Vascular Dementia - Causes, Functional Impairments, Diagnosis, and Management

What Is Vascular Dementia?

Vascular dementia results from reduced blood supply to the brain. Dementia is a neurological condition featuring loss of cognitive abilities in an individual. The cognitive functions include one’s capacity for thinking, reasoning, and remembering things and facts effectively. In vascular dementia, the blood vessels in the brain are destroyed or diminished for various reasons. Therefore the brain cells are starved of oxygen and nutrients and eventually die. When the cognitive function is impaired, one loses the ability to lead an independent life and meet everyday needs without external support.

What Are the Causes of Vascular Dementia?

Brain cells, known as neurons, require a consistent supply of oxygen, glucose, and other nutrients to function well. This is supplied by the well-established blood supply inside the brain, including numerous blood vessels and capillaries. Arteries are blood vessels that carry oxygen and nutrients to the brain. When these arteries get thinned down or blocked, the vascular system gets compromised. The inadequate blood supply in the long term causes irreparable damage to the nerve cells, compromising the functional abilities of the brain.

Several medical and physiological conditions lead to thinning and destruction (small vessel diseases) of blood vessels. Blocks inside the blood vessels also compromise the blood supply to the brain, which often results in a stroke. One may suffer a series of mini-strokes leading to a gradual decline in cognition. With major strokes, loss of function appears suddenly (post-stroke dementia). Often, stroke is the primary reason one may end up having vascular dementia. But again, the severity of the stroke and the area of the brain where the stroke decides on its cognitive impact. The natural aging process and genetic factors also play a role in developing vascular dementia.

The following are the most common causes among them:

• Type 2 diabetes.

• High cholesterol levels in the body.

• Thickening of the walls in a blood vessel (atherosclerosis).

• Obesity.

• High blood pressure.

• Heart diseases like atrial fibrillation.

• Improper breathing in sleep (sleep apnea).

• Habits like smoking.

• Sedentary lifestyle, lack of physical activity, and unhealthy diet.

What Are the Signs and Symptoms of Vascular Dementia?

Depending on the cause of a reduction in blood supply and the amount of nerve damage, symptoms of vascular dementia may appear suddenly or show a gradual decline in cognition.

The affected individual may have:

1. The trouble with learning something new and adapting to new routines.

2. Difficulties in reading, writing, and following instructions.

3. The thinking process slows down, making it hard to come to prompt decisions.

4. Become forgetful and keep misplacing things (short-term and long-term memory loss).

5. Face difficulties with everyday tasks like calculating money or paying bills.

6. The trouble with communication, use of language, and finding the right words to express something.

7. Find it hard to comprehend what others are talking about and continue conversations.

8. A general decline in interest in people, socialization, and other activities.

9. Tend to forget even the familiar routes to places.

10. Make frequent judgment errors and end up in danger, like falls and accidents.

11. Altered personality with frequent mood swings, depression, anger, and agitation.

12. Experience hallucinations and delusions.

13. Difficulty sleeping at night; tends to stay awake for long hours.

14. As the condition worsens, one loses time-place-person awareness.

15. If the dementia is a result of a stroke, there will be additional neuromotor symptoms.

How Is Vascular Dementia Diagnosed?

Vascular dementia is diagnosed by a thorough study of the symptoms and appearance of the patient. First, the doctor will review the patient's medical history and general lifestyle. Next, one needs to know about the problems the patient is facing in performing day-to-day activities to assess the level of cognitive disability. Speaking with someone in the family will give more information on this. Additional tests that follow the clinical examinations are:

• Neurological Assessment - To assess the level of cognitive functioning in thinking, reasoning, planning, judging, problem-solving, memory, communication, and comprehension.

• Brain Imaging Tests - Studying computed tomography (CT) images and magnetic resonance images (MRI) helps understand the evidence of stroke and areas of brain damage.

• Blood Tests and Urine Tests: These rule out thyroid diseases and nutritional deficiencies, which may mimic the symptoms of vascular dementia.

What Is the Treatment for Vascular Dementia?

Damage to the brain cells due to lack of blood supply cannot be cured or reversed by treatment. Therefore, the main focus of treatment is helping with the symptoms and prevention of future strokes. Treatment may improve the condition, but it is short-lived in most cases. The following strategies are used:

1. Prescribing blood thinners like Aspirin to prevent strokes and further brain damage.

2. Treatment to regulate diabetes, heart diseases, high blood pressure, and high cholesterol levels, as these are possible risk factors for stroke and block blood supply.

3. Medicines to control agitation, mental confusion, and lack of sleep.

4. Advice on lifestyle changes, adopting healthy diet patterns, reducing mental stress, and exercising regularly. Doctors recommend avoiding smoking and limiting alcohol consumption as well. In addition, efforts to maintain adequate body weight, stay hydrated, and prevent excess fats and salt in the diet may prevent stroke.

5. Visiting a memory clinic helps identify the type of memory loss and obtain additional support.

6. As the condition is irreversible, the affected individual might need full-time assistance from family, caretakers, or assisted living facilities.

7. Cognitive-behavioral therapy and speech therapy can help to some extent.

8. One may need long-term medical assistance in dealing with expected complications such as pneumonia, skin infections, urinary tract infections, and bedsores.

Conclusion:

Symptoms of vascular dementia are more or less similar to Alzheimer’s disease and always go unrecognized. But more than the memory loss apparent in Alzheimer’s, a vascular dementia patient has issues with the speed of thinking and problem-solving capabilities in day-to-day life. In the end-stage of the disease, the affected individual probably requires assistance in every aspect of life, like eating, bathing, using the toilet, dressing up, and more. Maintaining a healthy lifestyle helps prevent the onset of vascular dementia to some extent. It is recommended that individuals pertaining to the high-risk category for developing this condition undergo professional cognitive screening from time to time