Being a neurosurgeon, I see a lot of brain MRI scans. I'm usually looking for stroke, tumor, blood or excessive cerebrospinal fluid. More and more often I see evidence of previous small strokes. When I mention this, patients are almost always surprised. Even if I'm seeing them because they've just had a stroke, they never experienced stroke symptoms in the past. That's because you can have a very small stroke and never know. That may be lucky, but over time damage can add up. It can even result in dementia.
Vascular dementia occurs if enough brain becomes damaged due to inadequate blood supply. A brain blood vessel can be narrowed or completely blocked. If there is not enough blood flow, part of the brain will be deprived of oxygen, glucose and important nutrients. Brain cells will become injured, and can then die. That means a stroke. Over time enough brain cells may die to cause you to develop vascular dementia. Some refer to this as Vascular Cognitive Impairment or VCI. It is also known as multi-infarct dementia, which occurs due to a series of small strokes. Some experts feel that vascular dementia is just one type of vascular dementia.
Symptoms of Vascular Dementia
Symptoms of vascular dementia include sluggish thinking, difficulty understanding, a reduced ability to plan, changes in behavior, mood and personality. The person may feel confused much of the time, may experience changes in their manner of walking, and may have difficulty with balance.
Someone with early stage vascular dementia may become prone to mood swings which are inappropriate for the circumstances. This can be expressed as emotional outbursts, while at other times they may become apathetic.
Sufferers are also prone to symptoms of anxiety and depression, especially if they are aware of how the disease may progress and how it impacts their overall health.
Vascular dementia that occurs following a major stroke usually has accompanying physical symptoms. The patient may have vision and speech problems. They may also have problems using their limbs.
Cognitive problems associated with vascular dementia may be mild. This can then worsen as a consequence of repeated minor strokes, which cause cumulative brain damage.
Risk Factors and Causes of Vascular Dementia
Some cases of vascular dementia are caused by strokes and ministrokes. People over sixty are more prone to vascular dementia, since age increases the risk for having strokes. Mini-strokes can occur without obvious immediate symptoms that are not physically or immediately apparent. However small areas of damage caused by multiple ministries will add up. One third of patients will be more likely to develop dementia within a year after having a stroke.
Hypertension, or high blood pressure, tops the list of factors that contribute to vascular dementia. It accounts for about fifty percent of those who have vascular dementia. That's because high blood pressure can adversely affect your brain's white matter. Research has shown that elderly individuals who have white matter lesions in the brain's periventricular region have a higher risk of dementia.
Some autoimmune diseases, like temporal arteritis and lupus eythematosus can cause reduced blood flow to the brain. Those with these conditions face a higher risk of developing vascular dementia. Endocarditis, infection in the heart, can also lead to VD. Brain hemorrhage and extreme levels of hypotension can also increase the likelihood of vascular dementia.
Diagnosing Vascular Dementia
It can be difficult to differentiate vascular dementia from Alzheimer's disease. The signs and symptoms may be similar, and it is not uncommon for geriatric patients to have both diseases. The patient will usually undergo a brain CT (computerized tomography) scan and/or MRI (Magnetic Resonance Imaging).
Is Vascular Dementia Treatable?
Medications can help manage the symptoms of vascular dementia. Some may be given to prevent another stroke. It's important to prevent progression of the disease, and treatment plans for vascular dementia are aimed at reducing as much as possible the risk of further brain damage.
A few studies suggest that certain drugs that are helpful for those with Alzheimer's can also be beneficial for vascular dementia sufferers.