Understanding dementia as a journey, not a final stop – Andy’s story
Andy opens up on how his approach to his dementia diagnosis has changed over time, and the two layers of stigma he has experienced.
Vascular dementia is the second most common type of dementia after Alzheimer’s disease. It is caused by reduced blood flow to the brain. It can cause problems with concentration, thinking and carrying out daily activities.
This guide, written by our specialist dementia nurses, explores the symptoms, causes and treatments of vascular dementia.
What is vascular dementia?
Vascular dementia is a form of dementia that occurs when the brain does not receive enough blood supply, meaning it cannot carry out its normal functions.
It is caused by damage or disease to the blood vessels in the brain, often as the result of a stroke or transient ischaemic attack(s) (TIAs), also known as ‘mini strokes’.
Vascular dementia can also result from other conditions that affect the supply of blood to the brain, such as high blood pressure, heart disease and diabetes.
How does vascular dementia differ from other types of dementia?
The main difference between vascular dementia and other types is that vascular dementia is caused by the brain not getting enough blood, whereas other common forms (eg Alzheimer’s disease, frontotemporal dementia and Lewy body dementia) are caused by abnormal proteins building up in the brain.
The early symptoms of vascular dementia also differ from some other types – for example, changes in mood, behaviour and personality are initially more common than memory problems.
How blood flow affects the brain
Blood carries oxygen and nutrients to the brain, and every aspect of human functioning depends on the brain having an adequate blood supply. When this is reduced, the nerve cells in the brain cannot communicate with each other and eventually die.
If the blood flow to the brain is interrupted by a sudden or gradual blockage or damage to blood vessels, it can lead to symptoms of vascular dementia.
Common signs and symptoms of vascular dementia
While everyone will have their own experiences of vascular dementia, many people will share common symptoms.
Early signs of vascular dementia
The early signs of vascular dementia include:
- concentration problems
- difficulty with planning and decision-making
- slowed thought processes
- changes in mood, behaviour and personality
- difficulties with understanding
- short-term memory problems – although this is less common in the early stages than in other types of dementia, like Alzheimer’s disease
If someone develops symptoms of dementia after a stroke, they may also have speech or vision problems.
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. The person may have symptoms of both forms of dementia.
In one specific type of vascular dementia, called subcortical vascular dementia or Binswanger’s disease, the early symptoms include loss of bladder control, speech problems, movement changes, falls and reduced facial expressions.
Symptoms of advanced vascular dementia
As vascular dementia progresses, daily living activities can become increasingly difficult, and people may struggle to look after themselves. In the later stages, common symptoms include:
- increasing difficulty with speech, communication and understanding – possibly eventually losing the ability to speak at all
- disorientation in time and place
- loss of recognition of familiar people and places
- distressed behaviour
- mobility problems, including falls
- difficulty with eating and drinking
- continence problems
Stages of vascular dementia
As with other types of dementia, vascular dementia is progressive and is often roughly divided into three stages: early, middle and late.
In the early stage – which may last for months or even years – vascular dementia will begin to affect the person’s daily life, although the impact may not be severe at this point.
In the middle stages, the symptoms of vascular dementia will become more pronounced, and the person is likely to need increasing support with everyday life. There may be:
- more significant changes in mood, personality and behaviour
- memory problems
- increasing communication difficulties
- increased confusion, including sundowning (a strong sense of being in the wrong time or place that often occurs around dusk)
In the late stages of vascular dementia, every aspect of life is likely to be affected. The person is likely to need increasing levels of care, including support with eating and drinking, personal hygiene, communication and mobility.
How quickly does vascular dementia progress?
Vascular dementia progresses at different rates for different people. The onset is often gradual, although in some cases – for example, if the person has a stroke – it may be sudden.
People with vascular dementia may have periods where their symptoms seem stable, followed periods where it progresses more rapidly or suddenly (sometimes referred to as ‘step-wise progression’). It is difficult, however, to predict when this might happen, so it is better to focus on what the person can do now and how you can support them, rather than on how quickly their condition might progress.
Causes and risk factors
Vascular dementia is caused by narrowing, damage or disease to the blood vessels in the brain. There are various factors that can contribute to this. These include:
Age
Like many other types of dementia, vascular dementia becomes more common as people get older. People over the age of 65 are more likely to get vascular dementia. However, it can also develop in younger people. When dementia symptoms develop before the age of 65, it is known as young onset dementia.
Gender
Men are slightly more likely to develop vascular dementia than women.
Ethnicity
People from South Asian and African-Caribbean backgrounds are at increased risk of vascular dementia because they are more likely to have diabetes and cardiovascular conditions.
Underlying health conditions
Vascular dementia is more common in people who have health conditions that can affect the supply of blood to the brain. These include:
- stroke/mini strokes (TIAs)
- high blood pressure
- heart disease
- high cholesterol
- diabetes
Generally, vascular dementia is not thought to be hereditary. There is some evidence that people with a family history of vascular dementia have a slightly greater risk of developing the condition, but this is probably because diabetes, heart disease and strokes – which are associated with vascular dementia – can have a genetic link, rather than the condition being directly inherited.
Some people have a rare form of inherited vascular disease called CADASIL, which is linked to dementia. People with CADASIL are likely to have a family history of strokes. The symptoms typically begin between the ages of 30 and 50, and include repeated TIAs or strokes, migraine, slurred speech, weakness on one side of the body, confusion and memory problems. Around two out of three people with CADASIL will go on to develop dementia.
If CADASIL or another rare familial or genetic form of vascular dementia is suspected, the person’s GP or dementia specialist may refer them to a genetics service for counselling, advice and testing for the inherited gene.
Genetic forms of dementia are more common in people under the age of 65.
Lifestyle
Some lifestyle factors may increase the risk of developing dementia:
Diet
An unhealthy diet that is high in calories, saturated fats (found in foods such as fatty meat like sausages and bacon, cheese, butter, ghee, cakes and biscuits, crisps, chocolate and pastries), processed foods (eg ready meals, cooked meat like ham, sweetened drinks), sugar and salt may contribute to vascular dementia.
This sort of diet is linked to health conditions like obesity, type 2 diabetes, high blood pressure and heart disease, which can lead to vascular dementia.
Drinking alcohol in excess can also cause health problems that could increase the risk of vascular dementia.
Exercise
A lack of exercise can lead to problems like obesity, heart disease, high blood pressure and high cholesterol, which increase the risk of developing vascular dementia.
Smoking
There is a strong link between vascular dementia and smoking. This is because it can cause blockages in the arteries, which can disrupt the blood flow to the brain. It can increase the risk of high cholesterol, high blood pressure, strokes and heart attacks.
Reducing your risk of vascular dementia
While there is no guaranteed way to prevent vascular dementia, the best way to reduce the risk or delay its onset and progression is to follow the general advice for good heart health. This will help to prevent damage or disease to the blood vessels in your brain. This includes:
- increasing your physical activity – aim to exercise for 20 to 30 minutes per day, at least five days per week
- aiming for a healthy, balanced diet with plenty of fruit and vegetables and minimal amounts of processed, fatty and sugary foods – you could use the NHS Eatwell plate as a guide
- maintaining a healthy weight – a healthy body mass index (BMI) for most adults is between 18.5 and 25. You can check your BMI using a BMI calculator, but be aware that BMI is not always an accurate indicator of a healthy weight (eg if you are muscular, your BMI may be higher)
- aiming to keep your waist size to 94cm (37”) or below for men, and 80cm (31”) or below for women
- stimulating your brain, for example by learning a new skill, reading, playing chess
- stopping smoking
- drinking no more than 14 units of alcohol a week – the NHS has a guide to calculating your units
- keeping socially active and connecting with others
- avoiding activities that could lead to a head or brain injury, eg cycling without a helmet
- avoiding prolonged daily stress
- creating good sleep habits
You may wish to ask your GP for certain health checks, such as a blood pressure check and blood tests for raised cholesterol, high blood sugar and any deficiencies or hormonal problems, to help detect abnormalities, which can then be treated and monitored.
Regular sight and hearing checks are also important to identify and treat any problems.
Diagnosing vascular dementia
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 as soon as possible.
The first port of call is the person’s GP. To prepare for this appointment, it is helpful to keep a record of their symptoms, including:
- what the issues are
- when they started
- what happens
- any triggers
If possible, a family member or someone else close to the person should accompany them to the appointment so they can share their observations.
Medical tests
At the initial appointment, the GP should ask the person about their symptoms and family medical history, and carry out some physical examinations (eg checking blood pressure, weight and heart rate) to rule out other conditions that may have similar symptoms to dementia, such as depression, stress, menopause and infections.
They should also order blood tests to check for possible underlying conditions like vitamin deficiency, thyroid problems, diabetes and high cholesterol.
Cognitive assessments
The GP may conduct some brief cognitive tests, for example asking the person to name some common items, remember an address, and/or draw an everyday object (usually a clock face). However, as these initial tests usually focus on memory and orientation problems – which may not be significant in the early stages of vascular dementia – the person may score highly, which could delay a referral to a specialist.
If the GP suspects dementia, the person should be referred to a memory clinic for more comprehensive assessments focusing on attention, memory, fluency, language, visuospatial abilities and behaviour changes.
Brain imaging
Because vascular dementia is caused by damage/disease in the blood vessels rather than a build-up of proteins in the brain, a brain scan alone will not identify if someone has vascular dementia.
However, a person who is suspected to have the condition should be referred for a brain scan such as an MRI or CAT scan by their GP or memory clinic. These scans may show evidence of stroke damage to the brain and may also help rule out other types of dementia (eg Alzheimer’s disease).
Treatment for vascular dementia
Currently, there are no specific treatments for vascular dementia, but there are some things that a person can do to manage its impact on their life and potentially slow its progression.
Medication
While there is no specific medication for vascular dementia, medications may be given for underlying conditions that could be contributing to or increasing the risk of dementia, 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 (vascular dementia and Alzheimer’s disease).
If the person feels depressed or anxious about their diagnosis and the impact on their life, they should speak to their GP or specialist. In some cases, medication for depression or anxiety may be recommended.
Lifestyle changes
A person with vascular dementia should be supported to:
- stop smoking, if applicable
- take regular exercise
- eat a healthy, balanced diet – their GP or specialist may recommend specific dietary changes, like following a low-salt diet
- lose weight, if they are overweight
These steps will not cure vascular dementia, but they may slow its progression.
Cognitive therapy
For people in the early to middle stages of dementia, cognitive stimulation therapy (CST) may help with problems with thinking, memory, concentration and communication. This involves talking about their everyday interests, things relating to the current time and place, and past experiences and memories.
CST can take place one-to-one or in groups. You can find out if it is available in your area through the person’s GP or memory clinic.
People who are experiencing anxiety or depression connected to their vascular dementia may benefit from talking therapy like cognitive behavioural therapy (CBT), which aims to change negative patterns of thought. The person can be referred for talking therapy by their GP or can refer themselves.
Life expectancy for vascular dementia
It is impossible to predict a person’s life expectancy after a diagnosis of vascular dementia. It will depend on factors such as their age, the stage at which they were diagnosed, and the impact of other conditions (it is not uncommon for people with vascular dementia to die of a heart attack or stroke before their dementia reaches an advanced stage).
Because everyone’s dementia progresses differently, it is better to concentrate on supporting the person to have the best possible quality of life now than to try to predict their life expectancy.
Living with vascular dementia
These tips may help to prevent and manage the effects of vascular dementia so the person with the diagnosis can live as well as possible.
- Break complex tasks down into smaller steps – people with vascular dementia may have trouble following lengthy processes or instructions
- 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 with vascular dementia to carry a form of ID with details of their diagnosis and what support they may need. The Hidden Disabilities sunflower lanyard/ID cards are widely recognised as a sign that a person has additional support needs
- Support groups can provide an opportunity for people with vascular dementia and their carers to share experiences, tips and companionship
- A consistent routine and regular activities may reduce confusion and help the person feel more secure and relaxed
- Prioritise good sleep as tiredness can make symptoms like confusion and poor concentration worse
Supporting someone with vascular dementia
Because everyone with dementia has their own unique experience, the support they receive should be tailored to their needs, based on your understanding of them as a person. However, these tips may help:
- Encourage an overall healthy lifestyle with a balanced diet and regular exercise
- Consider any changes that could be made to the person’s home to help them maintain their independence and stay safe
- Look out for triggers of confusion and distress, such as being too hot or cold, noise, pain, misunderstanding, difficulty with emotional control, changes in routine, lack of activity or too much or too little stimulation
- Noisy or crowded places may be distressing and trigger changes in behaviour, so it may help to avoid these situations or provide support if they are unavoidable
- Encourage the person to keep up with activities they enjoy, eg socialising, volunteering, art, exercise, walking, taking care of a pet
- If the person becomes particularly confused or distressed in the evening, read our advice on supporting them with sundowning
- Think about ways to improve how you communicate with the person to help them understand better – eg talking in short, clear sentences; using touch to get their attention; avoiding open-ended questions
