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Vascular Dementia IS11 November 2016 Information Sheet Vascular dementia What is vascular dementia? Types of vascular dementia Vascular dementia is the second most There are several types of vascular common type of dementia after Alzheimer’s dementia, dependant on the areas of the disease. The word dementia describes brain affected. There are some overlapping a group of symptoms that may include symptoms between the different types, but memory loss, difficulties with planning, the symptoms tend to progress differently. problem-solving or language and sometimes changes in mood or behaviour. Arteriosclerotic dementia: reduced oxygen Vascular dementia is caused by a reduced supply to the brain (chronic ischaemia). blood supply to the brain, due to conditions Vascular dementia following a stroke: major such as: high blood pressure (hypertension), strokes can be fatal or may lead to physical irregular heart rhythms (arrhythmias) disability or vascular dementia due to and diseases which cause damage to damage to the brain. the arteries in the brain. It usually affects vascular dementia can be caused in several people between the ages of 60-75 years different ways, the most common cause is old and is more common in men than a blockage of small blood vessels (arteries) women. deep within the brain. When any part of the Vascular dementia is unique in that these body is deprived of blood it dies and this changes will generally occur in a stepwise is called an ‘infarct’; when this happens in pattern due to the sudden occurrence of the brain it’s known as a stroke. Depending strokes. The person will usually lose some on where the stroke occurs in the brain cognitive ability at the point that they have different functions of the brain will be a stroke, but they may improve or remain affected. Each side of the brain controls the stable for a while before the next stroke movement of the other side of the body, occurs, when they will lose more cognitive so strokes on the left side of the brain can ability. cause problems in moving the limbs on the right side of the body and vice versa. Causes of vascular dementia Strokes on the left side are also especially associated with problems in language and In order for them to work properly, brain memory. Strokes on either side can cause cells need a constant supply of blood to problems with recognition of objects and provide oxygen and nutrients. The network coordination of complex tasks. Strokes of vessels in the brain is known as the in certain areas of the brain can also vascular system. If the vascular system cause changes in the person’s mood and becomes damaged blood is unable to reach personality. the brain cells, causing them to die. The death of brain cells can cause problems Multi-infarct dementia (MID): develops with memory, new learning, recognition, fine gradually following a number of mini- motor movement and planning. strokes or transient ischaemic attacks (TIAs – see below), which the person may not realise they are having. MID affects the Page 1 Vascular dementia cerebral cortex, which is the outer part of • Thrombosis: A gradual narrowing and the brain. eventual blockage of an artery, usually Subcortical vascular dementia because of a build-up of cholesterol and (Binswanger’s disease): involves vascular fatty deposits. Approximately 60% of damage to the nerve cell fibres of the inner strokes are caused by thrombosis. parts of the brain (deep white matter) by • Embolism: A blockage of a brain or affecting the sheath which insulates nerve neck artery by a clot, either a blood clot fibres in the brain (demyelination). elsewhere in the body (often the heart) There is also a vascular dementia which which travels to the brain, or a piece involves both cortical and subcortical of fatty deposit broken away from the damage to the brain. lining of the arteries. Approximately 20% of strokes are caused by embolism. There are rarer causes of vascular dementia which may affect some people with auto- • Haemorrhage: A burst in a brain immune inflammatory diseases that artery causing bleeding in the brain. affect the arteries such as systemic lupus Approximately 20% of all strokes are erythematosus (SLE or lupus) and temporal caused by haemorrhage. arteritis. Symptoms and diagnosis Transient ischaemic attacks (TIAs) Serious forgetfulness, mood swings and Transient ischaemic attacks (TIAs) are other behavioural changes are not a normal temporary interruptions of blood flow to part of ageing. They could be caused by the brain, (a stroke is a permanent cut off poor diet, a malfunctioning thyroid, a lack of blood to part of the brain). TIA warning of sleep or too many medicines. Feelings of signs include: loneliness and boredom or depression can • numbness, weakness, or paralysis of the also cause forgetfulness. These conditions face, arm or leg, especially on one side can often be helped and medical advice of the body should be sought. Sometimes, however, • sudden blurred, decreased or complete mental changes are caused by diseases loss of vision in one or both eyes that permanently damage the brain cells. • difficulty speaking or understanding Diagnosis and tests simple statements Anyone who is worried about dementia and • loss of balance, dizziness or loss of has a history of strokes should contact their co-ordination especially when combined GP. Being diagnosed with vascular dementia with another warning sign early has the benefit of not only giving the • sudden severe headache in one part of person a reason for their symptoms but the head could also give them access to treatments. These warning signs can last for a few There is some evidence that treatment hours but never last longer than 24 hours. and lifestyle changes may slow down the They should not be ignored, as diagnosis progression of the underlying disease. and treatment may well prevent a serious There is no single test for vascular stroke. Contact a doctor immediately if dementia. The GP must first rule out these symptoms occur. other conditions, like depression, vitamin Strokes and thyroid deficiency and side-effects of medication, which can present with similar Strokes occur when brain cells are deprived symptoms. of their blood supply and then die. They can be caused by damage to the brain or neck The GP will go on to do a thorough arteries. The damage may be a blockage or evaluation of past medical history, including bleeding into the brain caused by: family medical history, ask about their Page 2 Vascular dementia current symptoms; a physical examination Caring for someone with and an assessment of the person’s mental abilities. This can give them an idea of vascular dementia any changes in the person and how they Information and support are coping with their day-to-day activities. If you need help with a particular problem, It can be helpful for a friend or family member to go to this appointment, as they specific information, or access to a service, may have noticed changes that the person it is essential that you ask for it. Speak themselves has not noticed. to your GP, social worker or Alzheimer Scotland for information and advice. Some GPs will make a diagnosis of vascular dementia following these investigations; The Dementia Helpline, Freephone however, they may choose to send the 0808 808 3000, is open 24 hours a day person to a specialist, either a psychiatrist for information and emotional support. or a geriatrician. The specialists are able Information is also available on the website to perform further in-depth tests that may at www.alzscot.org lead to a diagnosis of vascular dementia or Contact a local carers group to find out identify the underlying cause. more about other people who are caring or has cared for someone with vascular Control and treatment dementia. They will often be a vital source There is no cure for vascular dementia and of information and support. the damage caused cannot be reversed, Looking after someone with vascular however, people who have vascular dementia can be lonely, difficult and dementia can live well with the condition exhausting. There are ways you can find using various support methods. help and support. Strokes can be caused by high blood pressure, high cholesterol and heart Look after yourself disease. Medication can be used to control Being aware that changes will occur and these conditions, which will reduce the risk having support systems in place will help of further strokes. you cope with caring for a person with Giving up smoking, reducing alcohol intake, vascular dementia. having a healthy diet and regular exercise Make sure you have some time to yourself. can also lessen the risk of strokes. Speak This might mean having a member of your to your GP who will be able to help with family, a friend or another carer look after advice and information. the person with dementia while you take time to do the things you would like to do. Support Perhaps if the person goes to a day care Supporting someone with vascular centre you can use the time to catch up dementia can be difficult. In order for on errands or enjoy an activity you would them to live well with vascular dementia otherwise be unable to do. Respite breaks they may need treatment for symptoms, could give you a few days or even a couple rehabilitation after a stroke and support of weeks to go on holiday yourself or catch during daily activities. up things you might not have time to do. For information on helping someone live Having a break from caring is very important well with dementia see the information as it will enable you to care effectively sheet ‘Healthy living with dementia’.
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