Vascular Dementia

Vascular dementia is a condition characterized by the loss of cognitive function as a result of reduced blood flow to the brain. It is the second most common cause of dementia, after Alzheimer's disease.

Although the underlying trigger is often a condition that can be inherited from parents (hypercholesterolemia, hypertension, or heart disorders), vascular dementia itself is not a hereditary disease.

One of the differences compared with other types of dementia is that, although the disease usually progresses gradually, sudden deteriorations may occur if new cerebrovascular damage develops.

The prognosis of vascular dementia varies from person to person. In most cases, life expectancy ranges from five to ten years after diagnosis. During this period, the patient's independence gradually declines until complete dependency is reached.

Symptoms

The symptoms of vascular dementia vary depending on the area of the brain affected by vascular damage. The most common symptoms are:

• Attention deficits.
• Memory impairment.
• Reduced information-processing capacity.
• Difficulty planning.
• Temporal and spatial disorientation.
• Apathy.
• Mood changes.
• Irritability.
• Aggressiveness.
• Hallucinations.
• In some cases, difficulty speaking or swallowing, movement disorders, or urinary incontinence.

These symptoms develop progressively, and vascular dementia is therefore classified into seven stages in which the patient's condition gradually worsens:

• Stage 1: No symptoms are evident, although vascular damage may already have begun.
• Stage 2: This is the initial stage, in which memory lapses begin to appear.
• Stage 3: Mild cognitive impairment develops. Forgetfulness increases, and difficulties arise in finding words to express thoughts, organizing and planning, locating objects, or retaining recently learned information.
• Stage 4: Moderate dementia develops, making it difficult to perform daily activities such as bathing, dressing, cooking, or eating.
• Stage 5: The activities described above can no longer be carried out independently, and assistance is required. Judgment and personal memory begin to decline.
• Stage 6: The disease reaches a severe stage, characterized by hallucinations and personality changes, as well as difficulty recognizing family members and orienting oneself in space, with a risk of becoming lost.
• Stage 7: Cognitive impairment becomes very severe and may affect speech or the ability to remain seated or walk. Twenty-four-hour care is required.

Causes

Vascular dementia develops when the brain's blood vessels become damaged and, as a result, the amount of blood reaching the brain is insufficient to provide tissues with the oxygen and nutrients needed to function properly. This damage may occur as a consequence of one of the following conditions:

• Stroke caused by blockage of a cerebral artery by a blood clot. These are typically ischemic cerebral infarctions.
• Cerebral hemorrhage: a weakened blood vessel, often due to hypertension, ruptures and causes blood to leak into the brain.
• Narrowing of the blood vessels, making it more difficult for blood to flow through them. This is usually a consequence of hypertension, hypercholesterolemia, atherosclerosis, or diabetes.

Risk Factors

Some factors that increase the risk of developing vascular dementia include:

• Age: it is usually diagnosed after the age of 65.
• Personal history of stroke or heart attack.
• Hypercholesterolemia.
• Hypertension.
• Atherosclerosis, which is the narrowing of the blood vessels.
• Diabetes.
• Obesity.

Complications

People with vascular dementia often experience other associated health problems, including:

• Malnutrition.
• Dehydration.
• Dysphagia (difficulty swallowing).
• Aspiration pneumonia: because swallowing is impaired, food or oral secretions may enter the lungs through the airways.
• Fractures resulting from falls and injuries.
• Insomnia.
• Nocturnal wandering.
• Anxiety.
• Social isolation.

Prevention

Preventing vascular dementia is not always possible. However, maintaining a healthy lifestyle helps keep the heart and blood vessels healthy, thereby reducing the likelihood of developing the condition. Some of the most highly recommended habits include:

• Following a balanced diet.
• Not smoking.
• Monitoring blood glucose and cholesterol levels.
• Exercising regularly.

Which specialist treats vascular dementia?

Specialists in Neurology are the physicians who diagnose and treat vascular dementia. Neuropsychologists and specialists in Physical medicine and Rehabilitation may also be involved in patient care.