Vascular dementia is a common type of dementia caused by reduced blood flow to the brain. It's estimated to affect around 150,000 people in the UK.
Dementia is the name for problems with mental abilities caused by gradual changes and damage in the brain. It's rare in people under 65.
Vascular dementia tends to get worse over time, although it's sometimes possible to slow it down.
Symptoms of vascular dementia
Vascular dementia can start suddenly or begin slowly over time.
Symptoms include:
- slowness of thought
- difficulty with planning and understanding
- problems with concentration
- changes to your mood, personality or behaviour
- feeling disoriented and confused
- difficulty walking and keeping balance
- symptoms of Alzheimer's disease, such as problems with memory and language (many people with vascular dementia also have Alzheimer's disease)
These problems can make daily activities increasingly difficult and someone with the condition may eventually be unable to look after themselves.
Getting medical advice
See a GP if you think you have early symptoms of dementia, especially if you're over 65 years of age.
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 make an appointment with a GP and perhaps 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 clinic or another specialist for further tests if needed.
Tests for vascular dementia
There's no single test for vascular dementia.
The tests that are needed to make a diagnosis include:
- an assessment of symptoms – for example, whether these are typical symptoms of vascular dementia
- a full medical history, including asking about a history of conditions related to vascular dementia, such as strokes or high blood pressure
- an assessment of mental abilities – this will usually involve several tasks and questions
- a brain scan, such as an MRI scan or CT scan, to look for any changes that have happened in your brain
Treatments for vascular dementia
There's currently no cure for vascular dementia and there's no way to reverse any loss of brain cells that happened before the condition was diagnosed.
But treatment can sometimes help slow down vascular dementia.
Treatment aims to tackle the underlying cause, which may reduce the speed at which brain cells are lost.
This will often involve:
- eating a healthy, balanced diet
- losing weight if you're overweight
- stopping smoking
- getting fit
- cutting down on alcohol
- taking medicines, such as those used to treat high blood pressure, lower cholesterol or prevent blood clots
Other treatments, including physiotherapy, occupational therapy, dementia activities (such as memory cafes) and psychological therapies, can help reduce the impact of any existing problems.
Outlook for vascular dementia
Vascular dementia will usually get worse over time. This can happen in sudden steps, with periods in between where the symptoms do not change much, but it's difficult to predict when this will happen.
Home-based help will usually be needed, and some people will eventually need care in a nursing home.
Although treatment can help, vascular dementia can significantly shorten life expectancy.
But this is highly variable, and many people live for several years with the condition, or die from some other cause.
If you or a loved one has been diagnosed with dementia, remember that you're not alone. The NHS and social services, as well as voluntary organisations, can provide advice and support for you and your family.
Causes of vascular dementia
Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells.
This can happen as a result of:
- narrowing and blockage of the small blood vessels inside the brain
- a single stroke, where the blood supply to part of the brain is suddenly cut off
- lots of "mini strokes" (also called transient ischaemic attacks, or TIAs) that cause tiny but widespread damage to the brain
In many cases, these problems are linked to underlying conditions, such as high blood pressure and diabetes, and lifestyle factors, such as smoking and being overweight.
Tackling these might reduce your risk of vascular dementia in later life, although it's not yet clear exactly how much your risk of dementia can be reduced.
Symptoms-Vascular dementia
Vascular dementia causes problems with mental abilities and several other difficulties.
The symptoms can start suddenly or gradually. They tend to get worse over time, although treatment can help slow this down.
Early symptoms
Early signs of vascular dementia can include mild:
- slowness of thought
- difficulty with planning
- trouble with understanding
- problems with concentration
- changes to your mood or behaviour
- problems with memory and language (but these are not as common as they are in people with Alzheimer's disease)
At the beginning, these problems may be barely noticeable or mistaken for something else, such as depression. But they indicate some brain damage has happened and that treatment is needed.
Later symptoms
The symptoms often continue to get worse over time. This may happen slowly, or in sudden steps every few months or years.
The symptoms depend on the part of the brain that's affected, but can include:
- significant slowness of thought
- feeling disorientated and confused
- memory loss and difficulty concentrating
- difficulty finding the right words
- severe personality changes, such as becoming aggressive
- depression, mood swings and lack of interest or enthusiasm
- finding it difficult to walk and keep balance, with frequent falls
- loss of bladder control (incontinence)
- increasing difficulty with daily activities
Some people also have some symptoms of Alzheimer's disease.
Getting medical advice
See a GP if you think you have early symptoms of dementia, especially if you're over 65 years of age.
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 make an appointment with a GP and perhaps suggest that you go with them.
Symptoms of dementia can have several causes. A GP can do some simple checks to try to find out the cause and may refer you to a specialist for further tests.
Causes-Vascular dementia
Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells.
This is usually due to:
- narrowing of the small blood vessels deep inside the brain, known as subcortical vascular dementia or small vessel disease
- a stroke (where the blood supply to part of the brain is suddenly cut off, usually because of a blood clot), called post-stroke dementia or single-infarct dementia
- lots of "mini strokes" (also called transient ischaemic attacks or TIAs) that cause tiny but widespread damage to the brain, known as multi-infarct dementia
Some people with vascular dementia also have brain damage caused by Alzheimer's disease. This is known as mixed dementia.
Who's most at risk?
Things that can increase your chances of getting vascular dementia in later life include:
- high blood pressure (hypertension)
- smoking
- an unhealthy diet
- high blood cholesterol
- lack of exercise
- being overweight or obese
- diabetes
- drinking too much alcohol
- atrial fibrillation – a type of irregular heartbeat (arrhythmia) – and other types of heart disease
These problems increase the risk of damage to the blood vessels in and around your brain, or cause blood clots to develop inside them.
Can I reduce my risk?
By making healthy lifestyle changes, such as stopping smoking and exercising regularly, and treating any health conditions you have, you may be able to reduce your chances of getting vascular dementia.
This may also to help slow down or stop the progression of vascular dementia if you're diagnosed in the early stages. Find out more about treating vascular dementia.
But there are some things you cannot change that can increase your risk of vascular dementia, such as:
- your age – the risk of vascular dementia increases as you get older, with people over 65 most at risk
- your family history – your risk of problems such as strokes is higher if a close family member has had them
- your ethnicity – if you have a south Asian, African or Caribbean background, your risk of vascular dementia is higher, as related problems such as diabetes and high blood pressure are more common in these groups
In rare cases, unavoidable genetic conditions can also increase your risk of vascular dementia.
Treatment-Vascular dementia
Treatment can help prevent further damage to the brain in people with vascular dementia and may slow down its progression.
But there's currently no cure for the condition or a way to reverse the damage that's already happened.
Care plans
Before treatment starts, your current and future health and social care needs will be assessed and a care plan will be created. This is to make sure you receive the right treatment for your needs.
A care plan identifies areas where you may need help, such as:
- support for you or your carer so you can remain as independent as possible, including whether you might need care at home or in a nursing home
- changes that might need to be made to your home so it's easier to live in
- financial assistance
Lifestyle changes
The main aim of treatment for vascular dementia is to treat the underlying cause to help stop the condition getting worse.
This will usually involve making healthy lifestyle changes, such as:
- eating a healthy, balanced diet. For example, you may be advised to follow a low-salt diet to manage high blood pressure
- losing weight if you're overweight
- stopping smoking
- getting fit
- cutting down on alcohol
Medicines
Medicines may also be offered to treat the underlying cause of vascular dementia and help stop it getting worse.
These include:
- medicines to treat high blood pressure
- medicines to treat high cholesterol, such as statins
- medicines such as aspirin or clopidogrel to reduce the risk of blood clots and further strokes
- anticoagulant medicines, such as warfarin, which can also reduce the risk of blood clots and further strokes
- medicines to treat diabetes
An antipsychotic medicine, such as haloperidol, may sometimes be given to people showing persistent aggression or extreme distress where there's a risk of harm to themselves or others. A consultant psychiatrist should be involved in deciding whether to prescribe this medicine.
Alzheimer's disease medicines, such as donepezil (Aricept), galantamine (Reminyl), rivastigmine (Exelon) or memantine are not used to treat vascular dementia, but may be used in people who have a combination of vascular dementia and Alzheimer's disease.
Support and other therapies
There are also several therapies and practical measures that can help make everyday living easier for someone with dementia.
These include:
- occupational therapy to identify problems in everyday life, such as getting dressed, and find practical solutions
- speech and language therapy to help improve communication problems
- physiotherapy to help with movement difficulties
- psychological therapies, such as cognitive stimulation (activities and exercises to improve memory, problem-solving and language)
- relaxation techniques, such as massage, music or dance therapy
- social interaction, leisure activities and other dementia activities, such as memory cafes (drop-in sessions for people with memory problems and their carers to get support and advice)
- making changes to your home, such as removing loose carpet and potential trip hazards, making sure the home is well lit, and adding grab bars and handrails
It can also be helpful to get in touch with a support group, such as the Alzheimer's Society or Dementia UK.
End of life and legal issues
If you have been diagnosed with dementia, you might want to make arrangements for your care that take into account the decline in your mental abilities.
This may include making sure that your wishes are upheld if you're not able to make decisions for yourself.
You may want to consider:
- creating an advance decision, which makes your treatment preferences known in case you're unable to do this in the future
- having a "preferred place of care" plan, which outlines where you would like to receive treatment
- giving a relative lasting power of attorney, enabling them to make decisions about you if you're unable to.