What is vascular dementia?
Brain cells need a steady supply of blood to bring oxygen and nutrients. In vascular dementia, blood vessels in the brain are damaged or blocked. Parts of the brain do not get enough blood, and brain cells are damaged or die.
The word “vascular” means to do with blood vessels.
The NHS says vascular dementia affects around 180,000 people in the UK. Alzheimer’s Society describes it as the second most common type of dementia, after Alzheimer’s disease.
Types of vascular dementia
Alzheimer’s Society describes three main kinds. They differ in how the blood supply is affected.
| Type | What happens |
|---|---|
| Stroke-related dementia | Follows a single large stroke that damages part of the brain |
| Multi-infarct dementia | Caused by a series of small strokes, sometimes called mini strokes, which may not be noticed at the time |
| Subcortical vascular dementia | Caused by gradual narrowing and damage to the very small blood vessels deep in the brain |
Many people also have Alzheimer’s disease at the same time. This is called mixed dementia. Alzheimer’s Society says mixed dementia affects at least 1 in 10 people diagnosed with dementia, and Alzheimer’s disease with vascular dementia is the most common combination.
Symptoms
Symptoms depend on which parts of the brain are affected. Memory loss is not always the main early symptom. The NHS lists symptoms such as:
- slowness of thought
- difficulty concentrating
- difficulty planning, organising and making decisions
- changes in mood or personality, such as low mood, apathy or becoming easily upset
- feeling confused or disorientated
- problems with walking and balance
- memory and language problems similar to Alzheimer’s disease
Some people also have symptoms of stroke, such as weakness on one side of the body.
Stepwise changes
The NHS explains that vascular dementia often gets worse in sudden steps. There may be periods where symptoms stay about the same, followed by a noticeable drop. This can happen after a further stroke or mini stroke. In subcortical vascular dementia, changes may be more gradual.
Causes and risk factors
Vascular dementia is caused by:
- a stroke, where the blood supply to part of the brain is suddenly cut off
- a series of small strokes or transient ischaemic attacks (TIAs, sometimes called mini strokes)
- narrowing of the small blood vessels deep inside the brain
The NHS says the risk is higher in people with:
- high blood pressure
- diabetes
- high cholesterol
- heart problems, such as an irregular heartbeat
- a history of stroke or TIA
Lifestyle factors also play a part, including smoking, being overweight, lack of exercise and drinking too much alcohol. Age is the biggest risk factor, and risk rises after 65.
Diagnosis
There is no single test for vascular dementia. The NHS says diagnosis involves:
- talking about symptoms, ideally with someone who knows the person well
- a review of medical history, including strokes, blood pressure and diabetes
- memory and thinking tests
- a brain scan, such as MRI or CT, to look for signs of stroke or blood vessel damage
NICE advises that vascular dementia should not be diagnosed just because a scan shows blood vessel damage. Many older people have some changes on a scan without dementia. The diagnosis is based on the whole picture.
The first step is to see a GP, who can refer to a memory service or other specialist. See getting a diagnosis.
Treatment
There is no cure for vascular dementia. But the NHS says treating the underlying causes may help slow it down. This can include:
- medicines to lower blood pressure
- medicines to lower cholesterol, such as statins
- medicines to reduce the risk of blood clots
- managing diabetes well
- stopping smoking, eating healthily, being active and keeping to a healthy weight
- cutting down on alcohol
Only take, change or stop medicines on the advice of your doctor.
Dementia medicines
The medicines used for Alzheimer’s disease are not routinely used for vascular dementia. NICE says they should only be considered if the person may also have Alzheimer’s disease, Lewy body dementia or Parkinson’s disease dementia. See treatment.
Other support
Many of the non-drug approaches used for other dementias can help, including:
- cognitive stimulation therapy
- physiotherapy for walking and balance
- occupational therapy to help with daily tasks and home safety
- speech and language therapy for communication or swallowing problems
- support for low mood, which is common in vascular dementia
Living with vascular dementia
Slower thinking can be frustrating. It can help to:
- allow extra time for conversations and decisions
- do one thing at a time, in a quiet place
- keep to a routine
- write things down, or use a calendar or phone reminders
- keep up regular health checks for blood pressure, diabetes and cholesterol
See living well for practical ideas, and caring for someone if you support a family member.
Outlook
Vascular dementia usually gets worse over time. How quickly varies. Managing blood pressure and other risks may help reduce further damage. Over time, many people will need more help with daily life.
It is a good idea to plan ahead while you can, such as making a Lasting Power of Attorney. See legal and money matters.
For advice from specialist dementia nurses and advisers, see support and helplines.