Vascular Dementia (VD)

Updated on: August 18, 2014

What is Vascular Dementia?

VD in simple terms is a disorder of the brain which presents with relatively rapid onset of dementia and cognitive impairment primarily due selective damage to a particular part of the brain. Today, VD is considered to be the second most common cause of dementia after Alzheimer's disease. In some cases, the cause of VD is blockage of a blood vessel in the brain; in others it is due to rupture of very small blood vessels in a particular area of the brain and in others it may be related to narrowing of blood vessels which supply blood to the brain.

How common is Vascular Dementia?

Vascular dementia is the second most common form of dementia, ranking right behind Alzheimer's disease. Today, with our aging population, more cases of VD are seen than ever before. Most studies reveal that the prevalence of dementia increases from 1% in people aged 60 years to about 50% in those aged 90 and older. VD is seen in all ethnic groups, and the incidence is especially high in populations where blood pressure and diabetes are poorly controlled. In North America, the highest incidence of VD is seen in Asians, Blacks and Chinese.

What is so specific about VD?

Vascular dementia can result from either lack of blood (ischemia) or bleeding (hemorrhage) in the brain. In both cases, these injuries are at specific locations in the brain, which initially produce very tiny amounts of brain damage. The fascinating thing about VD is that the strokes are very selective and almost always affect cognitive behavior. The majority of individuals with vascular dementia will have deficits in cognition, memory and loss of concentration.

What Causes VD?

It is believed that in these individuals, a series of small multiple strokes occur which damage a select part of the brain. In essence the brain is deprived of essential oxygen and nutrients. The exact cause remains unknown but numerous conditions can be associated with VD. These include:

- Conditions which cause narrowing of blood vessels to the brain

- Conditions which completely block blood vessels in the brain

- Severely low blood pressure such that the brain is not getting enough blood

- Bleeding in the brain

- Damage to the brain by medical disorders (e.g. Lupus or temporal arteritis)

What is course of vascular dementia?

An individual with VD may in a relatively short time span experience a loss of his/her intellectual skills as compared to the gradual loss seen in individuals with Alzheimer's. Vascular dementia symptoms often begin suddenly and may worsen in a step-wise fashion, following a series of strokes or mini-strokes. The course of the VD progresses in small steps. In each case there is a steady phase followed by a rapid decline in intellectual function.

However, there are some forms of VD which do develop gradually and are easily confused with Alzheimer's disease. One difference is that memory loss is one of the first symptoms of Alzheimer's. In vascular dementia, memory problems typically occur much later in the disease process.

Can VD and Alzheimer's disease occur together?

Yes, Alzheimer's disease and vascular dementia are known to occur together but the relationship is complex. In fact, some physicians believe that it's more common for these two disorders to occur together than apart. The continual small strokes are thought to increase the chance of developing Alzheimer's disease.

What are risk factors for vascular dementia?

Non modifiable

Age: There is a higher incidence of VD after the age of 60

Sex: Vascular dementia occurs more frequently in males

Race: Rates of VD are much higher in Blacks, Chinese and Asians

compared to Caucasians

Modifiable

Education: Highly educated individuals have a low incidence of VD

Hypertension: This is the highest risk factor for VD

Hyperlipidemia: Elevated levels of cholesterol are a risk for developing plaques in the blood vessels and hence increasing the probability of a stroke

Coronary artery disease: Having a diagnosis of ischemic heart disease increases the chance of developing VD

Prior stroke: All evidence indicates that a prior stroke(s), especially those that affect language, can increase the risk of developing VD.

Diabetes: Diabetes significantly increases the chances of developing VD

Smoking: Smoking significantly increases the hardening of blood vessels and hence increases the chances of developing VD

What is the earliest feature of VD?

A classic presentation of VD in the early stages is the decline in the ability to organize thoughts or actions. These individuals find it extremely difficult to do more than one task at a time, and easily get frustrated and confused. In addition, these individuals are unable to communicate in a thoughtful and sequential manner.

What are signs and symptoms of VD?

The symptoms are quite varied but noticeable. They may not all be seen in one individual and may vary in intensity. The symptoms are also dependent on what part of the brain is affected. The symptoms include:

- Significant difficulty with responsibilities that require conscious control and preparation (early sign)

- Poor psychomotor presentation

- Sudden changes in personality

- Sudden changes in mood and behavior

- Difficulty with walking (slow and unsteady)

- Very prominent reflexes

- Loss of bladder control

- Facial muscle weakness

- Loss of sensation in one half of the body

- Visual problems (double vision, or partial loss of vision)

- Difficulty swallowing, coughing

- Inappropriate crying or laughing

- Recent memory impairment

- Difficulty speaking

- Sudden loss of intellect

- Depression

How is a patent with VD assessed?

The diagnosis of VD can be difficult and a comprehensive examination of the individual is required. The following are essentials in the assessment of an individual with VD:

- obtaining a history (onset, course, and nature of cognitive deficits; most of this information is always provided by family or friends)

- determining the presence of risk factors

- Cognitive assessment

- Behavioral evaluation (obtained from family/friends)

- Overall physical examination

- Evaluate for the presence of any functional losses

- Examination for the presence of a stroke

- Obtain brain imaging studies (CT scan and/or MRI)

- Further studies may involve evaluating

- - the heart (echocardiography)

- - brain fluid (to ensure there is no infection)

- - neuropsychologic evaluation- to assess orientation, recall, attention

calculation and language

- Evaluation of the functional status of the patient and the interpersonal and community supports available.

How is diagnosis of VD made?

VD is a disorder which is difficult to diagnose. A combination of the clinical features and radiological changes on the brain are usually used to make a diagnosis of VD. The ultimate diagnosis of VD can only be made at autopsy.

What is memory function like in VD?

Unlike Alzheimer's disease, most individuals with vascular dementia don't experience memory problems until late in the course of the disease.

Can Vascular Dementia be cured?

There is no cure for vascular dementia and no drugs have been approved by the Food and Drug Administration to treat it. However, medications designed to treat the symptoms of Alzheimer's disease also appear to help people with vascular dementia.

How does one treat VD?

Since VD is neither reversible nor curable, it is imperative that the underlying conditions be well controlled. Progression of VD can be halted by:

Control of blood pressure: This is an absolute requirement and the individual must ensure that the blood pressure is within normal limits.

Control of diabetes: It is essential that the blood sugar be well controlled other wise the risk of further mini strokes is almost a sure guarantee.

Control Hyperlipidemia: Levels of cholesterol must be controlled with exercise or even drug therapy. One should limit the intake of fat.

Smoking cessation: Smoking is known to worsen the disease in blood vessels and all efforts must be made to quit smoking.

Aspirin: In most individuals over the age of 50, it is recommended that an aspirin everyday may help to prevent both strokes and heart attacks.

Surgery: For those individuals who have a blocked blood vessel (carotid artery) surgery may be required to prevent further strokes.

Rehabilitation: All individuals with any type of stroke should enter a program of intense rehabilitation to regain their physiological function.

Weight control: Changes in life style and stress reduction are a necessary component in the treatment of any individual with VD

What medications can be used to treat vascular dementia?

There are a few medications that have been used to treat dementia in Alzheimer's disease. Some physicians recommend that these same medications may be effective in some patients with VD. The medications are:

Donepezil (Aricept)

Galantamine (Razadyne)

Rivastigmine (Exelon)

Memantine (Namenda)

These medications are thought to improve memory and judgment. Side effects can include nausea, vomiting and diarrhea. One should note that the medications do nothing to prevent the progression of the disease.

What is prognosis of patients with VD?

On average, individuals with vascular dementia have a poor prognosis. Data indicate that individuals with VD live several years less after diagnosis than those with Alzheimer's disease. Current statistics indicate that the median survival times after the diagnosis of VD is only 3-4 years. In most cases the cause of death is a stroke or a major heart attack.

What is role of family in VD?

Like any other dementias, individuals with VD are not able to care for themselves. The change in behavior and cognition severely handicaps these individuals and the role of the family becomes essential. As the disease progresses, the majority of these individuals will require full time care and supervision.

Are there any support groups for VD?

There are many programs to assist families with education, emotional support and care planning throughout the course of a dementing illness. With the growing awareness of the disease, numerous support services such as home care or adult day programs have been set up. Despite all the help, care of these individuals is challenging and stressful. For those without family, many end up in nursing homes.

Have specific questions?
ASK A DOCTOR

All Article Categories

Before & After Photos

Suggested Doctors

Recently Asked Questions