Vascular dementia

Vascular dementia is caused by problems in the blood supply to the brain due to damaged or diseased blood vessels, a stroke, or ‘mini strokes’ called transient ischaemic attacks (TIAs).

This deprives the brain cells of the oxygen and nutrients they need to function effectively, which may cause problems with concentration, thinking and carrying out everyday activities.

If these problems get progressively worse, the person may be diagnosed with vascular dementia.

Vascular dementia is most common in people aged over 65, and the risk increases as people grow older.

However, it can also occur in younger people, and is the second most common form of young onset dementia (where symptoms develop before the age of 65).

Vascular dementia is slightly more common in men, and people from South Asian and African-Caribbean backgrounds are at increased risk.

People with a family history of vascular dementia may also be at slightly greater risk.

Other factors that increase the chance of developing vascular dementia are:

• high blood pressure
• hearing impairment
• smoking
• obesity
• depression
• physical inactivity
• social isolation
• excessive alcohol consumption
• traumatic brain injury
• high air pollution and second-hand tobacco smoke

The symptoms of vascular dementia depend on which area of the brain is affected, but generally, early signs include:

• concentration problems
• poor short-term memory
• difficulty with everyday skills
• slowed thought processes

There may also be changes in:

• behaviour
• personality
• ability to solve problems
• ability to make decisions and plans
• organisational skills
• mood, particularly rapidly changing mood

If someone develops symptoms of dementia after a stroke, they may also have speech or vision problems.

In one specific type of vascular dementia, called subcortical vascular dementia or Binswanger’s disease, the symptoms include:

• early loss of bladder control
• speech problems
• movement changes
• personality and mood changes
• increased risk of falls
• reduced facial expressions

About 10% of people with dementia have ‘mixed dementia’. This is a combination of two or more types of dementia – usually Alzheimer’s disease and vascular dementia – and the person may have symptoms of both.

People with vascular dementia may have periods where their symptoms seem stable, but they will always worsen over time.

The following tips may help reduce the risk of vascular dementia or delay its onset and progression.

• If you smoke, try to stop as soon as possible
• Aim to be physically active for 20 to 30 minutes per day, at least five days per week
• Cut down on saturated fats (found in foods like fatty meat, sausages, bacon, butter, cheese and ghee), sugar and salt
• Try to maintain a healthy weight – for most adults, this is a body mass index (BMI) between 18.5 and 25
• Keep your brain active, for example by learning a new skill, reading, playing chess
• Drink alcohol only in moderation
• Keep socially active
• Avoid activities that could lead to a head or brain injury, eg cycling without a helmet
• Try to avoid prolonged stress
• Create good sleep habits
• Ask your GP for health checks such as blood pressure and cholesterol checks, and blood tests to identify any abnormalities
• Have regular sight and hearing checks

If someone is showing signs of dementia, it is important to get an accurate diagnosis so that advice, support and services can be put in place.

However, vascular dementia may be mistaken for other conditions, such as depression, stress, relationship problems, menopause and work-related issues. This can cause a delay in diagnosis.

Before the person sees their GP, it is helpful to make a list of your concerns, including:

• what the issues are
• when they started
• how often they occur
• what happens
• how they affect the person’s life and the people around them
• whether there is any family history of dementia

The GP should carry out or arrange a physical examination and blood tests to rule out other physical or mental health problems that may have similar symptoms to dementia.

They may also conduct a brief cognitive assessment, although these may not be reliable for people with vascular dementia.

If the GP suspects dementia, the person should be referred to a memory clinic for a full assessment, including a brain scan.

If possible, go to the assessment with the person so you can share your experience of the changes you have noticed.

Currently, there are no specific treatments for vascular dementia, but medication may be given for underlying conditions such as high blood pressure, high cholesterol, heart problems or diabetes.

Medications for Alzheimer’s disease are not effective for vascular dementia, unless the person has been diagnosed with mixed dementia.

A person with vascular dementia should be supported to stop smoking, exercise regularly, eat a healthy diet and maintain a healthy weight. These steps won’t cure vascular dementia, but it may slow its progression.

• Break complex tasks down into smaller steps that are easier to follow
• Use reminders, pill boxes or automatic medication dispensers to ensure the person takes any medication as prescribed
• It is a good idea for the person to carry an ID card with details of their diagnosis in case they need support in public
• Join support groups to share experiences and tips for living with dementia
• Be aware of triggers such as noisy or crowded places, being too hot or cold, pain, misunderstanding, changes in routine, too much or too little stimulation etc
• Keep to a regular routine to minimise confusion
• Encourage them to keep up with activities they enjoy, eg photography, art, exercise, walking, taking care of a pet
• In rare cases where familial or genetic forms of vascular dementia are suspected, such as CADASIL, consider asking the person’s GP or dementia specialist for a referral to a genetics service

CADASIL (which stands for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a form of vascular disease that causes multiple small strokes. It is a genetic condition and very rare, affecting only 1,200 people in the UK.

Strokes typically cause weakness on one side of the body which over time, may lead to permanent disability including arm or leg weakness, slurred speech and changes in cognition such as difficulties with thinking, reasoning and memory. Many people with CADASIL also experience migraines.

As CADASIL progresses, people often develop dementia, typically in their 50s or 60s. By the age of 65, most people with CADASIL will have dementia.

If a person has a parent with CADASIL, they will have a 50/50 chance of inheriting the faulty gene.

To speak to a specialist nurse about vascular dementia or any other aspect of dementia, please call the Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm) email helpline@dementiauk.org or book a phone or video call appointment with an Admiral Nurse.

Dementia UK resources

• What is dementia?
• How to get a diagnosis of dementia
• After a diagnosis of dementia: next steps checklist
• Alzheimer’s disease

Other resources

• Drinkaware
• NHS Better Health: quit smoking
• NHS Better Health: get active
• NHS Better Health: lose weight
• British Heart Foundation
• Stroke Association