What is vascular dementia?
Vascular dementia or vascular cognitive impairment (VCI) occurs when the blood flow to the brain is impaired. Inadequate blood flow can damage and kill cells anywhere in the body, but the brain, home to one of the body’s richest networks of blood vessels, is especially vulnerable. This blockage of blood flow leads to problems with reasoning, planning, judgement and memory.
What causes vascular dementia?
Vascular dementia develops after a stroke blocks an artery in the brain. Whether a stroke affects the thinking and reasoning that are a hallmark of dementia depends on the stroke’s severity and location. The onset of thinking problems may be mild and gradually worsen as a result of multiple minor strokes or other conditions that affect smaller blood vessels, leading to cumulative damage. Vascular dementia can also result from other conditions that reduce blood flow to the brain, depriving it of vital oxygen and nutrients.
What are the symptoms of vascular dementia?
Symptoms can vary depending on the severity of the blood vessel damage and the area of the brain that is affected. Symptoms will be most obvious when they occur soon after a major stroke, which include:
- Confusion
- Disorientation
- Trouble speaking or understanding speech
- Vision loss
The above symptoms can occur at the same time as physical stroke symptoms, such as sudden headache, difficulty walking or numbness or paralysis on one side of the face or the body.
However, multiple small strokes or other conditions that affect blood vessels and nerve fibers inside the brain may cause more gradual thinking changes as damage slowly accumulates. Common early signs of widespread small vessel damage include impaired planning and judgment; uncontrolled laughing and crying; declining ability to pay attention; impaired function in social situations; and difficulty finding the right words.
In the context of a will contest or trust contest, the onset of vascular dementia is important to recognize as it may alter the timing of when an issue with mental capacity sufficient to execute estate planning arises. For example, decreased executive function (that is, the functions that allow you to plan, organize, and complete tasks) is common early in vascular dementia (as opposed to Alzheimer’s Dementia, which is generally more gradual). Motor signs (such as changes in gait) are also common with vascular dementia. As with other dementias, vascular dementia can certainly interfere with the ability to validly execute a will and give rise to an inheritance dispute.
Are there factors that increase the risk of vascular dementia?
The risk factors for vascular dementia are the same as those for stroke and heart disease, including: increased age, especially over the age of 65; buildup of plaques in the arteries; history of heart attack, strokes or mini strokes; high blood pressure; high cholesterol; diabetes; smoking; obesity; and abnormal heart rhythm.
Is vascular dementia preventable?
The health of your brain’s arteries are directly related to the overall health of your body. The following steps that will help keep your heart healthy will help decrease the risk of stroke resulting in vascular dementia: maintain a healthy blood pressure; control cholesterol levels; prevent or control diabetes; quit smoking; and get regular physical exercise.
How is vascular dementia diagnosed?
Brief tests to assess memory, thinking and reasoning should be considered for anyone at high risk for this disorder. Those at the highest risk of course include stroke and mini stroke victims. Other high-risk individuals include those with high blood pressure and high cholesterol. According to “Vascular Dementia,” imaging techniques allow clinicians to identify specific lesions in the brain, classify them, and monitor changes using serial imaging.
If the screening tests suggest changes in thinking or reasoning, a more detailed assessment is needed. Core elements of a workup for vascular dementia typically include:
- Medical history, including family history of dementia
- Evaluation of independent function and daily activities
- Input from a family member or trusted friend
- In-office neurological examination assessing function of nerves and reflexes, movement, coordination, balance and senses
- Laboratory tests including blood tests and brain imaging
Is there treatment for vascular dementia?
At this time there are no drugs specifically earmarked to treat symptoms of vascular dementia. However, there is some clinical trial evidence that certain drugs approved to treat Alzheimer’s may offer a modest benefit in people diagnosed with vascular dementia.
One treatment strategy is to control the risk factors that increased the likelihood of further damage to the brain’s blood vessels. There’s evidence that this treatment improves outcomes and can postpone or prevent further decline.
Like other forms of dementia, vascular dementia shortens lifespan. Those who develop dementia following a stroke often survive on average for three years. It’s important to note that cognitive changes can improve during recovery and rehab from the acute phase of a stroke as the brain generates new blood vessels.
Source: Alzheimer’s Association