Vascular dementia

Vascular dementia explained

What is vascular dementia?

Vascular dementia is when your brain is not getting enough blood. This stops some of your brain cells from working as they should, causing them to die over time.

It causes symptoms that get worse over time, like memory loss and difficulty concentrating.

Vascular dementia is the second most common type of dementia. It does not have a cure, however with treatment, sometimes it's possible to slow down symptoms.

What is mixed dementia?

Mixed dementia is when you have more than 1 type of dementia. Some people with vascular dementia have another type of dementia too, most often Alzheimer’s disease. It’s more common in older people with vascular dementia.

This does not mean you need to see a different doctor. Specialists in dementia care will be able to support you or your loved one in managing the symptoms of both vascular and mixed dementia.

Symptoms

What are the symptoms of vascular dementia?

Early signs of vascular dementia include:

• Concentration problems, such as finding it hard to focus during a conversation.
• Mood and personality changes, such as feeling irritable or low.
• Struggling to remember recent things, like remembering a conversation or instructions. 

In the later stages, you may experience symptoms such as:

• becoming more confused and disorientated
• finding it hard to concentrate
• finding it hard to remember words and communicate
• difficulty with balance or falling over more
• depression and personality changes
• in some cases, not being able to control when you pee.

The symptoms of vascular dementia can happen suddenly or gradually.

Your early symptoms will depend on which part of your brain has been affected. This means different people can experience different symptoms.

Vascular dementia can affect people of all ages, although people over 65 are more affected. If you're under 65 years old, it's known as “young onset” or “early onset” vascular dementia.

Diagnosis

How is vascular dementia diagnosed? 

Vascular dementia can be diagnosed by your doctor. If you suspect you or a loved one might have vascular dementia, it’s important to talk to your GP as soon as possible.

The GP will:

• Ask about your symptoms, when they started and how often they’ve been happening.
• Ask how these issues have been affecting your life and those around you
• Carry out physical examinations, mental ability tests and other routine tests to help them rule out other physical or mental health causes.

Consider taking a loved one to you to the appointment, not only for support, but also to help the GP get a complete picture of how things have been for you.

If you are not able to have someone with you, your GP may want to reach out to them on the phone so they can better understand your daily routine and skills. This will only happen with your consent.

If your GP suspects vascular dementia, they will refer you to a specialist or memory clinic. You may have a CT or MRI scan to check your brain.

Getting a dementia diagnosis can take some time, which may feel unsettling. Speak to your GP about support available for you and your loved ones while you're waiting for results.

Causes

What causes vascular dementia?

Some conditions can lower the amount of blood supply to your brain and increase your chance of developing vascular dementia. 

These include:

• Small vessel disease – narrowing of small blood vessels deep inside your brain. It can be caused by a build-up on fatty material in your arteries (atherosclerosis).
• A stroke – where the blood supply to part of your brain is suddenly cut off, due to a blood clot or bleed (haemorrhage).
• Mini-strokes – known as transient ischaemic attacks (TIAs). These can cause tiny but widespread damage over time due to not enough blood getting to the brain. 

Is vascular dementia linked to atrial fibrillation?

Atrial fibrillation (AF)is an irregular heart rhythm which increases your risk of having a stroke.

AF can cause a blood clot to form in one of the top chambers of your heart. This can be pumped out of your heart to your brain where it can cause a stroke.

As vascular dementia often develops after a stroke, people with AF are at higher risk of getting vascular dementia.

Do I have a family history of vascular dementia?

Some people worry they might get the same illness as someone in their family who has vascular dementia. But most of the time, this illness does not get passed down in families. This means the chance of getting it is very small.

There are a few rare kinds that can run in families. One is called CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy). This happens because of a change in a gene. People with CADASIL may start having tiny strokes when they are an adult, and this can lead to vascular dementia later in life.

Treatment

How is vascular dementia treated?

Although we’re funding research to find new treatments, there's currently no cure for vascular dementia. However, there’s lots of help and support to help you to continue to live well.

Medicine

You might be given medicine to control high blood pressure or high cholesterol. This may have contributed to your condition and controlling it can help slow down your symptoms.

If you have vascular dementia, medicines used for Alzheimer’s disease are not usually recommended. 

Vascular dementia happens when the brain does not get enough blood. Usually this is caused by shrinking of the small blood vessels inside the brain, or after a stroke. Alzheimer’s disease happens because of an abnormal build-up of proteins in and around brain cells.

Treatment for vascular dementia focuses on managing blood pressure, cholesterol, diabetes and preventing further strokes. Treatment for Alzheimer’s focuses on reducing and removing the build of up abnormal proteins and easing symptoms.

Lifestyle changes

Research has shown that improving your lifestyle can help slow down the progression of vascular dementia. There are some small changes you can make that might reduce the chance of more damage to the blood vessels in your brain:

• eat healthily
• be physically active
• keep to a healthy weight and lose weight if necessary
• stop smoking
• cut down on alcohol
• control high blood pressure
• control cholesterol levels
• control blood sugar levels (if you have diabetes). 

Support programmes

Your healthcare team may also suggest a range of social activities to improve your wellbeing and slow down the progression as much as possible.

Some examples include:

• Group cognitive stimulation therapy – taking part in group activities and discussions to help with memory, thought, reasoning and memory. It can also help you to connect with others.
• Group reminiscence therapy - sharing life experiences, memories and stories from the past to help improve your wellbeing.
• Cognitive rehabilitation or occupational therapy – getting support in carrying out everyday tasks on your own for as long as possible.

Living with vascular dementia

What will life be like after a dementia diagnosis?

Some people living with vascular dementia are well for many years. However, it's understandable if you feel overwhelmed and worried about the future.

On a practical level, there are many things you can do to support yourself, or someone diagnosed with vascular dementia.

Some examples include:

• Break hard tasks down into small steps.
• Use reminders like sticky notes or a calendar, to write down appointments, events and important conversations.
• Set up permanent reminders for regular tasks like taking medicine, remembering your keys or other daily tasks. You could use a tablet organiser (dosette box), your phone alarms or permanent signs.
• Be aware of the things that make your symptoms worse, like noisy places.
• keep to a regular routine and be sure to include activities you enjoy, like hobbies and socialising with friends and family.

Find lots of helpful tips to help support you at Alzheimer’s Society.

Vascular dementia is a condition that gets worse over time (called a progressive condition). This means you’ll need more support at some point in the future.

It’s important for you and your family to discuss any help you might need, both now and in the future. It's also important that your wishes are considered at every step along the way. 

Support

Where can I get support for vascular dementia?

While this page has covered some of the basics, here are some other sources of information and support:

• For emotional support, you may want to talk to someone outside your family or friendship circle, such as a counsellor. If you’re not sure what kind of support you need, or want to learn more about psychological therapies, visit the Mind website.
• Alzheimer's Society offers a range of services for people with dementia and their carers. Use their dementia directory to find support in your area.
• You can also visit our emotional support page for advice on topics such as depression, stress and anxiety.
• Get advice from Dementia UK, and speak to an Admiral Nurse through their free helpline. Admiral Nurses are nurses who specialise in dementia care. They will be able to give you information, advice and support with any aspect of dementia.
• Age UK have a range of services available as well as an advice line. Visit their support page.
• Speak to our cardiac nurses by phone, callback, email or online chat on our Heart Helpline (Monday to Friday, 9am to 5pm).
• Caring for someone who has vascular dementia can be challenging in many ways. For advice on what to do and what to expect, read the NHS guide on looking after someone with dementia.

How can I support someone with vascular dementia?

Whether vascular dementia is affecting you or someone you love, it’s completely normal for the diagnosis to trigger a range of difficult emotions and questions about the future. Give yourself time to let the information sink in and try to seek support from loved ones.

• Age UK has support services available for carers. Visit their website for more information.