Vascular dementia is the second most common cause of dementia. The brain is damaged either due to repeated small strokes causing lack of blood supply (ischemic) or small bleeds (hemorrhagic). The arteries in the brain can get damaged due to hypertension, diabetes and cardiac problems. Vascular dementia also affects memory, planning, motor moments and thinking like Alzheimer’s, however, the progression here is stepwise.
The symptoms vary as per the area of the brain that has been affected due to damaged blood supply.
- Problems relating to attention and concentration
- Problems with memory
- Restlessness and agitation
- Sudden or frequent urge to urinate or inability to control passing urine
- Mild weakness in upper/ lower limbs
- Slurred speech
- Hallucinations where they see or hear things which are not real, or delusions
- Depression with emotional swings when laughter or tears can occur for no reason
- Arteriosclerotic: reduced oxygen supply to the brain
- Stroke: Can be major, multi-infarct or transient ischemic attack
- Multi-infarct Dementia: It is the most common type of vascular dementia and is caused by a number of ‘mini-strokes’. The person may not be aware of these small strokes and the symptoms may last for only a few hours up to a few days.
- Subcortical vascular dementia: Also known as Binswanger’s disease. White matter deep within the brain is affected i.e., the insulation sheath of nerve fibre is damaged.
If it’s a major stroke, then symptoms are usually severe and prognosis may not be very positive. The brain tissue which has been destroyed cannot be repaired and generally the person does not improve. If it’s multiple stroke that has led to multi-infarct dementia, symptoms may not be evident at the beginning of the disease, but gradually become more obvious as more strokes occur. Usually the disease progresses in a step-wise fashion following the strokes.
After a stroke the person will deteriorate, with the symptoms becoming more pronounced, and then will often improve and their condition will stabilize until the next stroke, when they will decline again. If no further strokes occur the progression of vascular dementia may stop and in some cases the abilities of the person may improve. Sometimes the steps are so small that the decline appears gradual, which is very similar to the progression of Alzheimer’s disease.
Diagnosis is made based on history which includes details of evident stroke episodes or vascular risk factors. This is followed by detailed blood work up and brain scans.
Neuropsychological assessments are done to understand the extent of cognitive deficit to aid the diagnosis.
Management of the condition requires multidisciplinary approach.
- Rehabilitation to restore as much mental or physical ability as possible
- General and symptomatic management with the drugs licensed for dementia
- Diagnosis and treatment of any underlying disease such as high blood pressure (hypertension), high cholesterol, or diabetes
- Speech and language therapy to help the person make the best use of their remaining abilities
- Occupational therapy to help the person cope better and more safely at home
The risk factors for vascular dementia are high blood pressure (hypertension), diabetes, high cholesterol level and heart disease. All these are modifiable risk factors. Early diagnosis and treatment of vascular risk factors can reduce the risk of strokes.
Medicines can be used to control blood pressure, high cholesterol, heart disease and diabetes.
Lifestyle modifications such as giving up smoking, avoiding an excessive alcohol intake, having a healthy diet and regular exercise will all lessen the risk of having a stroke.
- Try joining a support group , this may help to get some useful and practical tips from other carers who have been in the same situation
- Day care option can be explored to get a break
- Approach professionals for management of cognitive decline and behaviours
- When unable to take care look for institutional facilities