Victory Over Vascular Dementia

You have trouble remembering your way to your favorite park. You are overwhelmed and forget what you want to do next. You could be experiencing vascular dementia.

Vascular dementia results from a blockage or injury to blood vessels in the brain that interfere with circulation and deprive the brain of oxygen and nutrients. Its most common symptoms, in addition to memory problems, are confusion, difficulty concentrating, trouble organizing thoughts and tasks, and slow thinking.

Vascular dementia symptoms seem most clearcut following a stroke. When changes in your thinking and reasoning seem linked to a stroke, the condition is referred to as post-stroke dementia.

Vascular dementia is diagnosed if there is a decline in at least two types of thinking skills (like memory and language) that are related to a blood vessel blockage in your brain and impair your ability to function in daily life. If fewer than two abilities are impaired, or if changes to cognition don’t impact upon your daily life, this condition is called vascular cognitive impairment.

Vascular dementia is the second most common cause of dementia in older adults after Alzheimer’s disease.

According to the Cleveland Clinic, forgetfulness and problems with reasoning and problem solving are often the most noticeable change in someone with vascular dementia but other abilities can be impaired too, including thinking speed, communication skills, spatial skills (like sense of direction and depth perception), or attention and concentration. The size and location of damaged brain areas determine which abilities are affected. If additional strokes occur or problems with reduced blood flow continue, more and more brain tissue is damaged and more abilities are affected.

According to the Alzheimer’s Association, about 5 to 10 percent of people with dementia have vascular dementia alone. It’s most common in older adults between the ages of 60 and 75. Vascular dementia affects more men than women. The condition affects more Black people than other races.

Many of the medical conditions that put at risk for heart disease and stroke, make you vulnerable to vascular dementia. You may be at a higher risk if you are: of an older age (greater than >60), have high blood pressure, have had one or more strokes, have diabetes, have high cholesterol and lipid levels, have irregular heart rhythm, are a smoker, are physically inactive, are overweight, or have a family history of rare inherited diseases of the blood vessels that block the flow of blood in your brain.

There are different names for vascular dementia depending on the number of blood vessels involved and the way the symptoms progress.

·       Multi-infarct dementia: “Multi” means many and “infarct” means stroke, so multi-infarct means many strokes that affect blood flow to many areas of the brain. Changes from these strokes are often noticeable when they happen and so cognitive changes occur in a step-wise fashion (a sudden worsening over multiple periods of time).

·       Binswanger disease: This is a term for vascular dementia that happens when small blood vessels located throughout white matter (deep areas of the brain containing the “wiring” or connections between brain areas) are blocked over time by atherosclerosis (“hardening of the arteries”). This type of dementia, also called subcortical vascular dementia, occurs gradually over time (without sudden episodes of worsening).

·       Vascular dementia from a strategic single-infarct: Vascular dementia can happen after only one stroke if the blockage destroys brain tissue that’s needed for more than one thinking ability.

Vascular dementia is caused by conditions that damage blood vessels in your brain or partially or fully block blood flow. Reducing blood flow prevents oxygen and nutrient delivery to the brain. Without these, brain cells begin to die.

Common causes of vascular dementia include:

·       Narrowing (atherosclerosis) and/or blockage of many blood vessels (ischemic strokes) or tiny capillaries (small-vessel disease) that feed brain cells in your brain.

·       Bleeding from a ruptured blood vessel (e.g. a hemorrhagic stroke) inside your brain.

·       Other conditions that damage blood vessels, including infection, inflammation, high blood pressure and high cholesterol levels.

To diagnose vascular dementia, your doctor will do a medical history and physical. She may do other tests such as blood work, brain scans, a neuropsychological evaluation or a psychological/psychiatric assessment. You may be referred to a neurologist for these evaluations and tests.

Treatments for vascular dementia include medications, procedures to improve blood flow to the brain and lifestyle changes to manage risk factors that lead to vascular dementia.

Vascular dementia may be more preventable than other types of dementia. Managing risk factors that may lead to vascular dementia and the blockage of blood vessels that feed your brain is within your power. You can take steps to decrease those risk factors for conditions that affect your blood vessels.

You can try strategies such as knowing your numbers and keeping them within normal limits. Blood pressure should be less than <120/80 mm Hg. Cholesterol levels should be less than <200 mg/dL; LDL less than <100 mg/dL; triglycerides less than <150 mg/dL and blood sugar levels less than <126 mg/dL. Exercise for 30 minutes each day. Eat a well-balanced diet. Stop smoking. Cut back on alcohol. Manage your stress.

Vascular dementia is a serious illness that can get worse gradually or suddenly. Talk to your health provider about the options for care that you may face.