Vascular dementia

Vascular dementia, the second most common form of dementia in older adults after Alzheimer’s disease, and vascular cognitive impairment (VCI) result from injuries to vessels that supply blood to the brain, often after a stroke or series of strokes. The symptoms of vascular dementia can be similar to those of Alzheimer’s, and both conditions can occur at the same time (a condition called “mixed dementia”). Symptoms of vascular dementia and VCI can begin suddenly and worsen or improve over time.

Vascular Contributions to Cognitive Impairment and Dementia

Vascular contributions to cognitive impairment and dementia (VCID)cause significant changes to memory, thinking, and behavior. Cognition andbrain function can be significantly affected by the size, location, and numberof brain injuries. Vascular dementia and vascular cognitive impairment arise.

as a result of risk factors that similarly increase the risk for cerebrovasculardisease (stroke), including atrial fibrillation, hypertension, diabetes, andhigh cholesterol. Symptoms of VCID can begin suddenly and progressor subside during one’s lifetime. VCID can occur along with Alzheimer’sdisease. Persons with VCID almost always have abnormalities in thebrain on magnetic resonance imaging scans. These include evidence ofprior strokes, often small and asymptomatic, as well as diffuse changes inthe brain’s “white matter”—the connecting “wires” of the brain that arecritical for relaying messages between brain regions. Microscopic brainexamination shows thickening of blood vessel walls called arteriosclerosisand thinning or loss of components of the white matter.

Forms of VCID include:

• Vascular dementia refers to progressive loss of memory and other cognitive functions caused by vascular injury or disease within thebrain. Symptoms of vascular dementia may sometimes be difficult todistinguish from Alzheimer’s disease. Problems with organization,attention, slowed thinking, and problem solving are all more prominentin VCID, while memory loss is more prominent in Alzheimer’s.

• Vascular cognitive impairment involves changes with language, attention, and the ability to think, reason, and remember that are noticeable but arenot significant enough to greatly impact daily life. These changes, causedby vascular injury or disease within the brain, progress slowly over time.

• Post-stroke dementia can develop months after a major stroke. Not everyone who has had a major stroke will develop vascular dementia, but therisk for dementia is significantly higher in someone who has had a stroke.

• Multi-infarct dementia is the result of many small strokes (infarcts) and mini-strokes. Language or other functions may be impaired, dependingon the region of the brain that is affected. The risk for dementia is significantly higher in someone whohas had a stroke. Dementia is morelikely when strokes affect both sidesof the brain. Even strokes that don’tshow any noticeable symptoms canincrease the risk of dementia.

• Cerebral autosomal dominant arteriopathy with subcorticalinfarcts and leukoencephalopathy(CADASIL) is an extremely rare inherited disorder caused by athickening of the walls of small- and medium-sized blood vessels,which reduces the flow of blood to the brain. CADASIL is associatedwith multi-infarct dementia, stroke, and other disorders. The firstsymptoms can appear in people between ages 20 and 40. CADASILmay have symptoms that can be confused with multiple sclerosis.Many people with CADASIL are undiagnosed.

• Subcortical vascular dementia, previously called Binswanger’s disease, involves extensive microscopic damage to the small blood vessels andnerve fibers that make up white matter. Some consider it an aggressiveform of multi-infarct dementia. Cognitive changes include problemswith short-term memory, organization, attention, decision making, andbehavior. Symptoms tend to begin after age 60, and they progress in astepwise manner. People with subcortical vascular disease often havehigh blood pressure, a history of stroke, or evidence of disease of thelarge blood vessels in the neck or heart valves.

• Cerebral amyloid angiopathy is a buildup of amyloid plaques in the walls of blood vessels in the brain. It is generally diagnosed when multiple tinybleeds in the brain are discovered using magnetic resonance imaging.

Vascular dementia Resources
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