Understanding Vascular Dementia

Vascular dementia is the second most common type of dementia, and it occurs when the flow of blood vessels and oxygen in the brain is disrupted (either reduced or blocked by a blood clot), which–depending on the particular area of the brain being affected–can cause symptoms like memory issues, behavioural changes, and cognitive function issues which affect the mental processes required for things like processing information and reasoning.A vascular dementia diagnosis does not mean a person’s usual activities will be affected, particularly if only a small area of the brain is impacted, however over time they may notice more symptoms developing and will eventually require help to carry out daily activities.Alzheimer’s Association estimates around 5-10% of those with dementia have vascular dementia as an isolated condition, but it may be more common when considering the numbers of people with mixed dementia. In the UK, the NHS estimates around 180,000 people have vascular dementia, but there are others you can read about in our article: The Different Types Of DementiaAs a brief overview, some of the most common types of dementia in the UK are:

• Alzheimer’s disease: Alzheimer’s is the most common type of dementia, which occurs when substances called ‘amyloid’ and ‘tau’ (two proteins that interfere with communication between brain cells in some types of dementia) accumulate in the brain and form plaques and tangles. This affects cognitive function, which can lead to symptoms such as memory loss, difficulties with reasoning, communication challenges, and mood changes, among other things. You can learn more about this in our article: What Is Alzheimer’s?
• Lewy body dementia (LBD): Slightly less common than vascular dementia is Lewy body dementia, which is often categorised as either dementia with Lewy bodies, or Parkinson’s disease, as people with Parkinson’s have Lewy bodies present in their brain. This type of dementia can cause symptoms like hallucinations (this happens in up to 80% of LBD cases) and sleep disturbances (common in 90% of LBD cases). 
• Frontotemporal dementia (FTD): Another noteworthy type of dementia is frontotemporal dementia, which is a term for a number of dementia conditions that are more common in people aged 40-60. This type develops when certain proteins build up in the frontal and temporal lobes, leading to changes in behaviour, personality, and communication abilities.  

The risk factors involved in vascular dementia are linked to the cardiovascular system, which is how it gets its name, so those who have a higher risk of conditions like heart disease, stroke or diabetes may also have a higher risk of developing vascular dementia. Risk factors increase for older adults, and those with high blood pressure, high cholesterol, low physical activity, conditions that cause blood to clot more easily, and a family history of dementia. Those who are overweight or who smoke may also have a higher risk. If you have any questions about your likelihood of developing the condition down the line, you should speak to your doctor to determine your level of risk. 

How does vascular dementia affect the brain, and what causes it to happen?

Research has suggested that the signs and symptoms of vascular dementia vary depending on how much of the brain is affected, where in the brain is affected, and how severe the disease is. This could happen over a long period of time, or symptoms could appear suddenly after a stroke. As mentioned, vascular dementia is closely related to cardiovascular health and stroke risk, but in both cases it can impact the brain in similar ways to other types of dementia. Vascular dementia interrupts the flow of blood vessels and oxygen in the brain, whether by reducing them or blocking them altogether. If this impacts a small area of the brain that deals with memory, then a person may experience only issues with their memory. On the other hand, if a large area of the brain is impacted by the condition, a person may develop a number of other problems with things like clear thinking, problem-solving, or other day-to-day functions.A number of factors are thought to cause vascular dementia, such as blood clots, stroke, bleeding from ruptured blood vessels or damage to blood vessels (from things like infections, high blood pressure, etc.), or a condition called cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) which affects blood vessels in the white matter of the brain. The condition may also be caused by cerebrovascular disease, which can lead to damage to cognitive networks and eventually vascular dementia.Research has identified certain abnormalities in the brain when someone has vascular dementia, including diseased small blood vessels and altered white matter, which is responsible for relaying messages to different parts of the brain.

What are the stages of vascular dementia?

You can read about managing the different stages of dementia in our article, but it can be helpful to know what to expect if you have been diagnosed with vascular dementia, or you are caring for someone who has. This can enable you to plan ahead for future care needs. Although the stages of dementia are meant only as a guide, and symptoms differ from case to case, here are the three main stages of dementia that someone might experience over several years. 1.Early stage dementia Also referred to as mild dementia, this stage is when the person first starts experiencing symptoms which can initially be difficult to notice, and may be mistaken for more general age-related lapses in memory or judgement. In this early stage, the person can usually still function as they did before, but they might notice small instances of memory loss like forgetting certain words, where things are in their home, or recent events. That said, this is less common in vascular dementia, as thinking and decision-making are often affected later. At this stage they may also notice personality changes such as irritation or anxiety due to their declining abilities, becoming easily lost in familiar places, trouble with problem solving, and trouble carrying out administrative tasks such as managing finances. This stage can last up to 2 years, so it can help to encourage the person to continue doing tasks as independently as possible if they are able, and to take part in hobbies and interests they enjoy to keep them active and engaged.  In vascular dementia, the early stages of the condition are thought to last for the longest time, and could be many months or even years. 2. Middle stage dementia In middle (or moderate) stage dementia, symptoms become more noticeable, as people will usually find it difficult to continue with their daily tasks such as getting washed and dressed each day, or cooking their meals. For this reason, more daily support is often needed in the middle stages. During this phase of the condition, a person might begin to experience confusion and memory lapses, like forgetting family members’ names, repeating themselves, and being less able to make decisions for themselves. They may display more extreme personality and behavioural changes, and say inappropriate things. In stroke-related vascular dementia, they may develop communication issues such as speech difficulties, and may have weaker limbs.In addition, it is at this stage when they may experience more long-term memory loss, hallucinations (usually not common in vascular dementia) or delusions. When it comes to their sleeping patterns, these may be disrupted as they could experience confusion and restlessness at night, or “sundowning”.The middle stages of dementia typically last the longest, which is thought to be between 2 and 4 years.  3. Late stage dementia In the later stages of dementia (sometimes known as severe dementia), a person with the condition may require full-time care in order to manage their needs, such as personal care. This can take place either in their own home, or they may be moved to a care home for specialist care. It is in this stage that the person may experience a complete loss of ability to communicate with others, or will have a severely altered way of communicating. As this progresses in vascular dementia, brain functions continue to be damaged and they may experience more confusion and mood changes. They may also have an altered perception of time, and an inability to recognise family, friends or even themselves in the mirror. In addition, they may experience mobility issues that mean they require support, as they may have a complete loss of ability to walk, hold themselves up, swallow food, or control their bladder – at this time, incontinence may become an issue, and they will be at a higher risk for infections such as pneumonia. This stage of dementia is usually the shortest in length, lasting between 1 and 2 years, and at some point a person with this condition will require end-of-life care. Research suggests the life expectancy range for this type of dementia is 3 to 5 years, but a person with vascular dementia could also be at risk of suffering from heart disease or stroke due to its close links to these conditions. Ultimately, every person’s experience with dementia is different, so the above stages may overlap or progress more quickly or slowly than expected.

How is vascular dementia diagnosed and treated?

Studies suggest it can take an average of 2.8 years to obtain a dementia diagnosis, and although there is no cure, early diagnosis can help the person and their family to plan ahead before changes start to occur. Initially, if you notice any signs of dementia (no matter how mild), it is best to speak to your GP so they can look into your risk of dementia. They will usually attempt to rule out any other treatable conditions that may be causing similar symptoms, and do certain tests to find out if dementia could be the cause. These might include things like:

• A review of your medical and family history to determine your personal dementia risk 
• Brain scans to identify signs of strokes, tumours or other brain issues
• Psychiatric evaluations to explore any behavioural or mood changes
• Genetic tests to learn more about any family history of dementia
• Cerebrospinal fluid (CSF) tests to measure the proteins and other fluids in the brain and spinal cord
• A referral to a neurologist, a geriatric psychiatrist, or a memory clinic to look closer at the brain and nervous system, and carry out any necessary tests 

Although dementia testing can be a worrying time, early diagnosis is important so that medical professionals can recommend any treatments that could slow the onset of the condition. They can also help you manage the symptoms going forward, and plan for the future care you will require. 

What are some coping strategies families should be aware of?

No matter how mild or advanced a person’s dementia may be, looking for ways to maintain quality of life is important for their mental health, physical health, and positive outlook. In the early stages of dementia, do what you can to help them maintain independence by keeping them at home for as long as possible, and sticking to their regular routines so they maintain their usual comforts. Encourage them to engage in social events and activities they enjoy, as this can help to stimulate cognition. Emotional support will be crucial at this stage as they work through their feelings about their diagnosis. Validate how they feel with compassion and empathy so they know they have someone to talk to. Help with tasks they are struggling with, such as shopping for groceries or walking their dog. Start taking steps to help with memory issues, such as labelling what things are, using a dosette box to remember medications, or working with a calendar to remember important dates. In the middle stages of dementia, simplify as many tasks as possible and streamline their environment to minimise confusion. You should also make any home adaptations to improve safety, and set reminders so you know they are drinking and eating enough throughout the day. Depending on the severity of their symptoms, you could start to explore their need for home care, such as having someone take over their personal care needs to make sure they get washed and dressed every day.In the later stages of dementia, you will likely need to start coordinating medical professionals visiting the home, as they can help you cope with more difficult symptoms. At this stage, home care will almost certainly be required if your loved one does not want to move into a nursing home. You may find more useful advice in our guide to caring for someone with dementia at home.

When should someone with vascular dementia seek specialist care?

It may be difficult to know when to make the switch from caring for a loved one with dementia yourself, to bringing in one or more home care professionals who can manage sensitive needs like personal care, provide full-time specialist care, stay overnight with the person to ensure their safety, or simply help support you with things like light housework or providing respite care. At Home Instead, our Care Professionals can offer a high standard of specialist, person-centred, dementia-focused care through our unique training programme created by ageing experts, dementia specialists and key medical practitioners from across the world. This training is assured by City & Guilds, so you can always feel comfortable that your loved one is in the right hands.  You may find more helpful information in our guide to how to choose and arrange home care services, or learn more about our award-winning dementia care at home.We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.