Vascular Dementia
This week we’ll look further into the second most common cause of dementia: Vascular Dementia (also called Vascular Cognitive Impairment). To break it down into simpler terms, the vascular system is the blood flow system in the body and, over time, when there is obstruction or impaired flow to the brain, the thinking patterns that normally allow a person to complete day to day activities become damaged. In fact, the basic definition of dementia is a change in thinking patterns that affect a person’s ability to complete the tasks that are important for daily life that they were normally able to complete in the past.
Unlike other common dementias which are gradual in onset, vascular dementia can occur rather suddenly after a stroke or insidiously after a series of strokes. It also is less predictable as it manifests by the part of the brain that is affected. Some persons with vascular dementia may have their memory centers spared, and have other areas of the brain affected. Areas that help control social interactions, complex planning, language, and others can all affect a person’s ability to function in their day to day life. In people who have a cognitive impairment thought to be due to vascular dementia, brain imaging is important to the diagnosis; this usually occurs as an MRI of a person’s brain, but can also be a CT scan.
The treatment for and prevention of vascular dementia is to support our blood flow system’s health. Controlling risk factors such as diabetes, high blood pressure, high cholesterol, atrial fibrillation, and smoking while simultaneously maintaining a healthy exercise regimen are critically important. There have been autopsy studies that show people diagnosed with vascular dementia commonly have more than one problem in the brain. Alzheimer’s disease is the cause of up to 80% of dementia, and vascular dementia falls way behind causing up to 10%, but when a brain is looked at closely post-mortem, many of the people diagnosed with vascular dementia will have brain changes consistent with Alzheimer’s disease. Because of this, in many persons who have a diagnosis of vascular dementia will be offered medications reserved for those who have a diagnosis of Alzheimer’s disease such as donepezil. Studies are inconclusive to whether these medications provide “real-life” benefit as they only show small improvement on testing scales but not in things like retaining independence or slowing time to needing long-term care services.
Vascular dementia is less predictable in its prognosis than other dementias because if the risk factors are well controlled then the progression is slower. It usually remains stable for a period of time and then a person has a small drop in their function and thinking abilities; this is called a “stair-step” progression. Like any chronic disease, it is important to communicate about and plan for the progression while still doing the things that matter to the person with the diagnosis!
Key Points:
Vascular dementia is the second most common cause of dementia behind Alzheimer’s disease
Treatment involves controlling vascular disease and things that affect vascular system health
Keep an open communication line with people important in your life and do What Matters!
