Brain ischemia (the restriction of adequate blood flow to the brain) which deprives the brain of necessary oxygen (cerebral hypoxia) can cause brain damage that leads to neurological symptoms and conditions such as dementia. Vascular dementia is a condition involving dementia and cognitive impairment that results from the reduction of adequate blood supply to the brain. It is also called vascular cognitive impairment.
Definition & Facts
Vascular dementia is the second most common cause of dementia among the elderly, after Alzheimer's disease. Vascular dementia is caused by insufficient blood flow to the brain, which is usually the result of a stroke but which can also be caused by any condition that damages the blood vessels thereby inhibiting blood flow to the brain.
Symptoms can begin mildly and then worsen progressively. A person with vascular dementia may also have other forms of dementia such as Alzheimer's disease or dementia with Lewy bodies. Most diagnoses happen following a stroke.
Symptoms & Complaints
- Trouble speaking and understanding the speech of others
- Vision loss
- Problems with short-term memory
- Difficulty concentrating
- Loss of coordination or difficulties with balance
- Loss of bladder control (urinary incontinence) or loss of bowel control (fecal incontinence)
- Hallucinations or delusions
The most common condition that can lead to vascular dementia include stroke which can block a cerebral artery, causing a multitude of symptoms, including vascular dementia. There are, however, silent strokes and transient ischemic attacks. The larger the number of strokes, the larger the risk of vascular dementia.
Conditions that inflict damage on the blood vessels can lead to this disease such as high blood pressure (hypertension), hardening of the arteries (atherosclerosis), high cholesterol (hypercholesterolemia), lupus, obesity, brain hemorrhages, and diabetes. Damaged blood vessels can also be caused by the normal wear and tear associated with aging.
In addition to smoking, there are other risk factors that make a person more likely to suffer from vascular dementia. Family history may play a part, as well as ethnicity. Asians, Africans or those from the Caribbean have higher odds of having a stroke, which increases the risk of vascular dementia. Men are also more likely to have this condition than women.
Diagnosis & Tests
Diagnosis will involve the physician taking the patient's medical history and family history as well as performing a physical examination. Screenings will be done by professionals to test memory and reasoning. The patient will likely have a neurological examination that assesses the function of nerves, reflexes, coordination, sensory and motor responses. Neurological tests could involve hours of written or computerized tests that provide detailed information about specific thinking skills.
If the screening suggests there are changes in a person's brain function, the physician may recommend a more thorough assessment. Part of the testing and assessments could include an evaluation of independent function, input from trusted family or friends, laboratory tests that include blood tests, and neuroimaging tests. Medical imaging tests such as magnetic resonance imaging (MRI) scans and computed tomography (CT) scans could show evidence of a recent stroke or other changes in the brain, including blood vessel damage.
Treatment & Therapy
After a diagnosis is determined, there is unfortunately limited treatment that can reverse the damage done by vascular dementia. There is some evidence that medications used to treat Alzheimer's disease can be used to treat vascular dementia like cholinesterase inhibitors.
Controlling the risk factors associated with this disease can provide a serious impact on preventing further brain damage. Quitting smoking, exercising, healthy diet, and some medications can assist in that goal.
Though medical options are limited in the prevention of further damage and reversing symptoms, behavioral interventions can improve the lives of those affected by vascular dementia. Family members can assist in leaving reminders and instructions for the afflicted to help maintain independence. Heightening levels of communication can also help. Reminding the patient of the day, time, location and daily events in their lives can help them keep connected and help improve short-term memory.
There is also data that suggests that as with other stroke symptoms, cognitive function may improve with rehabilitation as the brain generates new blood vessels and cells outside the damaged area and take on new roles.
Prevention & Prophylaxis
The right kind of diet will decrease blood pressure, and aid in good cholesterol, reducing the risk of both stroke and heart attack, which are closely related to damaging brain vessels. Dieting also reduces the risk of being overweight which increases blood pressure, increasing the risk of damaging brain cells.
Targeting the risk factors associated with brain cell damage will reduce the risk of vascular dementia. Also, taking measures to reduce the risk of stroke and heart attack will do the same. After a stroke, proper after-stroke care can help prevent the further damage of any brain cells. By living an overall healthy life, a person can drastically reduce the risk of being diagnosed with vascular dementia.