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Vascular dementia

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Vascular dementia



Introduction

Vascular dementia is a common form of dementia that's estimated to affect more than 135,000 people in the UK.

The term dementia describes a loss of mental ability associated with gradual death of brain cells. It's rare in anyone younger than 65.

Signs and symptoms

Many cases of vascular dementia start with early warning signs, including slight:



slowness of thought



difficulty with planning



trouble with language



problems with attention and concentration



mood or behavioural changes



See your GP if you notice these signs. If it's spotted at an early stage, lifestyle changes and treatment may be able to stop the vascular dementia getting worse, or at least slow its progression.

Left untreated, your symptoms may continue to get worse.

 

What causes vascular dementia?

Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills the brain cells. 

This can develop as a result of:



narrowing and blockage of the small blood vessels deep inside the brain (known as small vessel disease)



a single large stroke (where the blood supply to part of the brain is suddenly cut off)



lots of mini-strokes that cause tiny, but widespread, damage to the brain



In many cases, these problems are linked to underlying health conditions – such as high blood pressure and d iabetes – as well as lifestyle factors, such as smoking and being overweight.

This may mean tackling these things might reduce your risk of vascular dementia in later life, as well as other serious problems such as strokes, although it's not yet clear exactly how much your risk of dementia can be reduced

See your GP if you think you may have early symptoms of dementia. If you're worried about someone else, encourage them to make an appointment and maybe suggest you go along with them.

Your GP can do some simple checks to see if there is a chance you could have dementia, and they can refer you to a specialist if necessary.

The specialist will carry out a physical check-up and an assessment of your mental abilities. You may also have blood tests and brain scans.

The results of these checks and tests will give your doctor a good idea as to whether your symptoms are caused by vascular dementia, another type of dementia, or something else entirely..

How vascular dementia is managed

There is no specific treatment for vascular dementia and no way to reverse the damage to the brain that has already occurred. However, treatment may help slow down the progression of the condition.

Medicines and lifestyle changes will be recommended to tackle the underlying cause, such as high blood pressure.

This includes:



eating healthily



losing weight, if you are overweight



stopping smoking, if you smoke



getting fit



cutting down on alcohol



Support such as physiotherapy, occupational therapy and speech and language therapy can help people regain lost functions, and dementia activities such as memory cafés and some psychological therapies can help manage symptoms.

 

Outlook

The symptoms of vascular dementia will usually get steadily worse over time. This often happens in sudden steps, with relatively stable periods in between, although it's difficult to predict when these steps will happen.

Although treatment can help, vascular dementia can significantly shorten life expectancy. The average survival time from diagnosis is around four years.

Most people will die either from complications of dementia, such aspneumonia, or from a subsequent stroke.

If you or a loved one has been diagnosed with dementia, you are not alone. social services and voluntary organisations will be able to provide advice and support to help you and your family.

More information

Living with dementia

Find dementia activities near you

Living well with dementia

Staying independent with dementia

Dementia activities

Looking after someone with dementia

Dementia and your relationships

Communicating with people with dementia

Coping with dementia behaviour changes

Care and support

Sources of help and support

Talk it through with a dementia nurse

Organising care at home

Dementia and care homes

 

Dementia and your money

Managing legal affairs for someone with dementia

End of life planning

How you can help

Become a Dementia Friend

Share your dementia experiences

Symptoms of vascular dementia and its early warning signs 

Early warning signs of vascular dementia can be hard to spot, but if they are identified early, treatment may help slow or halt the progression of the condition.

 

Early signs

Possible early signs of vascular dementia can include slight:



slowness of thought



difficulty with planning



trouble with language



problems with attention and concentration



mood or behavioural changes



This early stage is known as vascular cognitive impairment, and it may be barely noticeable or mistaken for something else, such asdepression.

However, these symptoms can indicate that some brain damage has already occurred and treatment needs to be started immediately.

 

Advanced symptoms

If the damage to the brain continues, symptoms can quickly worsen, making daily activities increasingly difficult.

The symptoms will typically get worse in sudden steps, with stable periods lasting months or years in between. However, the rate of progression varies and it can be very difficult to predict when your symptoms may worsen.

Symptoms of vascular dementia depend on which area of the brain has been damaged. Possible symptoms include:



severe slowness of thought



feeling disorientated and confused



memory loss and difficulty concentrating



difficulty finding the right words



severe personality changes, such as becoming aggressive



depression, mood swings and apathy (unresponsiveness)



finding it difficult to walk and keep balance, frequently falling



difficulty controlling urination (urinary incontinence)



seeing things that aren't there (hallucinations)



Some people with vascular dementia will also have some symptoms of Alzheimer's disease, too.

Seeking medical advice

If you think you may have early symptoms of vascular dementia, see your GP because the chances of slowing it down may be better if it's diagnosed early.

If you're worried about someone else, encourage them to make an appointment and perhaps suggest that you go along with them.

Symptoms of vascular dementia can have a number of different causes. Your GP can carry out some simple checks to find out what the cause may be, and refer you to a specialist if necessary.

 

Causes of vascular dementia 

Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills the brain cells.

This can happen for a number of reasons, including:



narrowing of the small blood vessels deep inside the brain – this is known as subcortical vascular dementia, or small vessel disease



a stroke (where the blood supply to part of the brain is suddenly cut off, usually as the result of a blood clot) – this is sometimes called post-stroke dementia, or single-infarct dementia



lots of "mini-strokes" that cause tiny, but widespread, damage to the brain – this is known as multi-infarct dementia



In some people, the damage to the brain may be caused byAlzheimer's disease in addition to one of these conditions. This is known as mixed dementia.

Who's most at risk?

Things that can increase your chances of developing vascular dementia in later life include:



high blood pressure (hypertension)



smoking



poor diet



high blood cholesterol



lack of exercise



being overweight or obese



diabetes



excessive alcohol consumption



an irregular heartbeat (atrial fibrillation)



These problems can result in damage to the blood vessels in and around the brain, or cause blood clots to develop inside them.

Can I reduce my risk?

By making healthy lifestyle changes – such as stopping smoking andexercising regularly – and treating any health conditions you have, you may be able to reduce your risk of developing vascular dementia.

This may also help slow down or stop the progression of vascular dementia if you are diagnosed in the early stages.

However, there are some things you can't change that can increase your risk of vascular dementia, such as:



your age – the risk of vascular dementia increases as you get older, with people over 65 most at risk



your family history – your risk of problems such as strokes is higher if a close family member has had them



your ethnicity – if you are south Asian, African or Caribbean, your risk of stroke is higher, as rates of diabetes and high blood pressure are higher in these groups



In rare cases, unavoidable genetic conditions can also increase your risk of vascular dementia.

For example, small vessel disease can occur as the result of an inherited disorder called cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

This is caused by a faulty gene that makes the blood vessels in the brain more susceptible to changes.

Diagnosing vascular dementia 

Confirming a diagnosis of vascular dementia can be difficult, particularly when the condition is in its early stages. This is because many of the symptoms of dementia can also be caused by other conditions.

However, it's important to get a diagnosis as early as possible because treatment and lifestyle changes may slow down or stop the progression of the condition.

For vascular dementia to be diagnosed correctly, you will have a number of tests and assessments, including:




an assessment of your symptoms and mental abilities, including how quickly your symptoms have developed



a full medical history, including whether you have a history of conditions related to vascular dementia, such as strokes or high blood pressure



a physical examination



a review of the medication you are taking in relation to your symptoms



a range of tests, including blood tests, to rule out other possible causes of your symptoms, such as a vitamin B12 deficiency



brain scans, such as a computerised tomography (CT) scan, which can check for signs of a stroke or brain tumour, or a magnetic resonance imaging (MRI) scan, which can detect any shrinking of the brain



a heart rhythm test called an electrocardiogram (ECG)




Some of these tests can be carried out by your GP. Some will be carried out by other specialists, such as a neurologist (an expert in treating conditions that affect the brain and nervous system), an elderly care physician, or a psychiatrist with experience of treating dementia.

Treating vascular dementia 

There's currently no cure for vascular dementia and no way to reverse the damage to the brain that's already occurred, but treatments can help prevent further damage and may help slow down its progression.

When you are diagnosed with dementia, your future health and social care needs will need to be assessed and a care plan drawn up.

This is a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as:



what support you or your carer need for you to remain as independent as possible



whether there are any changes that need to be made to your home to make it easier to live in



whether you need any financial assistance



 

Treating underlying conditions

The main aim of treatment for vascular dementia is to treat the underlying cause. This will usually involve making healthy lifestyle changes and taking medication.

Treating the underlying condition can help prevent further problems, such as strokes, and may help slow down or stop the progression of vascular dementia if it's diagnosed early.

 

Lifestyle changes

Adopting a healthier lifestyle should help reduce your risk of experiencing further damage to your brain. This may involve:



eating healthily – for example, following a low-salt diet to manage high blood pressure



losing weight, if you are overweight



stopping smoking, if you smoke



getting fit



cutting down on alcohol



The above links will take you to information and advice on making these lifestyle changes.

 

Medication

Any medication you're prescribed will depend on the underlying condition you have. You may be offered:



antihypertensives, such as angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, to treat high blood pressure



statins to treat high cholesterol



antiplatelets, such as aspirin or clopidogrel, to reduce your risk of blood clots and further strokes



anticoagulants, such as warfarin, which can also reduce your risk of blood clots and further strokes



diabetes medication, such as metformin



antidepressants to treat depression



Acetylcholinesterase inhibitorssuch as donepezil (Aricept), galantamine (Reminyl) or rivastigmine (Exelon), which are commonly used to treatAlzheimer's disease, aren't designed to treat vascular dementia specifically, but may sometimes be used.

They can be particularly helpful if you have a combination of vascular dementia and Alzheimer's disease.

Supportive measures and treatments

There are also a number of therapies that can help make everyday living easier if you have dementia. These include:



occupational therapy to identify problem areas in everyday life, such as getting dressed, and help work out practical solutions



speech and language therapy to help improve any communication  problems



physiotherapy to help with movement difficulties



psychological treatments, such as cognitive stimulation, to help improve memory, problem-solving skills, and language ability



relaxation therapies, such as aromatherapy, music or dance therapy, and massage



 

Legal matters

If you've been diagnosed with dementia, you'll need to make arrangements for your care that take into account the possible decline in your mental abilities. This should include ensuring that your wishes are upheld if you're not able to make decisions for yourself.

You may wish to draw up an advance decision after first receiving a diagnosis of dementia. This makes your treatment preferences known now in case you are unable to do this in the future.

You may also want to consider giving a relative lasting power of attorney. This is the power to make decisions about you if you are unable to.

 

Advice for carers



respite care, which can allow you to take breaks from caring



legal issues for carers, such as what to do when someone can no longer make decisions for themselves



benefits for carers, such as allowances and tax credits that may be available



looking after someone with dementia