It is caused by damage to brain tissue, which occurs due to decreased blood flow.
The vascular disease occurs when blood vessels are damaged and the supply of oxygen is at risk.
Blood flow to brain tissue may be completely blocked by a clot in a blood vessel, or blood flow may be decreased by a partial blockage of blood vessels in the brain.
If the oxygen supply fails in the brain, brain cells are likely to die, leading to a series of mini-strokes (heart attacks) and possible vascular dementia.
Vascular dementia accounts for 20-30% of all dementia cases.
The mini-strokes that cause vascular dementia are often so mild that they don’t cause immediate symptoms, or they can cause temporary confusion.
However, each stroke destroys a small area of cells in the brain by cutting off its blood supply and the cumulative effect of several mini strokes is often enough to cause vascular dementia.
Vascular dementia and Alzheimer’s disease often occur together and can often work in combination to cause dementia.
Vascular dementia can develop gradually, or it can manifest after a stroke or after undergoing major surgery, such as heart bypass surgery or abdominal surgery.
Dementia and other related diseases and conditions are difficult to distinguish because they share similar signs and symptoms.
Types of vascular dementia
Although vascular dementia is caused by problems with blood flow to the brain, this problem can occur in different ways.
The different types of vascular dementia are based on how each type occurs:
In some cases, there are symptoms of both vascular dementia and Alzheimer’s disease.
However, when mixed dementia occurs, it is generally considered a form of dementia with some characteristics of Alzheimer’s disease, rather than a case of Alzheimer’s disease with characteristics of vascular dementia.
This occurs after several small, often “silent” blockages, which repeatedly affect blood flow to a certain area of the brain.
The changes that occur after each blockage may not be apparent, but over time, the combined effect begins to cause symptoms of deterioration.
Multiple infarct dementia is also known as vascular cognitive impairment.
Men, especially those under the age of 75, are affected by vascular dementia more often than women.
Researchers believe that vascular dementia will become more common in the coming decades because:
- Vascular dementia is usually caused by conditions that occur more often in older people, such as atherosclerosis (hardening of the arteries), heart disease, and strokes.
- People live longer with chronic diseases, such as heart disease and diabetes.
Causes of vascular dementia
Blood flow to a certain part of the brain can be decreased or interrupted by:
- The presence of blood clots.
- Bleeding from a ruptured blood vessel.
- Damage to a blood vessel from atherosclerosis, infection, or other causes, such as an autoimmune disorder.
The effect of decreased or absent blood flow depends on the size and location of the affected area.
If a very small area in a part of the brain that controls memory is affected, for example, you may experience “forgetfulness” that does not necessarily change your ability to carry out normal activities.
If a larger area is affected, you may have trouble thinking clearly or problem solving, or major memory problems that change your ability to function normally.
Autosomal dominant cerebral arteriopathy with subcortical infarcts and leukoencephalopathy is a genetic disorder that generally leads to vascular dementia.
A parent with the gene for autosomal dominant cerebral arteriopathy with subcortical infarcts and leukoencephalopathy passes it on to a child, making it an inherited autosomal dominant disorder.
It affects the blood vessels in the white matter of the brain. Symptoms, such as migraine headaches, seizures, and severe depression, generally begin when a person is in their middle age; however, symptoms may not appear until later in life.
Risk factors for vascular dementia
Risk factors for vascular dementia include risk factors for conditions associated with vascular dementia, such as heart disease, stroke, diabetes, and atherosclerosis:
- Increasing age.
- High blood pressure
- Smoking cigarettes.
- High levels of cholesterol and triglycerides.
- Atrial fibrillation (fast and irregular speed of the two upper chambers of the heart).
- High level of homocysteine in the blood, which can cause blood vessel damage, heart disease, and blood clots.
- Lack of physical activity.
- Overweight or obese
- The use of birth control pills.
- Conditions that make blood “thick” or clot more easily.
- Family history of dementia.
- Family history of autosomal dominant cerebral arteriopathy with subcortical infarcts and leukoencephalopathy.
Signs and symptoms of vascular dementia
Vascular dementia symptoms depend on the location and amount of brain tissue involved.
Symptoms of vascular dementia can appear suddenly after a stroke or gradually over time.
Symptoms may get worse after another stroke, a heart attack, or major surgery. These are signs and symptoms of vascular dementia:
- Increased difficulty in performing normal daily activities due to poor concentration, communication, or inability to carry out instructions.
- Memory problems, although short-term memory may not be affected.
- Confusion, which may increase at night (known as ‘sundown syndrome’).
- Stroke symptoms, such as sudden weakness and trouble speaking.
- Personality changes
- Changes in mood, such as depression or irritability.
You change your pace when you walk too fast, shuffling.
- Problems with movement and / or balance.
- Urinary problems, such as urgency or incontinence.
In addition to a complete medical history and physical exam, the doctor may order some of the following:
- Computed tomography.
- Magnetic resonance imaging.
- Neuropsychological evaluations. These tests can help distinguish vascular dementia from other types of dementia and Alzheimer’s disease.
- Psychiatric evaluation. This can be done to rule out a psychiatric condition that may resemble dementia.
Although vascular dementia cannot be cured, the main goal of treatment is to treat underlying conditions that affect blood flow to the brain.
Treating these underlying conditions can help reduce risk factors for further damage to brain tissue.
These treatments can include:
- Medicines to control blood pressure, cholesterol, triglycerides, diabetes, and blood clotting problems.
- Lifestyle modifications, such as eating a healthy diet, being physically active, quitting smoking, and stopping or reducing alcohol use.
- Procedures to improve blood flow to the brain, such as carotid endarterectomy, angioplasty, and / or stenting; The carotid arteries are located in the neck and provide a flow of blood from the heart to the brain.
- To treat the progression of dementia, medications are prescribed, such as cholinesterase inhibitors.
Long-term prognosis for vascular dementia
Vascular dementia is a progressive disease with no cure. Cognitive decline is likely to have a clear onset date, and symptoms tend to progress in a series of steps after each attack.
Some areas of the brain may be more affected than others. Consequently, some cognitive abilities may be relatively unaffected.
A person with vascular dementia will eventually need a high level of care as a result of the loss of mental abilities, as well as a decrease in physical abilities.
Family members may be able to care for a vascular dementia patient from the beginning. However, as the disease progresses, the person may need more specialized care.
Respite programs, adult day care programs, and other resources can help the caregiver get away a little from the demands of caring for a loved one with vascular dementia.
Long-term care centers that specialize in caring for patients with dementia, Alzheimer’s disease, and other related conditions are often available once a person with vascular dementia can no longer receive care at home.
The doctor can provide resources for caregivers.