Vascular dementia

Vascular dementia is the second most common form of dementia in the UK, after Alzheimer’s disease. It affects about 150,000 people in the UK alone.

It can be related to a series of small strokes, or one larger stroke. In some cases people may be affected by both vascular dementia and Alzheimer’s. It’s very rare for anyone under 65 to have vascular dementia.

A stroke can cause damage by reducing the amount of blood reaching the brain. This happens when a blood clot blocks a narrowed blood vessel taking blood to your brain. If your brain doesn’t receive a steady supply of blood, and the vital oxygen and nutrients it contains, brain cells can die. When this happens your mental and physical abilities can be affected.

The amount of damage a stroke causes depends on where in your brain the blood clot happens, and how long the blood supply is cut off for. (You can also have a stroke if a blood vessel bursts open and blood leaks into your brain, but this doesn’t happen as often as having a blood clot).

Related: Stroke risk, prevention and symptoms

Symptoms of vascular dementia

These can vary, depending on the area of your brain that has been affected. They can include:

• difficulty concentrating and finding the words you want to say
• slowing down of your thought processes
• memory loss
• personality changes
• mood swings and depression

In some cases, people who have vascular dementia have Alzheimer’s symptoms as well.

Types of vascular dementia

There are a number of different types of vascular dementia.

Stroke-related dementia is when a blood clot blocks a blood vessel in the brain and stops the blood getting through. This can damage that part of your brain, and can for instance, affect your memory and your ability to think. When this is severe enough to affect your day-to-day life, it is diagnosed as vascular dementia.

Having a stroke doesn’t mean that you will definitely have vascular dementia. However, according to the Alzheimer’s Society, around 20 per cent of those who do have a stroke go on to develop vascular dementia within the next six months. This is known as post-stroke dementia.

Having one stroke puts you at greater risk of having more strokes. This in turn can put you at greater risk of having dementia.

If you think you may have had a transient ischaemic attack (TIA), or “mini-stroke” – where the symptoms are the same as for a stroke, but don’t last for long  – it’s important to see a doctor. This is vital, even if the symptoms have gone away, as having a TIA can be a sign that you’re likely to have a more serious stroke soon.

Related: Could it be a mini-stroke?

Single-infarct and multi-infarct dementia are both types of vascular dementia caused by one, (single-infarct) or a number (multi-infarct) of small strokes. Infarct is the term used for the small areas of dead tissue left by the stroke(s).

A single infarct that happens in a particularly important part of the brain, can cause dementia. However it’s more common to have multi-infarct dementia. This is caused by a number of small strokes, happening in different parts of the brain, sometimes months apart, causing multiple infarcts.

Subcortical vascular dementia

This type of dementia happens when very small blood vessels deep in the brain are affected by diseases (known as small vessel disease). The walls of the blood vessels become thick, and the vessels become stiff and twisted, reducing the blood flow.

This condition also affects the nerve fibres (known as white matter) that carry signals to different parts of the brain.

Because subcortical dementia happens deep in the brain the symptoms tend to be different to those caused by stroke. These include:

• being unsteady on your feet
• clumsiness, and falling often
• urinary symptoms that aren’t related to a urinary infection or disease.

Mixed dementia

Mixed dementia, where you have both vascular dementia and Alzheimer’s disease, affects at least 10 percent of people with dementia. The symptoms you have can be like Alzheimer’s, or like vascular dementia. However, they may include elements of both conditions.

Treatment for vascular dementia

If you think that you may have vascular dementia – or that someone close to you has - don’t wait, see your GP. If you’re diagnosed with vascular dementia when it’s still in the early stages, treatment and behavioural and lifestyle changes may be able to stop or slow down the disease.

Unfortunately at the moment there’s no cure for vascular dementia, and there’s no way to repair brain damage that has already happened.

However, once you’ve been diagnosed, there may be treatment and lifestyle changes that can help slow down the rate at which the disease develops.

Your treatment will focus on treating the cause of the dementia, and reducing the risk of further strokes. Strokes can be caused by high blood pressure, high cholesterol levels, and diabetes, all of which can be treated with medication.

Treating these conditions may actually help to slow down the speed at which your vascular dementia is progressing. So your doctor is likely to prescribe statins if you have high cholesterol, beta blockers if you have high blood pressure, and warfarin, or other anticoagulants to help guard against blood clots that could cause another stroke.

Other important elements in your treatment include lifestyle changes.

Try to keep to a healthy diet that contains plenty of:

• fruit and vegetables,
• carbohydrates - bread, rice, pasta and potatoes
• high protein foods – fish, meat and lentils
• small amounts of sugar, salt and fat

Eating a healthy diet, eating less saturated fat, sugar and salt and keeping an eye on your calorie intake, can help you lose weight.

Recent figures show how overweight we are as a nation. 67% of men and 57% of women are overweight or obese, and this dramatically increases our risk of developing heart disease, diabetes, various cancers, and having a stroke.

Having at least five different fruits and vegetables a day provides you with important vitamins and minerals and may reduce your risk of heart problems and further strokes.

Eating more healthily can also help you lose weight, if you’re overweight. This will improve your health and make you feel better.

Related: Learn more about eating healthily and losing weight

Exercise is another important factor in keeping you healthy, and helping to slow down the progress of vascular dementia. If you haven’t exercised for some time, and are at all unsteady on your feet, take it very slowly to begin with. It’s a good idea to check with your GP before embarking on any new exercise regime.

Always begin gently, with something that lets you take a rest when you need to. Walking is a good way to start, as is swimming. You can build up steadily from a slow start, to avoid hurting yourself and being put off the idea of exercise.

Another healthy lifestyle change you can make is reducing the amount of alcohol you drink. The latest government guidelines (published 8 January, 2016)  state that it is safest for your health (both men and women) if you don’t regularly drink more than 14 units a week. 14 units equals one and a half bottles of wine, or five pints of export-type lager.

Related: Find out more about the Government’s new alcohol guidelines

A good way to cut down how much you drink is to keep several days a week alcohol-free. Older people and people with health problems are among those most likely to be affected by alcohol.

And if you smoke, try to quit. If you can give up smoking it means that you’re likely to live longer, feel less stressed, have better lung capacity, and more energy.

If you can change your habits and live a healthier life, it may help reduce your risk of having more damage to your brain.