Vascular Dementia: The Heart & Mind

Updated: Dec 2, 2018


Image Source: MedIndia.net

Vascular dementia is the second most common form of dementia, with Alzheimer's Disease being the first. One of the challenges in recognition is that it shares some of its symptoms with Alzheimer's and other dementia. Sometimes called Vascular Cognitive Impairment (VCI), vascular dementia is characterized by changes in brain structure--and resultant cognitive change/impairment--because of lesions that compromise oxygenated blood flow to the brain.


Vascular dementia may occur along with Alzheimer's, resulting in a condition referred to as mixed dementia. As such, symptoms between the two typically overlap. Much like Alzheimer's, vascular dementia will appear in stages, ranging from onset to severe. Early symptoms of the cognitive impairment that accompanies vascular dementia include:

  • difficulty planning and organizing

  • thinking impaired to slower pace

  • loss of focus, unable to concentrate; short confusion periods

  • deficits in decision-making and problem-solving

  • difficulty following simple, clear, or chronological steps in a task

Associated also with early vascular dementia are physical manifestations that are concurrent with or caused by cognitive impairments, including:

  • restlessness accompanied by agitation

  • unsteady, unbalanced, or clumsy gait

  • depression, anxiety, or mood change

  • incontinence or urgent urination

  • mild memory impairment

  • language difficulty (conversational difficulties)

  • spatial impairment, especially losing 3D visual perception

  • mood changes, especially depression and/or anxiety

Image credit: Homeshealth.com

Of course, different parts of the brain control or influence different functions, including cognitive, motor, behavioral, and emotional changes. Among these changes, one may see from the above image that different functions may be affected when difference parts of the brain lose the necessary amount of oxygen they need when vascular dementia strikes.


Diagnosis

The American Heart Association, American Stroke Association, the Alzheimer's Association, and American Academy of Neurology agree to three broad areas of diagnostic criteria that suggest that dementia of cognitive impairment are caused by vascular dementia:

  1. The patient is diagnosed with dementia or mild cognitive impairment (MCI) based on neurocognitive testing that evaluates critical thinking skills, such as planning, judgment, problem-solving, logical reasoning, and memory/recall.

  2. Brain imaging--such as with and MRI--that reveals:

  • evidence of recent stroke, or

  • changes to blood vessels that show affected severity and patterning consistent with the impairment documented in #1 above.

3. Absence of other evidence indicating that other factors were causative to cognitive

decline.


Treatments

Like Alzheimer's, there is no cure for vascular dementia. There are, however, two categories of activities that can help to treat the underlying cause(s) of the vascular dementia; these options include medication and lifestyle changes.


While there are no FDA-approved medications designed for treating vascular dementia, by treating underlying causes of vascular dementia with other approved drugs, including:

  • statins that control cholesterol levels

  • anticoagulants/anti-platelets to reduce possibility of strokes or blood clots

  • medication to control diabetes

  • antidepressants and AD boosters

  • medication to control high blood pressure/hypertension

Lifestyle changes may also have a positive influence on vascular dementia risk factors, including:

  • losing excess weight and maintaining weight within accepted parameters

  • ceasing smoking

  • eliminating or reducing significantly drinking alcohol

  • healthy eating habits

  • regular aerobic and non-aerobic exercise

  • monitoring the serum indicators that show whether you are at higher risk, including blood pressure, blood sugars, and cholesterol...and maintaining recommended levels

Prognosis

The prognosis for vascular dementia is actually worse than that of Alzheimer's Disease! On average, life expectancy for those afflicted with vascular dementia is about 3-5 years. This is because onset may be sudden (such as stroke, blood clot, or lung disease). Also, while Alzheimer's is a slow, progressive deterioration, vascular dementia typically has an accelerated deterioration...and the underlying cause(s) may, it itself, be fatal. Arguably, the best treatment for vascular dementia is catching it early, immediately treating with medication, and prescribing/following positive lifestyle changes and eating habits.


Lists in this article adapted from Earlstein, F. (2016). Dementia Facts & Information. NRB Publishing: Nevada.

For more resources and references on Vascular Dementia, see the following:

Vascular Dementia News & Research: https://www.drcarlforkner.com/dementia-memory-news