Vascular dementia is a progressive disease that impacts a person’s thinking skills, judgment, and ability to perform daily activities. The speed at which vascular dementia progresses varies from person to person and is influenced by several factors. However, on average, symptoms tend to worsen steadily over time.
What is vascular dementia?
Vascular dementia is caused by reduced blood flow to the brain due to diseased blood vessels. It is considered the second most common cause of dementia after Alzheimer’s disease. The reduced blood flow starves brain cells of vital oxygen and nutrients, causing the cells to die off. This leads to cognitive impairment.
There are several types of vascular dementia, including:
- Multi-infarct dementia – caused by multiple mini-strokes or transient ischemic attacks (TIAs)
- Post-stroke dementia – caused by a major stroke
- Subcortical ischemic vascular dementia – caused by disease of the small blood vessels that lie deep in the brain
- Mixed dementia – vascular dementia combined with Alzheimer’s disease or other types of dementia
What are the early symptoms?
The early symptoms of vascular dementia can be very subtle. In the beginning stages, symptoms may come and go or only be noticeable under stressful conditions. Early signs can include:
- Problems with planning, judgment, and decision-making
- Difficulty concentrating and increased confusion
- Problems with memory, particularly short-term memory
- Mood changes, such as apathy, irritability, or depression
- Slowed thinking
How does vascular dementia typically progress?
The speed at which vascular dementia worsens depends on the type and location of blood vessel damage in the brain. In general, there are a few patterns of progression:
- Stepwise progression: Symptoms get suddenly worse in a stepwise fashion after each stroke or TIAs. There may be partial recovery between steps.
- Slow and steady progression: Symptoms worsen gradually over time with no distinct steps.
- Rapid progression: Symptoms get worse quickly over several months to a couple years.
On average, vascular dementia progresses steadily over 3 to 5 years. But the time course can vary considerably depending on the individual.
Mild vascular dementia
In mild vascular dementia, symptoms are noticeable but do not severely impact daily functioning. Early signs may include:
- Forgetfulness
- Limited ability to manage finances and medications
- Minor personality or mood changes
- Becoming lost or disoriented in unfamiliar places
- Difficulty finding the right words
At this stage, a person will usually still be able to function independently and continue most normal daily activities. Mild vascular dementia may last around 2 years, but timelines vary.
Moderate vascular dementia
In moderate vascular dementia, symptoms are more pronounced and begin to interfere with daily activities. Common signs include:
- Increased forgetfulness and confusion
- Worsening difficulties with communication and language
- Problems recognizing family members
- Inability to manage finances, medications, and driving
- Wandering or getting lost
- Personality changes, anxiety, agitation
- Needing more help with personal care and hygiene
At this stage, people usually require more supervision and assistance. Moderate vascular dementia typically lasts 1-2 years.
Severe vascular dementia
In severe vascular dementia, cognitive and physical function are heavily impaired. Symptoms include:
- Severe memory loss, including forgetting details about oneself
- Difficulty communicating and inability to speak
- An inability to recognize family members
- Confinement to bed or a wheelchair
- Urinary and bowel incontinence
- Loss of psychomotor skills
- Complete dependence on caregivers for daily activities and personal care
Severe vascular dementia leaves the person completely disabled. At this stage, round the clock care is usually required. Severe vascular dementia may last from 1-3 years.
What factors influence progression?
Several factors can influence the speed at which vascular dementia worsens including:
- Cause – Multi-infarct dementia often progresses in a stepwise fashion while subcortical vascular dementia advances slowly but steadily.
- Location of brain damage – Damage to specific brain regions impacts certain functions.
- Extent of blood vessel disease – Widespread brain vessel disease causes faster progression.
- Co-existing conditions – Diabetes, heart disease, high blood pressure, and high cholesterol increase progression risk.
- Lifestyle factors – Smoking, obesity, lack of exercise, and poor diet are linked to faster deterioration.
- Access to care – Proper medical treatment can slow decline.
Is progression predictable?
It is difficult to predict exactly how quickly an individual’s vascular dementia will progress. While there are general guidelines for the stages of the disease, there is significant variability from one person to the next. Progression is influenced by many factors unique to each individual.
However, while the precise rate of progression cannot be predicted, worsening over time is typical of the disease. Ongoing follow up and monitoring by a doctor is important to assess progression and provide the appropriate level of care and support.
Can progression be slowed?
There is no cure for vascular dementia and mental decline cannot be fully stopped. But certain lifestyle changes and medical treatments may help slow the rate of progression and prevent symptoms from worsening too quickly. Steps that may help include:
- Taking medications to control high blood pressure, high cholesterol, diabetes and manage heart disease – These conditions can worsen vascular dementia if left untreated.
- Quitting smoking and limiting alcohol – Smoking and heavy drinking put strain on the cardiovascular system.
- Eating a heart-healthy diet – A diet rich in fruits, vegetables, whole grains, fish, and lean meat may help protect blood vessels.
- Exercising regularly – Exercise improves blood flow and may encourage new brain cell growth.
- Controlling stress – Finding ways to manage stress and prevent anxiety may slow progression.
- Staying cognitively and socially active – Activities that keep the brain engaged may help prevent rapid deterioration.
- Taking dementia medications – Drugs for Alzheimer’s disease like donepezil (Aricept) may provide some benefit.
Is there a way to gauge progression?
Doctors can use measurement scales and mental status exams to evaluate vascular dementia progression over time. Some examples include:
- The Clinical Dementia Rating Scale (CDR) – Assesses memory, orientation, judgment, problem solving, and personal care ability on a scale of 0 to 3 (none, mild, moderate, severe).
- The Mini Mental State Exam (MMSE) – Evaluates arithmetic, memory, orientation and language on a 30-point scale.
- Montreal Cognitive Assessment (MoCA) – A 30-point test measuring visuospatial abilities, memory, attention and orientation.
Tracking scores on these tests at regular intervals allows doctors to quantify cognitive changes and determine if the dementia is advancing slowly, moderately or rapidly.
What is the life expectancy?
Life expectancy with vascular dementia depends on many factors, including age at diagnosis, location of brain damage, and presence of other medical conditions. However, on average, people live around 5 years following a diagnosis of vascular dementia.
In one study, life expectancy following diagnosis was:
- Age 65 – 7 years
- Age 75 – 5 years
- Age 85 – 3 years
Proper medical care, lifestyle changes, social support, and early treatment of symptoms can help optimize quality of life and prolong survival.
Conclusion
Vascular dementia causes a gradual decline in thinking skills and ability to function independently. But the rate of progression varies from person to person. On average, symptoms seem to worsen over 3 to 5 years. Mild stages may last 2 years, moderate stages 1-2 years, and severe stages 1-3 years. But many factors like the location of brain damage and presence of other health conditions influence individual progression. Steps like controlling high blood pressure and diabetes may help slow worsening of symptoms. Ongoing assessment by a doctor is key to gauging the speed of deterioration.