Definition

Vascular dementia is a type of dementia caused by problems with blood flow to the brain. The brain needs a continuous supply of oxygen, which is delivered through smooth blood flow, to function properly. One of the brain's functions is to serve as the centre for memory and decision-making. Therefore, if there is a blockage in the blood flow, it can affect cognitive functions. Vascular dementia can develop after a stroke, but not all stroke cases lead to vascular dementia.

Dementia generally occurs in individuals over the age of 65, and once it sets in, it cannot be completely cured. However, many measures can be taken to prevent and slow down the progression of the condition. Vascular dementia is the second most common type of dementia after Alzheimer's dementia.

The categories of vascular dementia include:

• Mixed dementia: This type occurs when vascular dementia appears alongside Alzheimer's disease.
• Multi-infarct dementia: This type occurs after small, repeated, and often undetected blockages appear in the blood flow to certain parts of the brain. This type of dementia can also be referred to as vascular cognitive impairment.

Causes

Vascular dementia can arise from several conditions that affect blood flow in the brain's blood vessels, resulting in a reduced supply of nutrient- and oxygen-rich blood necessary for optimal brain function.

The following conditions can cause vascular dementia:

• Stroke: Ischemic stroke, in particular, can cause vascular dementia.

• Brain hemorrhage: Brain hemorrhage can result from high blood pressure, causing blood vessels to rupture and leading to bleeding in the brain.

• Chronic narrowed or damaged blood vessels: Conditions that narrow or cause long-term damage to the brain's blood vessels can lead to vascular dementia. These conditions are often associated with aging, hypertension, and diabetes.

Risk factor

The risk factors that increase the likelihood of vascular dementia include:

• Age:  The risk of vascular dementia increases with age, rarely occurring in those under 65.

• History of heart attack, stroke, and transient ischemic attack (TIA):  Previous incidents of heart attack, stroke, and TIA can affect the blood vessels in the brain.

• Atherosclerosis: This condition occurs when fatty plaques build up in the blood vessels, narrowing them. Atherosclerosis increases the risk of vascular dementia by narrowing the brain's blood vessels.

• High cholesterol: Elevated levels of cholesterol or saturated fats, commonly known as LDL, are associated with an increased risk of vascular dementia.

• High blood pressure: High blood pressure makes blood vessels more prone to rupture, leading to brain hemorrhage and vascular dementia.

• Diabetes: Diabetes accelerates the aging process of blood vessels throughout the body, including the brain.

• Smoking: Smoking can cause atherosclerosis, indirectly increasing the risk of vascular dementia.

• Obesity: Fat accumulation in obese individuals is associated with increased body fat, including in blood vessels, which can lead to atherosclerosis and higher vascular dementia risk.

• Atrial fibrillation: This condition causes irregular heart rhythms, increasing the risk of blood clots that can travel from the heart to the brain's blood vessels. If untreated, these clots can cause blockages in the brain's blood vessels, leading to vascular dementia.

Symptoms

The symptoms of vascular dementia include:

• Confusion
• Difficulty concentrating
• Trouble planning tasks
• Inability to analyze, develop plans, and communicate them to others
• Limited thinking abilities
• Difficulty making decisions
• Memory problems
• Restlessness
• Sleep disturbances
• Unstable walking
• Difficulty controlling urination
• Depression and apathy towards the surroundings

Diagnosis

Doctors will conduct patient interviews, physical examinations, and supplementary tests. After the physical examination, a neurological assessment will be performed, including balance tests, motor function tests, and sensory function tests. Additionally, cognitive abilities will be assessed using a questionnaire called the Mini Mental State Examination (MMSE).

Doctors will instruct patients to perform daily activities such as raising their hands, repeating words, counting, and writing. The patient's cognitive abilities will be evaluated, and the results will determine whether the patient has dementia.

Supplementary tests that doctors may conduct include blood laboratory tests to identify other diseases affecting the patient's condition, as well as CT scans or MRIs to examine the brain and blood vessels.

Management

The management of vascular dementia focuses on reducing the severity of future cognitive decline, with treatment depending on the underlying conditions causing the dementia. Management strategies include:

• Medications to lower high blood pressure, reduce cholesterol levels, prevent blood clots, and control blood sugar levels.
• Lifestyle changes such as increasing physical activity, consuming a balanced diet, avoiding tobacco smoke (both active and passive), and avoiding alcohol consumption.
• Weight loss programs for those who are obese.
• Procedures to improve brain blood flow.

Complications

Possible complications of vascular dementia include:

• Stroke
• Heart disease
• Loss of social and interaction abilities
• Increased risk of infections such as lung infections, urinary tract infections, and skin infections

Prevention

Preventing dementia can be achieved through a healthy lifestyle. A recommended healthy lifestyle includes regular physical activity from a young age, with moderate-intensity physical activity for 150 minutes per week and high-intensity physical activity for 75 minutes per week. Additionally, maintaining a balanced diet, increasing protein intake, and reducing excessive sugar and salt intake can prevent obesity.

Adequate water intake, avoiding smoking, and alcohol are also essential. If you have conditions like high blood pressure, high cholesterol, and diabetes, it is crucial to control your blood pressure, cholesterol, and blood sugar levels. Engaging in social activities and communities to increase interaction with the surroundings is also beneficial.

When to see a doctor?

See a doctor immediately if you experience a decline in consciousness, confusion, or inability to perform daily activities. You can seek treatment at an emergency department or consult a neurologist.

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