What is vascular dementia?

Vascular dementia is a form of dementia that develops because of problems with the blood’s circulation to the brain. It causes problems with reasoning, planning, judgement, memory and other thinking.

Vascular dementia is the second most common form of dementia after Alzheimer's disease. People with vascular dementia tend to decline more rapidly than people with Alzheimer's disease.

What are the symptoms of vascular dementia?

The symptoms of vascular dementia are often similar to those of Alzheimer’s disease, and the 2 conditions often occur together.

The symptoms of vascular dementia depend on which part of the brain is affected. However, common symptoms include:

• confusion
• trouble with attention and concentration
• trouble understanding speech
• difficulties in organising thoughts, analysing a situation and deciding what to do
• memory problems
• restlessness and agitation
• being unsteady on your feet
• needing to urinate urgently, or being unable to control urination
• personality changes
• depression
• paranoia
• hallucinations or delusions

Sometimes symptoms develop straight after a stroke (known as post-stroke dementia), or they can get progressively worse in stages after a series of small strokes. In the second case, you might notice a clear deterioration after each stroke rather than the steady decline you often see in other forms of dementia.

The early symptoms are often misdiagnosed as depression. As the disease progresses, the person might develop other symptoms of dementia including difficulty finding the right words, personality changes, mood swings, balance problems, loss of bladder control and finding it harder to live from day to day.

What causes vascular dementia?

Vascular dementia can sometimes be caused by one large stroke or a series of small strokes that block blood flow to the brain. It can also be caused by hardening of the arteries or the build-up of cholesterol and fatty plaques in the blood vessels.

You are more likely to develop vascular dementia if you have:

• already had a stroke
• untreated high blood pressure (hypertension)
• smoking
• obesity
• diabetes or insulin resistance
• high cholesterol
• atrial fibrillation
• heart rhythm abnormalities

What are the different types of vascular dementia?

There are several types of vascular dementia. Two of the most common are:

• Multi-infarct dementia: This is a common form of vascular dementia caused by several strokes which damage the brain’s cortex, the area responsible for learning, memory and language.
• Binswanger's disease or subcortical vascular dementia: This form develops when high blood pressure, thickening of the arteries and inadequate blood flow damage the ‘white matter’ in the brain.

How is vascular dementia diagnosed?

There is no specific test for vascular dementia and it can be difficult to distinguish from other types of dementia. It is diagnosed by a specialist neurologist, geriatrician or psychiatrist, who will look at a person’s history of heart disorders, strokes or other cardiovascular problems.

They may do tests to measure heart health, blood pressure, cholesterol levels, blood sugar or whether any other diseases are causing symptoms of vascular dementia. They will do a physical examination and may order brain imaging such as a CT scan or MRI scan to show any evidence of strokes or mini strokes. They may also do an ultrasound to look for any problems in the carotid arteries (which run up the side of the neck to the brain) and order neuropsychological testing to measure brain function.

How is vascular dementia treated?

While it is not possible to reverse any damage that has already been done, it is very important to prevent future strokes. To do this, a person might be given medicine to control high blood pressure, high cholesterol, heart disease and/or diabetes. Some people may need surgery to remove a blockage in the carotid artery.

It is very important to follow a healthy diet, to exercise and to give up smoking and drinking a lot of alcohol.

Sometimes medicines are used to treat restlessness or depression, or to help the person sleep. Sometimes Alzheimer’s medicines may be used.

People with vascular dementia may need therapy and support to help them manage day to day. Often, they will need help at home, and eventually care in a nursing home. People with vascular dementia often die from a heart attack or major stroke.

Can vascular dementia be prevented?

To make it less likely that you will develop vascular dementia, you should take the same steps as those used to avoid heart disease and strokes:

• keep your blood pressure healthy
• look after your cholesterol
• prevent or control diabetes
• quit smoking
• eat a healthy diet
• exercise regularly

Resources and support

• Dementia Australia
• National Dementia Helpline (1800 100 500)
• Help and support for carers