Vascular dementia: could research lead to new treatment?

Why is research into vascular dementia important?

Most people associate dementia with Alzheimer's disease, but vascular dementia is equally devastating for people living with the condition and their loved ones.

Vascular dementia is the second most common form of dementia, affecting around 180,000 people in the UK, and this number is expected to double over the next 25 years.

The most common cause of vascular dementia is small vessel disease. This is when the tiny blood vessels in the brain do not work properly, preventing the brain from getting enough oxygen and nutrients.

Small vessel disease is even more widespread than vascular dementia itself – about 10 per cent of people over 50 and 1 in 3 people over 80 are estimated to have it.

But despite how common it is, vascular dementia is generally understudied and underfunded.

How can we better understand what causes vascular dementia?

In 2023, the British Heart Foundation partnered with the UK Dementia Research Institute to create the BHF-UK DRI Centre for Vascular Dementia Research, aiming to better understand vascular dementia and improve treatments. This was an important step, showing that vascular dementia is being taken seriously.

The centre combines the expertise and funding of both organisations and helps researchers with different specialties at universities across the UK to work together.

Importantly, it brings together scientists working in the lab with clinical researchers who work with patients. This collaboration will help keep the focus on helping people who have or who are at risk of vascular dementia.

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How could research lead to new treatment for vascular dementia?

Some risk factors, such as high blood pressure, obesity, smoking and diabetes, can be treated with medications and lifestyle changes to reduce the chance of developing vascular dementia.

However, there is currently no treatment that specifically targets and treats vascular dementia itself or stops its progression.

To find this kind of treatment, we need to better understand the root causes of the condition. My work, for example, is focused on white matter, the brain regions made up of nerve fibres which transmit messages.

Dr Rikesh Rajani looking through a microscope as part of his research into vascular dementia.

We know that the changes in blood vessels, which happen in small vessel disease, damage white matter and this is linked with a decline in people’s thinking abilities. But we do not fully understand how this happens.

If we can uncover the mechanisms, this could help us find treatments to prevent white matter damage.

The ultimate goal would be to create a simple blood test to identify people at risk.

Another approach being explored is to focus on treating the changes in the blood vessels of the brain. Professor Joanna Wardlaw, who is clinical director at the centre, is running a clinical trial, called LACI-3, to see if 2 existing drugs used to treat heart and circulatory conditions can be repurposed to treat small vessel disease.

There are also studies looking into the genes that can put people at greater risk of developing small vessel disease and vascular dementia.

So, is vascular dementia hereditary?

There is a hereditary element to vascular dementia but the forms of vascular dementia which are directly inherited are rare.

Generally, if multiple family members have suffered from it, you are slightly more likely to get it. But it does not mean you will. The extent to which hereditary factors are important is still being studied.

Can vascular dementia ever be cured?

The ultimate goal would be to create a simple blood test that could identify people at risk of vascular dementia and then provide them with a treatment to stop the disease from developing.

We’re in the early stages of research working towards this. Professor Wardlaw, for example, is looking at chemical markers in the blood that might show how symptoms will develop.

Dr Rikesh Rajani using a pipette as part of his research into vascular dementia treatment.

While the blood test is a long-term goal, there are more immediate advances likely to happen which can help people at high risk of developing vascular dementia.

For example, there are researchers looking at which blood pressure medications might be the most effective for preventing or slowing the progression of vascular dementia.

While a cure may not be imminent, we are making progress in understanding the disease and finding ways to help people with vascular dementia live better lives.