4 September 2018, by Siobhan Chan
What are the biggest questions around the prevention, treatment and management of vascular dementia that we’ve yet to answer?
The BHF funds £100 million of research into heart and circulatory conditions and their risk factors every year, and vascular dementia is one of the conditions in which we’re hoping to improve care.
Vascular dementia is estimated to affect 150,000 people in the UK. There's currently no cure, but treatment can sometimes slow down its progression.
It is caused by a lack of blood supply to the brain which causes the surrounding cells to die. The causes of a reduced blood supply to your brain include small vessel disease (narrowing of small blood vessels deep inside the brain); a stroke; or transient ischaemic attacks (TIAs), also known as mini strokes that can cause tiny but widespread damage over time.
Here are six questions about vascular dementia that we’re trying hard to answer, so we can one day beat the heartbreak it causes.
1. Who’s at risk of developing vascular dementia after a stroke?
Researchers at the University of Edinburgh want to help improve how healthcare professionals detect cognitive problems after a stroke and find the best ways to care for people at risk of developing vascular dementia.
The team, led by Professor Joanna Wardlaw, is studying people who have had a stroke to see whether they are having issues with thinking and memory.
They’re also collecting scans and blood samples that will help to identify markers for vascular dementia. The results will help them work out what causes the condition and how to predict those at risk of developing it.
2. Does having heart and circulatory disease put you at higher risk of dementia?
Professor Alun Hughes from University College London is studying a group of 375 people born in a single week in 1946, whose heart health has been tracked throughout their lives. His team plans to assess this cohort’s heart and circulatory health in detail, including the blood flow in their brain, and combine this with results of a brain assessment.
This will help to identify how heart and circulatory disease during a person’s life influences cognitive decline and dementia, and it could highlight new targets for treatment.
3. How can people with an abnormal heart rhythm reduce their risk of vascular dementia and stroke?
Dr James Fisher from the University of Birmingham has found that the ability of blood vessels in the arm to widen, for example when blood flow is increased, is impaired in people with AF. He’s now trying to find out whether blood vessels in the brain are similarly affected, which would explain why stroke, cognitive decline and dementia are more common in AF patients.
Dr Fisher’s team will also examine if blood vessels in the brain are healthier as a result of doing regular physical activity. This research will reveal if the brain’s blood vessels are damaged in AF and help doctors detect those most at risk. It will reveal if physical exercise could help protect people with AF.
4. Is there a genetic link to a condition that causes strokes and vascular dementia?
Cerebral small vessel disease (SVD) is a group of conditions that affects the small vessels of the brain. It causes a quarter of all strokes and puts people at risk of developing vascular dementia.
Professor Hugh Markus at the University of Cambridge and his team are working with scientists from around the world to study 5,000 patients with SVD.
They’re searching for new genes that may cause the condition, and working out if any particular gene changes are more common in people who have had a stroke compared with those who have not. This could help identify genetic risk factors for a stroke. They’ll also study MRI scans from these people to see exactly how SVD affects the brain.
5. How can we treat a type of stroke that causes dementia?
A lacunar stroke is caused by damage to the small blood vessels in the brain, and can lead to difficulty with thinking, memory, walking and ultimately dementia. There’s currently no known treatment.
Professor Joanna Wardlaw from the University of Edinburgh is leading a clinical trial to help find treatments for people who have this type of stroke. She and her team are looking at two existing drugs to see if they can reduce the damage to arteries in the brain. These drugs are cilostazol, used to treat peripheral arterial disease, and isosorbide mononitrate, used to treat angina.
In the trial, around 200 patients will be treated with either cilostazol, isosorbide mononitrate or both. If successful, this research could lead to a larger trial of these drugs to treat lacunar strokes and potentially prevent some cases of dementia.
6. Does vascular dementia happen because of a problem with the brain’s waste elimination system?
The brain eliminates waste materials along extremely thin lymphatic drainage pathways embedded in the walls of narrow blood vessels.
Dr Roxana Carare from the University of Southampton believes vascular dementia happens because the brain cannot get rid of waste and fluid properly, as these pathways aren’t correctly anchored to the blood vessel wall.
In this project, Dr Carare will study how this ‘anchoring’ affects water transport and the brain by comparing the brains of mice that have disrupted anchoring with human brains that have vascular dementia.
This research could lead to targeted treatments for vascular dementia that work by draining waste fluid from the brain.
For information and support for your vascular dementia patients, visit our patient information section.