Signs, symptoms and causes of vascular dementia – and how to prevent it

According to research, vascular dementia is slightly more common in men than women

Alzheimer’s disease is not the only cruel condition to adversely affect brain function and rob sufferers of their faculties and quality of life. Vascular dementia is the second most common form of dementia, affecting around 180,000 people in the UK. Like Alzheimer’s, it is progressive and significantly shortens life expectancy, yet far less is heard about it. So, what is vascular dementia? What causes it? And can anything be done to slow progression or better still, prevent it? We asked leading experts to share their knowledge and unravel the truth around this far less familiar yet equally devastating disease.

Jump to:

What is vascular dementia?

What causes vascular dementia?

Who is affected by vascular dementia

Vascular dementia symptoms

What is the first sign of vascular dementia?

When should you see a doctor?

What are the stages of vascular dementia?

Can you prevent vascular dementia?

How is vascular dementia diagnosed and tested for?

Is there any treatment for vascular dementia?

Does vascular dementia affect life expectancy?

Is vascular dementia hereditary?

The future regarding vascular dementia

What is vascular dementia?

The British Medical Journal defines vascular dementia as “a chronic progressive disease of the brain bringing about cognitive impairment”. To be clear, “dementia” is an umbrella term, describing a set of symptoms including difficulties with memory, thinking, problem-solving, judgement or language. With vascular dementia, these symptoms occur when the supply of blood to the brain is compromised, thus damaging or killing brain cells by depriving them of the oxygen and nutrients they need to function.

Back to menu

What causes vascular dementia?

“Vascular damage to the brain leads to vascular dementia and that damage can happen in a number of ways,” says Clive Ballard, professor of age-related diseases at the University of Exeter Faculty of Health and Life Sciences. “The blood vessels can become blocked by a clot, narrow over time, leak or burst.”  Prof Ballard has authored over 600 papers on dementia and has led more dementia and cognitive health trials than anyone else in Europe over the last decade.

He explains that there are four distinct types of vascular dementia which may develop depending on how and where in the brain damage occurs:

• Single-infarct dementia (or stroke-related dementia).

“Firstly, you can have a blockage in one of the blood vessels, leading to a single big stroke (or stroke-related dementia).

• Multi-infarct dementia

If the damage occurs due to multiple smaller strokes or TIAs (transient ischaemic attacks).

• Subcortical vascular dementia

“This is the result of the small blood vessels in the white matter of the brain underneath the cortex narrowing, so that blood cannot travel easily through them.”

• Mixed dementia

According to Prof Ballard, it’s also increasingly common to be diagnosed with this combination of neurodegenerative diseases. “Over the age of 85 it’s very unusual to find a single cause of dementia. You usually get a mixture of Alzheimer’s and vascular dementia. Both contribute to the challenge and in terms of treatment approach, it’s a matter of which seems to be the predominant problem,” he says.

But what causes our blood vessels to narrow, or clots to form, blocking them and impeding blood flow in the first place?

“There are many factors which raise the risk of this happening,” says Prof Ballard. These include:

• High blood pressure
• High cholesterol
• Diabetes
• Smoking
• Obesity
• Physical inactivity

“The risk factors for vascular dementia are actually similar to those for heart disease. The phrase we use is: ‘What’s good for the heart is good for the brain!’ – or conversely, ‘What’s bad for the heart is bad for the brain.’”

Management of these risk factors is key and research shows that keeping an eye on our blood pressure is particularly important. A recent study by scientists at the Geoffrey Jefferson Brain Research Centre at the University of Manchester, funded by the British Heart Foundation and published in the journal Proceedings of the National Academy of Sciences, uncovered how consistently high blood pressure causes arteries in the brain to remain constricted, restricting blood flow, resulting in vascular dementia. Prof Adam Greenstein, leading researcher on the study said, “Allowing blood to return as normal to damaged areas of the brain will be crucial to stopping this devastating disease in its tracks.”

Back to menu

Who is affected by vascular dementia

According to Dementia UK, the specialist dementia nurse charity offering support and advice to anyone affected by dementia, vascular dementia is slightly more common in men than women. Also people from South Asian and African-Caribbean backgrounds are at a slightly increased risk, but the truth is anyone can develop the disease, particularly if they ignore the health factors previously outlined.

“You are at risk if you are over the age of 65 and the risk increases as we age,” says Paul Edwards, a nurse who specialises in dementia care across the NHS and director of clinical services for Dementia UK. “Vascular dementia doesn’t have quite as strong a relationship to age as Alzheimer’s,” adds Prof Ballard, “but it’s still going to be most common in people over 80. However, if you have high levels of the vascular risk factors it can happen early – before the age of 65 – which is why it’s so vital we pay attention to our blood pressure, cholesterol levels, weight and lifestyle choices.”

Back to menu

Vascular dementia symptoms

“These will vary from person to person, depending upon which area of the brain is affected, as different areas of the brain control different abilities and function,” Edwards says. Common symptoms experienced by those living with vascular dementia include:

• Difficulties with planning
• Reduced concentration
• Slowed thought process
• Struggling with complex tasks
• As the disease progresses, a person may also experience changes in personality and mood

Back to menu

What is the first sign of vascular dementia?

“First signs can be subtle,” says Prof Ballard, “especially with dementia that hasn’t been caused by a stroke, as you probably won’t have limb weakness or issues with speech for example.” In the very early stages, you might have a sense that something’s not right but struggle to pinpoint exactly what.

“Often with vascular dementia memory is not as severely affected as it is in those with Alzheimer’s disease,’ says Prof Ballard, “but red flags include slow thinking, issues with planning skills, struggling to follow step by step instructions – such as a recipe.”

Another thing to notice is general attitude. “Someone affected by subcortical vascular dementia will seem to lose the will to do the things they used to.  It’s not so much that the person isn’t physically capable of doing a certain thing – they just haven’t got the energy or volition to do it,” says Prof Ballard.

Back to menu

When should you see a doctor?

If you or a loved one is experiencing any of the symptoms above, or you are concerned about your (or their) cognitive health, particularly if over 65, you should make an appointment. Keep a symptom diary and take someone with you to see the GP.

When it comes to the right time to consult a professional, the consensus is that the earlier you can be seen the better. “If someone is showing signs of dementia, it is important to get an accurate diagnosis so that adequate advice, support, and services can be put in place for them,” says Edwards. “The earlier the better because there are things you can monitor and lifestyle changes you can make to slow down the progression,” agrees Prof Ballard.

Back to menu

What are the stages of vascular dementia?

As a progressive disease, vascular dementia does have stages of decline.  Early stage, meaning mild cognitive decline, middle stage, with moderate decline and later stage, meaning severe decline.

In the early stages the individual might experience slowed thinking, have difficulty following instructions or making plans. In the mid-stages speech may become less fluent, the person may begin to struggle with daily tasks and forget self-care routines.

In later stage vascular dementia, characterised by moderately to severe cognitive decline, the individual will need an increasing amount of assistance in everything from dressing to eating and drinking. They will need constant supervision and may need full-time care. However, both experts are keen to state the unpredictable nature of the disease and the need to avoid generalising.

“Vascular dementia is often described as having a ‘stepped’ progression, meaning that symptoms can fluctuate, then stabilise for a time and then worsen rapidly, particularly if further underlying physical health issues have occurred,” says Edwards. “This makes it difficult to attribute symptoms to stages of the disease. It is advisable to monitor the person’s condition and if there are any rapid changes in symptoms, visit the GP.”

Back to menu

Can you prevent vascular dementia?

There is increasing evidence to suggest that managing risk factors such as blood pressure, cholesterol and weight can make a big difference. While management of these risk factors might not prevent vascular dementia, it will lessen your chance of developing the disease. Edwards points to a hopeful study: Dementia prevention, intervention, and care: 2020 report of the Lancet Commission analysed the 12 modifiable risk factors of dementia, including: hypertension, smoking, obesity, depression, physical inactivity, diabetes, low social contact and excessive alcohol consumption. Findings showed that modifying those risk factors might prevent or delay up to 40 per cent of dementias and advised that the medical community should be “ambitious about prevention”. The study stated that prevention is a two-prong approach about policy and individuals. “Contributions to the risk and mitigation of dementia should begin early and continue throughout life, so it is never too early or too late,” says Edwards.

Prof Ballard agrees. “Proactive screening of risk factors among a younger portion of the population would make a massive difference,” he says.

Back to menu

How is vascular dementia diagnosed and tested for?

Once you’ve taken the step to see a doctor, getting a correct diagnosis for vascular dementia can be tricky.  GPs have to rule out other conditions such as vitamin deficiencies, depression or anaemia first, and they are also hampered by short appointment times which make it difficult to get the complete picture about a patient’s health. People under 65 often find it particularly difficult as GPs tend to look for common conditions based on age, so younger patients can find early on-set dementia ruled out in favour of other diagnoses such as stress, anxiety or depression.

Perseverance is key. There is no one test for dementia. Your GP will usually take a history, will try to rule out other possible causes and you may then be offered a mental agility test. With vascular dementia this could show up as a slower speed of thought and difficulty thinking things through, which are more common than memory loss.

If vascular dementia is suspected, you should be referred to a specialist for further neurological testing and a CT or MRI brain scan.

Back to menu

Is there any treatment for vascular dementia?

The answer here can seem bleak. Drugs for Alzheimer’s are less effective for vascular dementia. “There are no specific treatments for vascular dementia at present,” says Prof Ballard, “although medication may be given for associated depression or underlying conditions such as high blood pressure, high cholesterol, heart problems or diabetes.” Addressing these risk factors, says Prof Ballard, is vital, because the management of these will substantially reduce progression. There are a lot of studies which prove this – particularly those led by Florence Pasquier at the University of Lille.

Back to menu

Does vascular dementia affect life expectancy?

Evidence suggests that people with vascular dementia live for around five years after their symptoms begin. However, both experts agree that various factors can influence this. “As with so many other conditions, it is not always possible to provide a definitive on life expectancy,” says Edwards.

Back to menu

Is vascular dementia hereditary?

Unlike with Alzheimer’s which can be caused by the inheritance of a single gene, there is no single gene which causes vascular dementia: “There is an inherited condition called CADASIL that causes strokes in young people, leading to dementia,” says Prof Ballard. “But that’s very rare – only a handful of families in the UK are affected. For most people with dementia the answer is no, it’s not directly hereditary.”

However, although there are no direct genes that cause dementia, many of the risk factors for vascular dementia are hereditary. “There are genes that cause risk for high blood pressure, genes that cause risk for high cholesterol, genes that cause increased risk for diabetes,“ warns Prof Ballard. “There is not a single dementia gene but there are genetic factors which contribute to the risk of developing vascular dementia.” Those with a family history of high blood pressure, high cholesterol and diabetes should therefore pay even more attention to these risk factors with regular health checks and careful lifestyle choices.

Back to menu

The future regarding vascular dementia

With no current treatment for vascular dementia it is easy to feel anxious about any possible diagnosis. However, it is a form of disease where taking responsibility for and proactively managing risk factors, can make a huge difference to outlook.

There are also glimmers of hope for the future as after years as a sidekick to Alzheimer’s, research focus is gradually shifting towards vascular dementia.

The UK Dementia Research Institute (UKDRI), for example, has vascular dementia as one of its seven research themes, and is focusing on understanding the mechanisms behind vascular and blood-brain barrier dysfunction during ageing and disease.

“At Exeter, one of the things we’ve been looking at is the effect of beetroot juice extract on the vascular system,’ says Prof Ballard. “It helps improve oxygen extraction from blood vessels, helping the system get more oxygen out of the blood into the organs. There’s emerging evidence it could be helpful in people with vascular disease. It’s still very much an embryonic research area, but it’s looking promising.”

The Manchester University study is also giving hope, as by revealing the way in which high blood pressure disrupts messaging within artery cells in the brain, causing them to constrict and limiting blood flow to the brain, there is hope that drugs will be identified to restore this communication, improve blood supply to affected areas and slow the progression of vascular dementia.

For more information about vascular dementia: https://www.dementiauk.org/information-and-support/types-of-dementia/vascular-dementia/

Back to menu

Recommended

The daily habits that boost brain health and help prevent dementia

Read more

Play The Telegraph’s brilliant range of Puzzles – and feel brighter every day. Train your brain and boost your mood with PlusWord, the Mini Crossword, the fearsome Killer Sudoku and even the classic Cryptic Crossword.