What is vascular dementia?

Vascular dementia can be caused by a series of strokes or other conditions that block blood flow to the brain. It causes problems with reasoning, planning, judgement, memory and other thinking.

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

People with vascular dementia tend to decline more rapidly than people with Alzheimer's disease.

Types of vascular dementia

There are several types of vascular dementia, including:

• 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.

Symptoms

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

• confusion
• trouble with attention and concentration
• 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
• depression

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.

Diagnosis

There is no specific test for vascular dementia. It can be difficult to distinguish vascular dementia 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 your neck to the brain) and order neuropsychological testing to measure brain function.

Treatment

While it’s 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’s 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. They may also receive Alzheimer’s medicines.

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.

Prevention

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

Who can help?

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

Not sure what to do next?

If you are still concerned about your symptoms, why not use healthdirect’s online Symptom Checker to get advice on when to seek medical attention.

The Symptom Checker guides you to the next appropriate healthcare steps, whether it’s self-care, talking to a health professional, going to a hospital or calling triple zero (000).