Introduction

Vascular dementia is a common type of dementia caused by reduced blood flow to the brain. It's estimated to affect around 150,000 people in the UK.

"Dementia" is the name for problems with mental abilities caused by gradual changes and damage in the brain. It's rare in people under 65.

Vascular dementia tends to get worse over time, although it's sometimes possible to slow it down.

This page covers:

Symptoms of vascular dementia

Vascular dementia can start suddenly or come on slowly over time.

Symptoms include:

  • slowness of thought
  • difficulty with planning and understanding
  • problems with concentration
  • mood, personality or behavioural changes
  • feeling disorientated and confused
  • difficulty walking and keeping balance
  • symptoms of Alzheimer's disease, such as problems with memory and language (many people with vascular dementia also have Alzheimer's)

These problems can make daily activities increasingly difficult and someone with the condition may eventually be unable to look after themselves.

Read more about the symptoms of vascular dementia.

Getting medical advice

See your GP if you think you have early symptoms of dementia, especially if you're over 65 years of age.

If it's spotted at an early stage, treatment may be able to stop the vascular dementia getting worse, or at least slow it down.

If you're worried about someone else, encourage them to make an appointment with their GP and perhaps suggest that you go with them.

Your GP can do some simple checks to try to find the cause of your symptoms and they can refer you to a memory clinic or another specialist for further tests if needed.

Read more about getting a dementia diagnosis.

Tests for vascular dementia

There's no single test for vascular dementia.

The following are needed to make a diagnosis:

Read more about the tests used to diagnose dementia.

Treatments for vascular dementia

There's currently no cure for vascular dementia and there is no way to reverse any loss of brain cells that occurred before the condition was diagnosed.

But treatment can sometimes help slow down vascular dementia.

Treatment aims to tackle the underlying cause, which may reduce the speed at which brain cells are lost. This will often involve:

Other treatments including physiotherapyoccupational therapy, dementia activities (such as memory cafés) and psychological therapies can help reduce the impact of any existing problems.

Read more about how vascular dementia is treated.

Outlook for vascular dementia

Vascular dementia will usually get worse over time. This can happen in sudden steps, with periods in between where the symptoms don't change much, but it's difficult to predict when this will happen.

Home-based help will usually be needed, and some people will eventually need care in a nursing home.

Although treatment can help, vascular dementia can significantly shorten life expectancy. But this is highly variable and many people live for a number of years with the condition or die from some other cause.

If you or a loved one has been diagnosed with dementia, remember that you're not alone. The NHS and social services, as well as voluntary organisations, can provide advice and support for you and your family.

Causes of vascular dementia

Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills the brain cells. 

This can develop as a result of:

  • narrowing and blockage of the small blood vessels inside the brain
  • a single stroke (where the blood supply to part of the brain is suddenly cut off)
  • lots of "mini strokes" that cause tiny but widespread damage to the brain

In many cases, these problems are linked to underlying conditions – such as high blood pressure and diabetes – and lifestyle factors such as smoking and being overweight.

Tackling these might reduce your risk of vascular dementia in later life, although it's not yet clear exactly how much your risk of dementia can be reduced.

Read more about the causes of vascular dementia.

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Symptoms

Vascular dementia causes problems with mental abilities and a number of other difficulties.

The symptoms can come on suddenly or gradually. They tend to get worse over time, although treatment can help slow this down.

Early symptoms

Early signs of vascular dementia can include mild:

  • slowness of thought
  • difficulty with planning
  • trouble with understanding
  • problems with concentration
  • mood or behavioural changes
  • problems with memory and language (but these aren't as common as they are in people with Alzheimer's disease)

As this point, these problems may be barely noticeable or mistaken for something else, such as depression. But they indicate some brain damage has occurred and that treatment is needed.

Later symptoms

The symptoms often continue to get worse over time. This may happen slowly, or in sudden steps every few months or years.

The symptoms depend on the part of the brain that's affected, but can include:

  • significant slowness of thought
  • feeling disorientated and confused
  • memory loss and difficulty concentrating
  • difficulty finding the right words
  • severe personality changes, such as becoming aggressive
  • depression, mood swings and lack of interest or enthusiasm
  • finding it difficult to walk and keep balance, with frequent falls 
  • loss of bladder control (incontinence)
  • increasing difficulty with daily activities

Some people also have some symptoms of Alzheimer's disease.

Getting medical advice

See your GP if you think you have early symptoms of dementia, especially if you're over 65 years of age.

If it's spotted at an early stage, treatment may be able to stop the vascular dementia getting worse, or at least slow it down.

If you're worried about someone else, encourage them to make an appointment with their GP and perhaps suggest that you go with them.

Symptoms of dementia can have several causes. Your GP can do some simple checks to try to find out the cause and may refer you to a specialist for further tests.

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Causes

Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills the brain cells.

This is usually due to:

  • narrowing of the small blood vessels deep inside the brain – known as subcortical vascular dementia or small vessel disease
  • stroke (where the blood supply to part of the brain is suddenly cut off, usually as the result of a blood clot) – called post-stroke dementia or single-infarct dementia
  • lots of "mini strokes" that cause tiny but widespread damage to the brain – known as multi-infarct dementia

Some people with vascular dementia also have brain damage caused by Alzheimer's disease. This is known as mixed dementia.

Who's most at risk?

Things that can increase your chances of getting vascular dementia in later life include:

These problems increase the risk of damage to the blood vessels in and around the brain, or cause blood clots to develop inside them.

Can I reduce my risk?

By making healthy lifestyle changes – such as stopping smoking and exercising regularly – and treating any health conditions you have, you may be able to reduce your risk of vascular dementia.

This may also help slow down or stop the progression of vascular dementia if you're diagnosed in the early stages. See treating vascular dementia for more information.

But there are some things you can't change that can increase your risk of vascular dementia, such as:

  • your age – the risk of vascular dementia increases as you get older, with people over 65 most at risk
  • your family history – your risk of problems such as strokes is higher if a close family member has had them
  • your ethnicity – if you have a south Asian, African or Caribbean background, your risk of vascular dementia is higher, as related problems such as diabetes and high blood pressure are more common in these groups

In rare cases, unavoidable genetic conditions can also increase your risk of vascular dementia.

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Treatment

Treatment can help prevent further damage to the brain in people with vascular dementia and may slow down its progression.

But there's currently no cure for the condition or a way to reverse the damage that's already occurred.

See below for information about:

Care plans

Before treatment starts, your current and future health and social care needs will be assessed and a care plan drawn up.

This is a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as:

  • what support you or your carer need for you to remain as independent as possible – including whether you might need care at home or in a nursing home
  • whether there are any changes that need to be made to your home to make it easier to live in
  • whether you need any financial assistance

Read more about care plans.

Lifestyle changes

The main aim of treatment for vascular dementia is to treat the underlying cause to help stop the condition getting worse.

This will usually involve making healthy lifestyle changes, such as:

  • eating healthily, for example, you may be advised to follow a low-salt diet to manage high blood pressure
  • losing weight if you're overweight
  • stopping smoking
  • getting fit
  • cutting down on alcohol

Medication

Medication may also be offered to treat the underlying cause of vascular dementia and help stop it getting worse.

These include:

  • medication for high blood pressure
  • statins to treat high cholesterol
  • medicines such as aspirin or clopidogrel to reduce the risk of blood clots and further strokes
  • anticoagulant medication, such as warfarin, which can also reduce the risk of blood clots and further strokes
  • medication for diabetes

Some medicines may also help with some of the symptoms of vascular dementia. For example, antidepressants can help relieve depression.

Alzheimer's disease medicationssuch as donepezil (Aricept), galantamine (Reminyl) or rivastigmine (Exelon) aren't used to treat vascular dementia, but may be used in people with a combination of vascular dementia and Alzheimer's disease.

Support and other therapies

There are also a number of therapies and practical measures that can help make everyday living easier for someone with dementia.

These include:

  • occupational therapy to identify problem areas in everyday life, such as getting dressed, and help work out practical solutions
  • speech and language therapy to help improve any communication problems
  • physiotherapy to help with movement difficulties
  • psychological therapies, such as cognitive stimulation (activities and exercises designed to improve memory, problem-solving skills and language ability)
  • relaxation techniques, such as massage and music or dance therapy
  • social interaction, leisure activities and other dementia activities, such as memory cafés (drop-in sessions for people with memory problems and their carers to get support and advice)
  • home modifications, such as removing loose carpets and potential trip hazards, ensuring the home is well lit, and adding grab bars and handrails

It may also be helpful to get in touch with a support group, such as the Alzheimer's Society or Dementia UK.

Read more about living well with dementia.

End of life and legal issues

If you've been diagnosed with dementia, you might want to make arrangements for your care that take into account the decline in your mental abilities.

This may include ensuring that your wishes are upheld if you're not able to make decisions for yourself.

You may want to consider:

  • drawing up an advance decision – this makes your treatment preferences known in case you're unable to do this in the future
  • having a preferred place of care plan – this outlines where you would like to receive treatment
  • giving a relative lasting power of attorney – this is the power to make decisions about you if you're unable to

Read more about managing legal affairs for someone with dementia and end of life planning.

Help and advice for carers

If you care for someone with dementia, you may find it helpful to read more about:

Looking after someone with dementia

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 26/06/2018 11:49:52