Vascular Dementia

Signs, Symptoms, Prevention, and Treatment of Multi-Infarct and Other Types of Vascular Dementia

Vascular DementiaVascular dementia is the second most common form of dementia and is caused by reduced blood flow to the brain—usually from a stroke or series of strokes. While the strokes may be unnoticeably small, the damage can add up over time, leading to memory loss, confusion, and other signs of dementia. While there is no known cure, you can learn to manage symptoms, prevent further strokes, and enjoy a full, rewarding life.

What is vascular dementia?

Vascular dementia refers to a progressive decline in memory and cognitive functioning caused by a blockage or reduction in the blood flow to the brain. When the blood supply to the brain is interrupted, brain cells are deprived of vital oxygen and nutrients, causing damage to the cortex of the brain—the area associated with learning, memory, and language. Vascular dementia is the second most common type of dementia after Alzheimer’s disease, accounting for up to 40 percent of dementia cases in older adults.

Depending on the person, and the severity of the stroke or strokes, vascular dementia may come on gradually or suddenly, and can range from mild to severe. Currently, there is no known cure for vascular dementia, but there are steps you can take to help prevent strokes, compensate for cognitive losses, and slow its development.

Multi-infarct dementia: The most common type of vascular dementia

Multi-infarct dementia (MID) is caused by a series of small strokes (sometimes called “mini-strokes” or “silent strokes”) that often go unnoticed. These mini-strokes, also referred to as transient ischemic attacks (TIAs), result in only temporary, partial blockages of blood supply and brief impairments in consciousness or sight. Over time, however, as more areas of the brain become damaged, the symptoms of vascular dementia begin to appear. MID usually affects people between the ages of 60 to 75, and is more common in men than women.

What is mixed dementia?

Although it is rarely diagnosed during life, up to 45 percent of people with dementia are believed to have mixed dementia, where more than one type of dementia occurs simultaneously, usually vascular dementia and Alzheimer’s disease or Lewy Body dementia.

The combination of two types of dementia can have a greater impact on the brain than either by itself. Mixed dementia is often indicated by cardiovascular disease and dementia symptoms that get worse slowly over time.

Signs and symptoms of vascular dementia

Vascular dementia affects different people in different ways and the speed of the progression varies from person to person. Some symptoms may be similar to those of other types of dementia and usually reflect increasing difficulty to perform everyday activities like eating, dressing, or shopping.

Behavioral and physical symptoms can come on dramatically or very gradually, although it appears that a prolonged period of TIAs—the mini-strokes discussed above—leads to a gradual decline in memory, whereas a bigger stroke can produce profound symptoms immediately. Regardless of the rate of appearance, vascular dementia typically progresses in a stepwise fashion, where lapses in memory and reasoning abilities are followed by periods of stability, only to give way to further decline.

Common Signs and Symptoms of Vascular Dementia
Mental and Emotional Signs and Symptoms
  • Slowed thinking
  • Memory problems; general forgetfulness
  • Unusual mood changes (e.g. depression, irritability)
  • Hallucinations and delusions
  • Confusion, which may get worse at night
  • Personality changes and loss of social skills
Physical Signs and Symptoms
  • Dizziness
  • Leg or arm weakness
  • Tremors
  • Moving with rapid, shuffling steps
  • Balance problems
  • Loss of bladder or bowel control
Behavioral Signs and Symptoms
  • Slurred speech
  • Language problems, such as difficulty finding the right words for things
  • Getting lost in familiar surroundings
  • Laughing or crying inappropriately
  • Difficulty planning, organizing, or following instructions
  • Difficulty doing things that used to come easily (e.g. handling money, paying bills, or playing a favorite card game)
  • Reduced ability to function in daily life

Vascular dementia causes and risk factors

Vascular dementia is typically caused by stroke, small vessel disease, or a mixture of the two. Most commonly there is a blockage of small blood vessels somewhere in the vast system of arteries that feeds the brain and enters through the base of the skull. Blockages may be caused by plaque build-up on the inside of the artery wall, or by blood clots that have broken loose and clogged a tributary further downstream. Clots can form as a result of abnormal heart rhythms, or other heart abnormalities. Also, a weak patch on an artery wall can balloon outward and form an aneurysm, which can burst and deprive the brain cells of oxygen.

Know the symptoms of stroke

Call your country’s emergency number (911 in the United States) immediately if you experience any of the following symptoms, which may indicate you’ve had a stroke or a transient ischemic attack (TIA), or mini-stroke.

It’s important to act quickly. Prompt treatment may be able reopen a blocked blood vessel and reduce the severity of the stroke.

Risk factors

The risk factors for vascular dementia are similar to those for stroke or heart disease, and include:

Lower your risk for vascular dementia by reducing your risk for stroke

Source: National Stroke Association

Vascular dementia diagnosis and treatment

Symptoms of vascular cognitive impairment can often go unrecognized, so if you’ve suffered a stroke, mini-stroke, or have other risk factors for heart or blood vessel disease, your doctor may recommend cognitive tests. If initial screening tests suggest cognitive changes, your doctor may embark on a more detailed assessment of thinking skills such as judgment, planning, problem-solving, reasoning, and memory. This assessment may also include brain scans and tests to rule out other causes of your symptoms.

To make a diagnosis, your doctor may also seek input from family members or trusted friends about any subtle changes they’ve noticed in your behavior or cognitive abilities.

Treating vascular dementia

While there is currently no cure for vascular dementia, the earlier any brain damage is caught, the better your chance of preventing dementia, or at least slowing down the progression of the disease. By treating the risk factors that led to vascular dementia, such as high blood pressure or diabetes, you may even be able to reverse some of the symptoms.

Physiotherapy, occupational therapy, speech therapy can help you to regain some or all of any lost functions following a stroke. A number of medications used to treat the cognitive symptoms of Alzheimer’s disease appear to work for vascular dementia, too, but the most important thing is to minimize your risk of having another stroke and making the dementia worse. Your doctor may prescribe medications to lower blood pressure and prevent clots from forming, and may change or stop medications that can exacerbate symptoms of dementia, such sedatives, antihistamines, or strong painkillers. However, adopting healthier lifestyle changes is also a vital part of vascular dementia treatment. This means eating right, losing weight, exercising, getting high blood pressure under control, avoiding cigarettes, and controlling cholesterol levels and diabetes.

Lifestyle changes to help manage vascular dementia

A diagnosis of dementia is scary. But it’s important to remember that many people with dementia can lead healthy, fulfilling lives for years after the diagnosis. Don’t give up on life! As much as possible, continue to look after your physical and emotional health, do the things you love to do, and spend time with family and friends.

  • Find new ways to get moving. Research suggests that even a leisurely 30-minute walk a day may reduce the risk of vascular dementia and help slow its progression. Regular exercise can also help control your weight, relieve stress, and boost your overall health and happiness.
  • Create a network of support. Seeking help and encouragement from friends, family, health care experts, and support groups can improve your outlook and your health. See Resources and References section below for help finding a support group near you.
  • Eat for heart health. Heart disease and stroke share many of the same risk factors, such as high LDL cholesterol (bad cholesterol), low HDL cholesterol (good cholesterol), and high blood pressure. Adopting a heart-healthy diet may improve or slow down your dementia symptoms.
  • Make it a point to have more fun. Laughing, playing, and enjoying   yourself are great ways to reduce stress and worry. Joy can energize you and inspire lifestyle changes that may prevent further strokes and compensate for memory and cognitive losses.
  • Learn how to relax and manage stress. Stress is a major contributor to high blood pressure and heart disease, so it’s helpful to practice relaxation techniques, such as yoga, meditation, deep breathing, or rhythmic exercise, and know how to quickly reduce stress in the moment by employing one or more of your senses.
  • Challenge your brain. Your brain remains capable of change throughout your life, so you may be able to improve your ability to retain and retrieve memories. Set aside some time in the evening to recall the day’s events, which can build memory capacity. Learning new skills, such as a foreign language or how to paint, can also help build brain capacity if done consistently.

Managing symptoms of vascular dementia

Managing the symptoms of vascular dementia means learning practical ways to manage memory loss, while staying as optimistic and realistic as possible. Although you may not be able to bring back what’s lost, you can still find ways to make a challenging situation easier.

Helping someone with vascular dementia

Caring for a person with vascular dementia can be very stressful for both you and your loved one. You can make the situation easier by providing a stable and supportive environment. Modify the caregiving environment to reduce potential stressors that can create agitation and disorientation in a dementia patient. Avoid loud or unidentifiable noises, shadowy lighting, mirrors or other reflecting surfaces, garish or highly contrasting colors, and patterned wallpaper. Use calming music or play the person’s favorite type of music as a way to relax the patient when agitated.

A stable environment starts with a stable, healthy you. It’s easy to lose sight of your own needs when your loved one is dealing with dementia. But taking care of yourself isn’t optional. Stress and burnout are common in caregivers—and that isn’t a good thing for you or the person you’re caring for. Nurturing and protecting your own emotional and physical health isn’t selfish. It’s the best thing you can do for the person you love. Getting anxious or upset can increase your loved one’s stress or agitation. Try to remain flexible, patient, and relaxed. If you find yourself becoming anxious or losing control, take a time out to cool down. Try not to take problem behaviors personally and do your best to maintain your sense of humor.

Tips for caring for a loved one with vascular dementia

More help for vascular dementia

Alzheimer’s Disease and Dementia Help Center: Educate yourself about Alzheimer’s disease and dementia and make important decisions early to help you feel more in control.

Vascular dementia help

Resources and references

General information about vascular dementia

Facts About Dementia – Gives clear definitions of the symptoms, causes, diagnosis, and treatment of vascular dementia. (Alzheimer’s Society, UK)

Vascular Dementia – Provides a through definition of the disorder, diagnosis, prognosis and how it differs from other memory disorders (UCSF Memory Clinic)

Vascular Dementia – Learn about the symptoms, treatment, and prevention of vascular dementia and multi-infarct dementia. (Memory Disorders Project at Rutgers-Newark)

Caregiving and vascular dementia

Coping Strategies for Vascular Dementia Caregivers – Practical tips for caregivers on how to care for a loved one with vascular dementia. (UCSF Medical Center)

Ten Real-Life Strategies for Dementia Caregiving – Strategies for relating to someone with memory loss and dementia and making the caregiving experience easier. (Family Caregiver Alliance)

Finding Support for Vascular Dementia

In the U.S.:

American Heart Association offers a directory of support groups and online support resources for life after stroke.

Alzheimer’s Association offers a directory of support groups and other dementia services.

In the UK:

Alzheimer’s Society offers a national dementia helpline and a directory of services and support groups.

In Australia:

Ozcare offers a directory of dementia advice and support services.

In Canada:

Alzheimer Society Canada offers programs and services for people living with dementia.

What other readers are saying

“Great article, clearly written and answers everything I need to know at the moment, caring for mother with mild Vascular Dementia. Thank you so much.” ~ United Kingdom

Authors: Lawrence Robison, Jocelyn Block, M.A., Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: August 2015.

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