Vascular dementia

Dementia is a collective name for diseases that affect the health of the brain. There is a memory disorder in combination with one or more other cognitive disorders (aphasia, apraxia, agnosia, disorder in the executive functions) and a negative influence on daily functioning.
When cognitive disorders occur, it will have to be investigated whether there are other causes.
A person can deteriorate both mentally and physically. There are more than 50 types of dementia.

The types are different, but they all have in common that the brain is damaged and that the process is progressive.

Although there are more than 50 types of dementia, these types are the most common:

• Alzheimer's disease
  
• Vascular dementia (On this page)
  
• Frontotemporal dementia
  
• Lewy body dementia

Alzheimer's disease is the most common of these four types. After Alzheimer's, vascular dementia is the most common.

 

Vascular dementia is a form of dementia caused by problems with the blood flow to the brain. If the blood flow is not good, there can be a lack of oxygen in the brain. This can cause brain cells to die and the brain can have problems processing information.
In one in six people with dementia, vascular damage is the main cause. Vascular dementia generally starts in people between the ages of 65 and 75.
On average, men are slightly more likely to develop this type of dementia than women. Vascular dementia is also called "multi-infarct dementia" (MID), because there can be an accumulation of small and / or large cerebral infarctions.

See also our page about Small Vessel Disease (SVD).

 

Possible complaints

People with vascular dementia can experience the following complaints, among others. These are possible complaints and do not necessarily occur in everyone. These complaints are also not unique to vascular dementia.

 

• Slower thinking, speaking and acting The ability to concentrate and / or do multiple things at the same time is reduced.

 

• Memory problems

A problem with memory is often the first symptom that is noticed. But with vascular dementia it is often less noticeable than with Alzheimer's disease.

 

• Aphasia 

Aphasia is a language disorder that makes speaking, writing and understanding language more difficult.

 

• Apraxia

Apraxia or action disorder: the person can no longer perform simple actions. For example, prepare a sandwich.

 

• Ataxia

Ataxia is a disorder that can cause difficulty in coordinating movements. For example, difficulty walking, problems with grasping objects and unclear speech.

 

• Agnosia

Agnosia is the inability to recognize things, such as smell, sound or image.

 

• Paralysis or loss of sensation. For example, less sensation in hands or feet.

 

• Behavioral problems

Dementia can cause anxiety because someone loses control over their own body. This can also cause feelings of anger, irritation and sadness. A characteristic is that people with vascular dementia can be aware of their deterioration for a long time, which can also cause anxiety, anger and sadness.

 

• Mood swings

A person's mood can change quickly and extremely. One moment they can have a fit of crying and a moment later they can have a fit of laughing.

 

• Sleep problems

People are restless and anxious. As a result, they have problems with falling asleep or waking up often.

 

• Delusions or hallucinations

Sometimes it happens that someone gets delusions or hallucinations. For example, someone thinks that something has been stolen.

 

Noticing the changes

It often takes a very long time before it is clear that the symptoms are related to vascular dementia. It often takes years before a diagnosis is made. This also applies to other forms of dementia.

This can sometimes be very difficult and frustrating for the person with the symptoms and the people around them, such as the partner or family. The people around them are often the first to notice that some things are different than before. It is often through encouragement from the environment that the symptoms are eventually investigated further by a doctor.

One of the reasons why vascular dementia is recognized late is that it is difficult to recognize. The above possible symptoms are not unique to vascular dementia.
What also makes vascular dementia difficult to recognize is the diversity of the possible symptoms and the large differences that are seen between people.

 

One person with vascular dementia can have very different symptoms than another. Some people experience physical symptoms more often.

In others, cognitive symptoms can be more prominent. The clinical picture is therefore different for each person. This has to do with the areas of the brain that are damaged, among other things.

 

Diagnosis

Making a diagnosis is not easy and can take a long time. Symptoms such as forgetfulness and behavioral changes can have many different causes. Such as a vitamin deficiency or a hormone disorder.

 

In order to make a diagnosis, several steps are taken. The first step is taken by the general practitioner. The doctor examines the patient's symptoms and maps them out well. Urine and blood tests can be used to determine whether the symptoms cannot be explained by another clinical picture. The general practitioner can also have a conversation with a loved one. They then check whether the loved one recognizes the symptoms. This is called a heteroanamnesis.

 

If the symptoms persist or increase, the patient is referred to a specialist in the hospital.

 

In most cases, a neurological examination is performed and possibly an MRI or CT scan is made to determine dementia. The specialist will also determine which disease is causing the dementia, for example vascular damage.

 

Treatment

Unfortunately, vascular dementia cannot yet be cured.

What can be done is to treat the risk factors for the underlying cardiovascular diseases and to reduce further damage. Possible treatments include treating high blood pressure and administering blood thinners.

 

For the mental consequences of vascular dementia, a rehabilitation program can be started. This program often consists of learning to deal with memory and concentration problems and learning new ways to do this. Difficulty with planning and maintaining an overview can also be treated.

 

More information:

• https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793
• https://www.nhs.uk/conditions/vascular-dementia/
• https://www.nia.nih.gov/health/vascular-dementia/vascular-dementia-causes-symptoms-and-treatments