Vascular dementia develops when the blood vessels in the brain are damaged by other health conditions. This damage keeps the brain from getting the oxygen it needs. Vascular diseases such as atherosclerosis or high blood pressure contribute to one-fourth to one-half of all cases of dementia. Vascular dementia often occurs in combination with Alzheimer’s disease, dementia or other dementias rather than just by itself. Cardiovascular research studies, or studies on the heart and blood vessels, are identifying other potential causes of dementia, such as problems in the heart’s chambers.

Dementia refers to problems with memory, thinking, behavior, language skills, and decision making, beyond what is expected during the healthy aging process.  Early signs of vascular dementia can include symptoms such as mood and behavior changes. The decrease in blood flow to the brain that occurs with this dementia  can also cause problems with planning, memory, the ability to pay attention, and other thought processes.  A healthcare provider may consider the following problems as signs of vascular dementia:

• Forgetting to pay bills
• Getting lost in your neighborhood
• Having difficulty preparing meals
• Experiencing short-term memory loss

Vascular dementia refers to changes to memory, thinking, and behavior resulting from conditions that affect the blood vessels in the brain. Cognition and brain function can be significantly affected by the size, location, and number of vascular changes.

Symptoms of vascular dementia can begin gradually or can occur suddenly, and then progress over time, with possible short periods of improvement. Vascular dementia can occur alone or be a part of a different diagnosis such as Alzheimer's disease or other forms of dementia. When an individual is diagnosed with vascular dementia, their symptoms can be similar to the symptoms of Alzheimer's.

What causes vascular dementia?

Vascular dementia is caused by different conditions that interrupt the flow of blood and oxygen supply to the brain and damage blood vessels in the brain.

People with vascular dementia almost always have abnormalities in the brain that can be seen on MRI scans. These abnormalities can include evidence of prior strokes, which are often small and sometimes without noticeable symptoms. Major strokes can also increase the risk for dementia, but not everyone who has had a stroke will develop dementia.

Other abnormalities commonly found in the brains of people with vascular dementia are diseased small blood vessels and changes in "white matter" — the connecting "wires" of the brain that are critical for relaying messages between brain regions.

Researchers are investigating how these changes in the brain — and their underlying causes — are involved in the onset and progression of dementia. Research has shown a strong link between cardiovascular disease, involving the heart and blood vessels, and cerebrovascular disease, involving the brain, and subsequent cognitive impairment and dementia. This area of research is referred to as “vascular contributions to cognitive impairment and dementia,” or VCID. It is helping researchers better understand this connection and whether the methods used to prevent and treat cerebrovascular disease and heart disease could also help prevent dementia. Researchers investigating VCID are exploring diverse conditions that affect blood flow to and within the brain, including infarcts (an area of dead tissue resulting from a lack of blood supply), hemorrhages (bleeding from ruptured or damaged blood vessels), cerebral hypoperfusion (reduced blood flow), and small vessel disease in the brain such as that thought to be associated with white matter hyperintensities (white patches seen on brain MRI scans), and stroke.

What are the symptoms of vascular dementia?

People with vascular dementia may experience:

• Difficulty performing tasks that used to be easy, such as paying bills
• Trouble following instructions or learning new information and routines
• Forgetting current or past events
• Misplacing items
• Getting lost on familiar routes
• Problems with language, such as finding the right word or using the wrong word
• Changes in sleep patterns
• Difficulty reading and writing
• Loss of interest in things or people
• Changes in personality, behavior, and mood, such as depression, agitation, and anger
• Hallucinations or delusions (believing something is real that is not)
• Poor judgment and loss of ability to perceive danger

How is vascular dementia treated?

Because many different disease processes can result in different forms of vascular dementia, there may not be one treatment for all. However, vascular dementia is often managed with medications to prevent strokes and reduce the risk of additional brain damage. Some studies suggest that medications that are used to treat Alzheimer's might benefit some people with an early form of vascular dementia. Treating modifiable risk factors like high blood pressure, diabetes, high cholesterol, and problems with the rhythm of the heartbeat can help prevent additional stroke. Living a healthy lifestyle is important to help reduce the risk factors of vascular dementia.

Vascular dementia is caused by conditions that damage the blood vessels in the brain or interfere with blood flow and oxygen delivery to the brain. This oxygen shortage keeps the brain from working as well as it should. For example, a stroke may block blood flow to the brain and lower oxygen levels. Atherosclerosis in the brain’s blood vessels also can lead to vascular dementia.

Other risk factors for vascular dementia include:

• High blood pressure
• High cholesterol
• Atrial fibrillation
• Diabetes
• Smoking

People with vascular dementia may experience:

• Difficulty performing tasks that used to be easy, such as paying bills
• Trouble following instructions or learning new information and routines
• Forgetting current or past events
• Misplacing items
• Getting lost on familiar routes
• Problems with language, such as finding the right word or using the wrong word
• Changes in sleep patterns
• Difficulty reading and writing
• Loss of interest in things or people
• Changes in personality, behavior, and mood, such as depression, agitation, and anger
• Hallucinations or delusions (believing something is real that is not)
• Poor judgment and loss of ability to perceive danger

To diagnose cognitive impairment and dementia, your healthcare provider may:

• Ask about any symptoms you have such as problems carrying out daily activities
• Give you brief memory or thinking tests
• Ask to speak with a relative or friend who knows you well and can answer questions about your daily habits and behavior

To determine whether vascular dementia is the cause of any cognitive impairment or dementia that you may have, your doctor will consider your medical history and your lifestyle (such as your eating patterns, physical activity level, sleep health, and whether you are or have been a smoker), and order imaging tests.

Diagnosis can take time. This is because it is often difficult to tell whether symptoms are a result of problems with the blood vessels, as is the case with vascular dementia, or whether they are from Alzheimer’s disease.

Currently there are no treatments that reverse dementia, but there are ways to manage your symptoms. If you are diagnosed with vascular dementia, your treatment plan may include taking medicine or using medical devices to manage any other conditions that can cause your vascular dementia to get worse. Those other conditions may include high blood pressure,  atherosclerosis, or sleep apnea.

Some studies suggest that medicines that improve memory in people living with Alzheimer’s disease might benefit people experiencing early vascular dementia. Other medicines may help manage certain symptoms and behavioral issues associated with vascular dementia.

Your healthcare provider may also recommend that you make heart-healthy lifestyle changes. These include eating, a heart-healthy diet, limiting alcohol, getting regular physical activity, aiming for a healthy weight, quitting smoking, controlling diabetes, and managing stress .

Many years before you have a stroke or notice dementia, uncontrolled high blood pressure narrows your arteries, decreasing blood to your brain. If you're a Black man 28-45, take charge of your health today. Because nobody can lower your risk of stroke and dementia like you.

Nobody Can Lower Your Risk of Stroke & Dementia Like You

Many people with high blood pressure know that they could be at risk for stroke and heart attack. However, too many people, despite what they may know, still struggle to get their blood pressure under control. Now a new risk of high blood pressure is emerging: the connection between uncontrolled blood pressure and dementia. Important new studies link high blood pressure, especially in midlife, to an increased risk for dementia later in life.

Scientists are working hard to learn more about this connection. In the meantime, don’t take unnecessary risks. Keep your blood pressure under control.