Vascular Dementia: Causes, Symptoms and Prevention

The term dementia is familiar to everyone, however, what is Vascular Dementia? Throughout this article will explain what is this type of dementia, its causes, symptoms and what we can do to improve them. In addition, some tips are provided on how to prevent it.

Dementia is an acquired syndrome of organic origin, which causes a progressive deterioration of cognitive functions. This deterioration becomes a functional incapacity, personally, socially and in the workplace. 

The symptoms that accompany dementia are cognitive (memory loss, attention, spatiotemporal orientation, recognition of objects or people, etc.), psychiatric or behavioral (depression, anxiety symptoms, irritability or aggressiveness, psychotic episodes, hallucinations, delusions, etc.), as well as the functional area (inability to manage basic daily activities such as hygiene or food, and instrumental areas like family, economy situation, social).

Origin of vascular dementia

Dementia has been repeatedly explained, however, it is not a homogeneous syndrome, but the term dementia encompasses several types. The most basic classification is in two major groups: primary and secondary.

Vascular dementia corresponds to the group of secondary dementias, that is, dementias that develop because of another injury or pathology. Vascular dementia originates from vascular type lesions in the brain (such as stroke). The patient’s profile with vascular dementia and the neurological alterations will both very heterogeneous since it depends on the location and extent of the lesion.

Cerebrovascular diseases will cause an alteration in the blood supply to the brain, resulting in specific, brain damage or a more global and scattered effect known as diaschisis. This alteration can originate from two types of cerebrovascular accidents:

1. Vascular dementia due to cerebral ischemia:

It is an interruption of the blood circulation in the brain, which causes the lack of oxygen and nutrients necessary for the maintenance of its cells. The symptoms prior to cerebral ischemia are:

• Lethargy.
• Inability to speak. 
• Lack of understanding.
• Lack of vision in one or both eyes. 
• Numbness on one side of the body.
• Difficulty in motor coordination.
• An intense and sudden headache.
• Tingling in arms and hands.

2. Vascular dementia due to cerebral hemorrhage:

Due to the rupture of an aneurysm (abnormal enlargement of an artery) the blood starts taking up space in the brain. The cognitive effect generated by cerebral hemorrhage is usually more generalized and severe than that caused by ischemia. The symptoms that appear prior to the cerebral hemorrhage are:

• A severe headache.
• Nausea and vomiting.
• Loss of consciousness.
• Stiff neck.

The probability of having a stroke increase for seniors. It is common for small and multiple strokes (subclinical) to occur in various areas, which cause less specific and generalized cognitive impairment. Although these are not perceived at the time of their occurrence, they can be observed through neuroimaging (CAT).

Diagnosis of Vascular Dementia

Vascular dementia is the second most prevalent form of dementia, ranking behind Alzheimer’s disease. It is complicated to establish certain clinical criteria for the vascular dementia diagnosis because, due to the location and extent of the brain lesion, there will be a great heterogeneity in the clinical forms of the lesion. The criteria provided by NINDS-AIREN to carry out a diagnosis of vascular dementia are the following:

• Clinical features of dementia (cognitive and functional impairment)
• Clinical characteristics of cerebrovascular disease (having suffered a vascular cerebral accident: ischemia or hemorrhage)
• Temporal relationship (three months) between cerebrovascular accident and the appearance of clinical symptoms corresponding to dementia, or sudden onset of dementia with fluctuating course (instability in symptoms)
• Confirmation by neuroimaging, by means of CT or Magnetic Nuclear Resonance (MRI)
• Histopathological confirmation ( the study of organic tissues) of the existence of ischemic or hemorrhagic brain damage and exclusion of other pathological changes associated with dementia.

Types of vascular dementia

There are three types of vascular dementia caused by different lesions:

• Cerebral vasculopathy: There is a degeneration of arterial vessels due to two causes: age and arterial hypertension.
• Lacunar Stroke Syndromes: The term “lacunar” refers to the cavities that are formed after suffering a transient ischemic stroke (duration of 2-3 minutes). Most of these lacunar strokes are multiple and constitute a major risk of cerebral ischemia. The risk factors, in this case, are also age and high blood pressure.
• Binswanger’s disease: This type of vascular dementia is caused by chronic ischemia. Brain damage is associated with a decrease in myelin density (a substance that envelops and protects axons in neurons, promoting an increase in the rate of nerve impulse transmission). Clinical symptoms include a reduction in the speed of mental and motor processes, attention deficit, dysarthria (articulatory difficulty for speech expression), and depression.

Symptoms of Vascular Dementia 

As previously mentioned, unlike other types of dementia such as Alzheimer’s disease, it is complicated to establish specific symptoms and evolution for vascular dementia. This is due to the variety of the brain lesions and, consequently, in their symptoms. However, there are a number of symptoms that are considered characteristic of vascular dementia:

• Executive Dysfunction: Executive functions are a series of superior skills that guide our behavior, such as planning, problem-solving, decision making, or monitoring and oversight of actions. Patients with vascular dementia present a deterioration in these cognitive processes. Discover activities to improve executive functions.
• Visuospatial impairment: It implies a difficulty in the perception and mental management of figures, as well as recognition of objects and faces.
• Apraxia: It is an inability to carry out simple or complex movements.
• Attention Deficit: Moderate or severe distraction.
• Fluctuating course: The person with vascular dementia does not remain stable throughout. The person can be more impaired in some moments in time than others.
• Behavioral abnormalities: Apathy, depression, irritability, and anxiety more commonly.
• Functional impairment: Difficulty performing basic and instrumental activities of daily living.

Evolution and treatment of Vascular Dementia

Vascular dementia, like all other dementias, is a neurodegenerative disease. That is, it is a disorder which leads to a progressive deterioration of the affected functions. Therefore, despite the fact that in the case of vascular dementia the course is fluctuating, the deterioration of cognitive symptoms progresses, causing over time a total loss of functionality.

The pharmacological treatment used for vascular dementia focuses on trying to slow down the deterioration process, as well as on achieving an improvement in cognitive and behavioral symptoms. On the other hand,  it is advisable to perform cognitive stimulation activities for dementias to reinforce their capacities.

How to prevent the development of Vascular Dementia?

Vascular dementia develops after having suffered a cerebrovascular accident, therefore, to prevent vascular dementia, certain factors that increase the risk of ischemia or hemorrhage must be taken into account.

There are risky circumstances that can’t be controlled, such as age, sex (men have this condition more often than women), genetic features, or a disease such as cancer or autoimmune diseases. However, taking into account other activities that promote a healthier life is important such as:

• Not smoking helps prevent vascular dementia.
• Control blood pressure maintaining a diet or prescribed drugs for this purpose.
• Perform physical exercise, avoid a sedentary life.
• Avoid high salted meals.
• Do not eat foods with saturated fats.
• Watch your weight.
• Eat fruits and vegetables that increase potassium. Discover 13 superfoods for your brain.
• Reduce alcohol consumption, given the consequences of alcohol on the brain.
• Monitor cholesterol levels through diet and medication if needed.

Thank you for reading. If you have any questions write a comment below.

This article is originally in Spanish written by Natalia Pasquín Mora, translated by Alejandra Salazar.

Alejandra Salazar

Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.