

There is no cure for vascular dementia.

The prevalence of vascular dementia ranges from 1 to 4 percent in people over the age of 65. There are no drugs currently approved by the U.S. Food and Drug Administration (FDA) to treat vascular dementia.

Persons with high blood pressure, high cholesterol, hardening of the arteries, diabetes, or other risk factors for heart disease are at high risk for vascular dementia. Monitoring of blood pressure, weight, blood sugar, and cholesterol are essential to avoid vascular dementia, or to lesson the chances of suffering from vascular dementia. Healthy eating, exercise, and taking medication as prescribed are important.

Vascular Dementia Symptoms
  • Problems with memory or forgetfulness
  • Confusion, agitation and sudden mood swings
  • Difficulty concentrating, planning, and communicating
  • Unsteady gait, poor balance, or shuffling feet
  • Urinary urgency or Incontinence
  • Night wandering or getting lost in familiar surroundings
  • Depression
  • A decline in the ability to organize thoughts
  • Trouble communicating details
  • Sudden weakness and difficulty speaking

Vascular dementia symptoms can begin suddenly and may worsen progressively, following a series of strokes or mini-strokes. However, some forms of vascular dementia develop gradually and the symptoms can be confused with Alzheimer's disease.
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Vascular Dementia Causes

Vascular dementia can be caused in several different ways. Most commonly there is a blockage of the small blood vessels in the arteries of the brain. These blockages may be caused by plaque build up on the inside of the artery wall, or by blood clots that break loose and block a tributary in the brain.

Most people believe complete blockage of an artery in the brain causes a stroke (infarction), but some blockages don't produce stroke symptoms. These infarctions when "silent" increase a persons risk of vascular dementia.

Vascular dementia can be caused by narrowing of the blood vessels in the brain. In this scenario portions of the brain can be deprived of oxygen. This causes reduced blood flow to the brain from arteries narrowed by vascular disease.

Vascular dementia can also be caused by: high blood pressure or profoundly low blood pressure, high cholesterol, a family history of heart problems, disease in arteries elsewhere in the body, heart rhythm abnormalities, brain damage caused by hemorrhaging, or blood vessel damage from such disorders as lupus erythematosus or temporal arthritis.

Vascular Dementia Risk Factors
  • Aging. This is one of the biggest risk factors for vascular dementia. The disorder is rare before the age of 65.
  • History of stroke. The brain damage that occurs with strokes appears to increase the risk of developing dementia.
  • Hardening of the arteries (atherosclerosis). Atherosclerosis occurs when plaque builds up in your arteries and narrows your blood vessels. This can increase your risk of vascular dementia.
  • High blood pressure. Hypertension puts extra pressure on blood vessels throughout the body. This increases the risk of vascular problems in the brain.
  • High cholesterol. High levels of bad cholesterol (LDL) are associated with an increased risk of vascular dementia, and possibly with a higher risk of Alzheimer's disease.
  • Diabetes. High glucose levels damage blood vessels throughout the body, increasing the risk of stroke and other vascular problems in the brain.
  • Smoking. Smoking increases the risk of hardening of the arteries and other vascular diseases, including vascular dementia.
Preparing for an Appointment with your Doctor

You may first be seen at the hospital if you've had a stroke. Or, if your symptoms are mild, you may start by first seeing your personal care physician. If so, you should insist on a referral to a doctor who specializes in disorders of the nervous system (neurologist).

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together.

Here are a list of question that you might ask:
  • What causes the symptoms
  • Are there other possible causes for my symptoms?
  • What kinds of tests do I need?
  • Do these tests require any special preparation? Is this condition temporary or long-lasting?
  • What treatments are available, which do you recommend and will they interact with my other medicine?
  • What types of side effects can I expect from treatment?
  • What's my prognosis?
  • How quickly will I lose my memory?
  • Will I need nursing home care?
  • Are there any alternatives to the primary approach that you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there any brochures or other printed material that I can take home with me?
  • What Web sites do you recommend?
  • Is there any increased risk to my children?
Don't be hesitant or afraid to ask any and all questions that you have. You want to come to a clear understanding of any diagnosis and treatment protocol.

You should prepare in advance to answer any questions your doctor might ask. These include:
  • When did you start experiencing symptoms
  • Did your symptoms begin abruptly or slowly?
  • Have your symptoms been continuous or occasional?
  • Do you have a history of high blood pressure, elevated cholesterol, diabetes, heart disease or stroke?
  • What were your first symptoms?
  • Have other symptoms occurred since the first set of symptoms occurred?
Vascular Dementia Tests and Diagnosis

You can expect any or all of these test.
  • Computerized tomography
  • Magnetic resonance imaging (MRI).
  • Positron emission tomography (PET).
  • Doppler ultrasound.
  • Neuropsychological tests.

Neuropsychological tests assess orientation, learning, recall, attention, calculation and language.

Exam results for people with vascular dementia typically show the same types of cognitive deficits as the exam results of people who have Alzheimer's disease.

One major difference, however, is in memory function. Most people with vascular dementia don't experience memory problems until later in the course of the disease unless there is a stroke in the exact area of the brain that controls memory.

Vascular Dementia Treatments and Drugs

There is no cure for vascular dementia and no drugs have been approved by the Food and Drug Administration to treat it. However, medications designed to treat the symptoms of Alzheimer's disease also appear to help people with vascular dementia.

Ask your doctor about these drugs. Cholinesterase inhibitors — such as donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon) — are Alzheimer's drugs that work by boosting levels of a chemical messenger involved in memory and judgment. Side effects can include nausea, vomiting, muscle cramps, and diarrhea.

 Memantine (Namenda) also has been shown to provide a modest benefit in people who have vascular dementia. Memantine works by regulating a chemical messenger involved in information processing, storage and retrieval. Side effects can include headache, constipation, confusion, and dizziness.

 Additionally, if you treat the risk factors that may have contributed to vascular dementia, you may be able to slow the progression of dementia. This means controlling your blood pressure, cholesterol levels,  diabetes, and quitting smoking.

Doctors may also prescribe medications to help you control these conditions, along with aspirin or an anti-platelet aggregator medication, such as ticlopidine (Ticlid) and clopidogrel (Plavix), to help keep your arteries clear. None of these measures, however, can restore lost cognitive function.

Original content Bob DeMarco, Alzheimer's Reading Room