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Vascular dementia (also known as Vascular Cognitive Impairment) refers to a group of conditions in which IMPAIRED blood supply to the brain causes neuronal DYSfunction, leading to loss of memory and other cognitive abilities. It is the second most common type of dementia, after Alzheimer’s – a neurodegenerative disease.
Vascular dementia may develop following a stroke, or a series of mini-strokes. A stroke can be ischemic or hemorrhagic. An ischemic stroke happens when a blood clot BLOCKS an artery, interrupting blood flow. Blood clots may form locally, on top of cholesterol plaques as these rupture; or, travel to the brain from the heart, in a condition known as atrial fibrillation, where the heart does not pump properly, blood stagnates and coagulates. Hemorrhagic stroke, on the other hand, occurs when an artery leaks or ruptures. This can result from high blood pressures, overuse of blood-thinners/anticoagulant drugs, or abnormal formations of blood vessels such as aneurysms. As a hemorrhage takes place, brain tissues located BEYOND the site of bleeding are deprived of blood supply. Bleeding also induces contraction of blood vessels, narrowing them and thus further limiting blood flow.
Dementia symptoms may appear SUDDENLY following a SINGLE LARGE stroke, or develop in a STEPWISE fashion as a result of multiple, sometimes unnoticeable, small strokes. Symptoms VARY from person to person depending on the part of the brain that is affected, and may include: problems with memory or thinking skills, confusion, mood changes, speech disorders, impaired balance and movement. The way the symptoms appear can be used to differentiate stroke-related dementia from Alzheimer’s disease, which usually develops GRADUALLY, with specific symptoms appearing in a largely typical order.
But vascular dementia may also progress silently in a CONTINUOUS manner, as a result of age-related vascular wear-and-tear, or any conditions that DAMAGE or NARROW blood vessels over time, such as high blood pressure, high cholesterol, diabetes and amyloid deposit. These factors often affect SMALLER blood vessels deep inside the white matter of the brain, causing small blockages and microbleeds that often go unnoticed to the patients. This is known as “cerebral small vessel disease” and is the most common cause of vascular dementia in older adults.
Another cause of vascular dementia is HYPOperfusion of the entire brain. This may result from heart failures, hypotension, or carotid artery occlusion.
There is no cure for vascular dementia but prevention by controlling vascular risk factors, such as high blood pressures, can be effective. Life style changes such as healthy diets, quitting smoking, and physical exercise have been proven to be beneficial. Treatment is by managing the underlying conditions.
