Vascular dementia is a progressive condition caused by reduced blood flow to the brain. It is considered the second most common cause of dementia after Alzheimer’s disease. The symptoms of vascular dementia can vary greatly depending on the extent of damage and the part of the brain affected. However, there are some common signs and characteristics that point to vascular dementia. In this article, we will explore the typical ways a person with vascular dementia behaves and the impact this has on their daily life.
What is vascular dementia?
Vascular dementia is caused when the blood vessels leading to the brain become narrowed or blocked, resulting in strokes or small vessel disease. This deprives brain cells of vital oxygen and nutrients, causing the cells to die. The location and size of brain damage determines which mental functions are affected. Some key facts about vascular dementia include:
- It accounts for around 20% of dementia cases.
- The most common cause is stroke due to high blood pressure, diabetes, high cholesterol.
- It can occur suddenly after a major stroke or may begin gradually as smaller strokes accumulate.
- It often coexists with Alzheimer’s disease, a condition known as mixed dementia.
- The frontal lobes of the brain, important for planning and judgment, are often damaged.
While Alzheimer’s disease starts in the hippocampus where memories are formed, vascular dementia is more diffuse as it depends on where vascular damage occurs. This results in variations between individuals in the presentation of the condition.
Common symptoms
The symptoms of vascular dementia relate to the functions controlled by the damaged areas of the brain. However, there are some characteristics that are typical:
1. Impaired judgment
Individuals with vascular dementia often exhibit increasingly poor judgment and dangerous behaviors, such as unsafe driving or financial decisions. Damage to the brain’s frontal lobe reduces impulse control and the ability to anticipate consequences. The person may act rashly and struggle with multitasking or complex planning.
2. Difficulty concentrating
Problems with attention span and concentration emerge. The person may frequently lose their train of thought or struggle to follow the thread of conversations, TV programs or books. Focusing and shifting between tasks becomes more challenging.
3. Slowed thinking
Processing information and thoughts takes longer. The person seems increasingly slowed down, both physically and mentally. They may speak, think and move more carefully to compensate. Like concentration, thinking speed and flexibility declines.
4. Short-term memory loss
Remembering recent events, conversations or newly learned information is significantly impacted. The person tends to ask repetitive questions and forget appointments, medication and directions they have just been given. Long-term memories from the past remain relatively intact.
5. Communication issues
Finding the right words in conversation becomes noticeably difficult. The person may pause frequently to find words or use unspecific words like “stuff” or “things”. Following long or complex sentences and abstract concepts also presents problems. retaining the thread of conversations with multiple people is particularly challenging.
6. Reduced motivation
Initiating thoughts and actions independently often decreases. The person seems increasingly passive and may need prompting to start or switch between activities. Spontaneity gives way to apathy and immobility, especially in the later stages.
7. Mood and personality changes
Depression, anxiety, agitation, emotional flatness or inappropriate behaviour may start to manifest due to the brain changes. The person’s personality may seem different with less behavioral control. Emotional volatility and obsessive tendencies are common.
8. Movement issues
Clumsiness, tremors, shuffling gait, balance impairment and limb weakness can indicate vascular dementia as key movement centers in the brain are compromised. Falling is a particular risk. The person may seem physically rigid or slow.
Daily living impact
In the early stages, symptoms like difficulty concentrating and slowed responses are subtle, so the person may still function fairly well. As their thinking processes and judgment decline, daily living activities start to become more challenging in these ways:
Work and social life
The ability to hold complex work conversations or follow organizational plans is reduced. Keeping track of schedules, tasks and details also worsens. Socially, keeping up with group conversations and engaging in small talk becomes difficult. Maintaining previous social roles and relationship closeness suffers without this ability.
Self-care and habits
Motivation to maintain hygiene, clothing and healthy habits decreases as initiating action and organization is impaired. The person may miss medication doses, meals and doctor visits without routine prompting and reminders. Previously habitual activities like bathing and getting dressed start to require step-by-step guidance.
Household activities
Cooking, cleaning, yardwork and home maintenance demand focus, sequencing and judgment skills. Safety issues like leaving water or stoves running, become common. Bills and household paperwork pile up unattended. The person has trouble remembering household rules and appropriate behavior.
Navigation and transportation
The ability to drive safely declines early, given the need for quick reactions and constant environmental scanning. Even walking alone becomes hazardous if the person gets lost or disoriented. Using public transportation requires planning abilities and dividded attention that also suffer.
Stages of progression
Like other forms of dementia, vascular dementia progresses through mild, moderate and severe stages as more brain damage occurs. The rate of decline varies greatly depending on the extent of underlying vascular disease. General hallmarks of these stages are:
Mild vascular dementia
Difficulties with complex tasks and reasoning/judgment emerge. The person may still function well in familiar environments with memory aids. Depression and behavioral symptoms manifest.
Moderate vascular dementia
Clear impairments in daily living activities like cooking, finances and household care. Memory problems worsen and confusion increases. Wandering and agitation may occur. The person needs supervision for safety and may need prompting with self-care.
Severe vascular dementia
Unable to independently perform any daily tasks or self-care. Memory deteriorates further although past memories may remain. Communication becomes limited and physical symptoms like incontinence manifest. The person now requires constant supervision and full-time care.
Diagnosis
Obtaining an accurate diagnosis of vascular dementia can be challenging since changes often evolve slowly over time. There are no definitive diagnostic tests, but a physician will assess:
- Medical history – Especially vascular risk factors like stroke, heart disease, high blood pressure, high cholesterol and diabetes.
- Neurological exam – Checks balance, limb function and reflexes which may indicate stroke.
- Cognitive tests – Assess thinking skills including memory, language and problem-solving.
- Brain imaging – CT or MRI scans detect areas damaged by limited oxygen and blood flow.
- Blood tests – To rule out other causes of dementia symptoms, like vitamin deficiencies.
These tools combined can help confirm significant vascular damage contributing to progressive cognitive decline to diagnose vascular dementia. The underlying blood vessel blockage and stroke risk factors also need to be identified and managed.
Treatment and management
While vascular dementia cannot be cured, certain treatments may help slow further progression and manage symptoms:
Medical treatments
Medications to reduce stroke risks, treat blood pressure, cholesterol and diabetes are critical to prevent more vascular damage. Drugs to improve blood flow like cholinesterase inhibitors may temporarily improve cognition, behavior and daily function.
Lifestyle changes
Adopting a ‘heart healthy’ diet and exercise program improves overall vascular health and brain function. Quitting smoking and cutting alcohol intake prevents further vessel damage. Intellectual activities and social engagement also help strengthen thinking abilities.
Brain rehabilitation
Speech therapy, occupational therapy and memory exercises aim to activate and re-establish damaged brain pathways through regular focused training. This may improve specific areas like communication, attention or movement control.
Daily assistance
Creating routines, reminders, to-do lists and other memory prompts compensates for short-term memory deficits. Adaptive aids like pill boxes, calendar clocks and location devices support independence and safety at home. Caregivers provide 24-hour supervision as abilities deteriorate.
Prognosis
The progression rate of vascular dementia depends greatly on the severity of underlying vascular disease and extent of brain damage. With aggressive treatment of vascular risks and lifestyle changes, progression may be slowed significantly, with symptoms plateauing for extended periods. However, symptoms will gradually worsen over 3-5 years as strokes recur leading to ultimate physical dependence.
Prevention
While some risk factors like age, gender and genetics cannot be changed, addressing these key areas can greatly reduce the chance of developing vascular dementia:
- Control high blood pressure
- Regulate cholesterol levels
- Treat diabetes and high blood sugar
- Quit smoking and substance abuse
- Maintain healthy diet and weight
- Exercise regularly
- Avoid excessive alcohol intake
- Manage stress
- Engage in mental activities
Making these lifestyle changes, along with proper medical management of vascular conditions, can prevent further strokes and cognitive decline even into old age.
Caring for someone with vascular dementia
Caring for a loved one with vascular dementia poses many challenges as their thinking, capabilities and personality change. Some recommendations for providing care while coping with the demands include:
Understand the condition
Learning about vascular dementia helps make sense of symptoms and creates realistic expectations. Joining a caregiver support group provides invaluable advice and encouragement.
Create a safe environment
Remove clutter/tripping hazards, install grab bars/ramps, use labels/reminders and hide car keys to prevent dangerous situations. GPS tracking devices can provide location security if wandering is an issue.
Establish routines
Set up consistent daily schedules for meals, bathing, activities, rest periods. Routines reduce confusion and anxiety while stabilizing mood and behavior. Keep environments calm and controlled.
Use memory aids
Notes, signs, calendars, checklists and electronic reminders provide memory prompts and compensate for cognitive impairment. Repeat instructions and redirect gently when forgotten.
Do things together
Engage in simple, enjoyable activities like music, exercise, crafts or reminiscing. Focus on remaining abilities not limitations. Stay patient, flexible and inject humor when possible. Avoid overwhelming stimulation.
Care for the caregiver
Make personal health, respite breaks, relaxation and socialization priorities. Get comfortable asking family/friends for practical help. Seek support services like counseling, daycare and group activities. Managing stress and emotions is essential.
Conclusion
Vascular dementia progressively impacts thinking, movement and behavior as blood flow to the brain is compromised. While the specific symptoms vary based on the location of vessel damage, common effects include impaired judgment, slowed processing, memory loss, and personality changes. Performing daily living activities becomes increasingly difficult, creating safety risks and the need for supervision, eventually full-time care. However, controlling stroke risk factors can dramatically slow decline and maintain quality of life. Knowledge, preparation and support empower caregivers to compassionately manage changes as vascular dementia follows its course.