What is vascular dementia and how can you reduce the risk of developing it?

(Picture: Karlsson /Heimsmyndir/Getty Images)

You may not have heard of it, but vascular dementia affects around 150,000 people in the UK every year.

Vascular dementia is the second most common type of dementia, after Alzheimer’s disease, and it is caused by a reduction in the blood supply available to the brain.

All types of dementia involve problems with memory, thinking, speaking and reasoning. This kind of cognitive impairment is very rare in people under the age of 65.

Unlike Alzheimer’s, of which the true cause still isn’t known, vascular dementia occurs when the brain isn’t receiving enough of the oxygen and nutrients it needs to function.

Blood reaches the brain through a network called the vascular system. If the blood vessels in that system get blocked or start leaking, blood won’t reach the brain. When brain cells aren’t getting enough blood, they eventually die.

What are the main types of vascular dementia?

Vascular dementia comes in five major forms. These are stroke-related dementia, post-stroke dementia, single-infarct and multi-infarct dementia, subcortical dementia, and mixed dementia. These types share some of the same symptoms, but differ in others.

As the name suggests, stroke-related dementia occurs when someone has a stroke.

Strokes happen when the vital blood supply to a part of the brain is suddenly stopped. Usually, it means that a blood vessel has become narrowed and is blocked by a clot.

Strokes are very serious and can be life threatening. The damage done by strokes is dependent on how quickly a person receives medical intervention, so if you believe someone is having a stroke, call 999 immediately.

If someone is having a stroke, call 999 straight away. (Picture: stocknshares)

Post-stroke dementia usually develops after someone has had a major stroke.

A major stroke is where the blood flow to a large vessel in the brain is permanently and suddenly cut off. This abrupt interruption in blood supply can lead to the death of a large volume of the brain’s tissue. Around 20% of people who have a stroke develop post-stroke dementia. One stroke increases the likelihood of more strokes and heightens the risk of dementia.

Single-infarct and multi-infarct dementia are caused by smaller strokes, sometimes so small that the person having them don’t realise that they’re happening at all.

With small strokes, symptoms may only last for a couple of minutes before the blockage clears itself and blood supply to the brain is re-established.

However, if the bloody supply is blocked for more than a few minutes, a small area of brain tissue will die, known as an ‘infarct’. One infarct might affect a crucial area of the brain, leading to single-infarct dementia. Lots of small strokes can cause multi-infarct dementia.

Subcortical dementia is where very small blood vessels inside the brain become diseased. They might thicken or become twisted, impeding the flow of blood through them. This disease in small vessels can damage ‘white matter’, the bundles of nerves that carry signals around the brain, and it can also cause small infarcts near the base of the brain.

Although subcortical dementia is the most common form of vascular dementia, the damage caused in the brain is quite different to the neurological impact of strokes because it tends to occur so much deeper inside the brain.

Finally, mixed dementia refers to dementia caused by a mixture of Alzheimer’s and vascular disease. The symptoms can match either Alzheimer’s or vascular disease, and can also be a combination of the two. More than 10% of dementia cases are believed to be a mixture of the two most common forms of the disease.

What causes vascular dementia?

The biggest risk factor for vascular dementia is age. The risk of getting vascular dementia doubles every five years once you reach the age of 65.

Dementia usually develops in people over the age of 65. (Picture: John Stillwell)

Having a stroke, heart disease or diabetes also doubles your likelihood of developing vascular dementia. The condition has been linked to depression and sleep apnea, where someone stops breathing for a few seconds or minutes while they’re asleep.

High blood pressure, high cholesterol and being overweight are all linked to cardiovascular disease which also increases the risk of vascular dementia. To reduce your chances of developing high blood pressure or becoming overweight, it’s important to eat a balanced diet, take regular exercise and drink alcohol in moderation. Smoking increases your risk of strokes, coronary heart disease and sustaining damage to blood vessels and arteries that supply the brain.

Ethnicity plays a part, as people with Indian, Bangladeshi, Sri Lankan and Pakistani heritage living in the UK have higher rates of stroke, heart disease and diabetes. People with Afro-Caribbean backgrounds are more likely to develop diabetes and have strokes. These differences are believed to be both inherited and caused by lifestyle choices such as diet, exercise and smoking.

According to the Alzheimer’s Society, although genes do play a role in the development of vascular dementia, their impact is fairly small.

How is vascular dementia treated?

There is no cure for dementia, but the symptoms can be eased or slowed with various treatments.

If vascular dementia has been caused by a cardiovascular disease (this includes coronary heart disease, strokes, peripheral arterial disease and aortic disease), treating and controlling the cardiovascular condition can slow down the progression of dementia.

This means taking prescription medications to reduce blood pressure, lower cholesterol and thin the blood so that it doesn’t clot. Diabetes and heart conditions also require medication and regular check-ups.

You don’t have to run marathons, but regular exercise is really important in reducing your risk of vascular dementia. (Picture: Isabel Infantes/Anadolu Agency/Getty Images)

Someone with vascular dementia will be advised to exercise regularly (this could mean physiotherapy exercises for stroke patients), quit smoking and eat a low-fat, low-salt diet rich in oily fish, fruit and vegetables.

The drug therapies available to treat Alzheimer’s disease are not recommended for people with vascular dementia.

However, the majority of dementia patients can benefit from a calm environment, respectful, person-centred care from support staff, gentle talking therapies to help them come to terms with the condition, and the soothing influence of therapy animals. Breaking daily tasks down into small, manageable chunks can stop sufferers becoming overwhelmed and distressed. For patients with memory loss, sticking to a regular routine can be very helpful.

If you want to reduce your risk of developing any kind of dementia, it’s important to stay mentally fit and active. Exercise your mind with puzzles, games, a course of study, challenging reading material, and discussions with family and friends. Look after your physical health with a balanced diet, regular exercise and drink to the recommended guidelines. It’s also a good idea to quit smoking.

You can learn more about different types of dementia, risk factors, current research and how to fundraise or volunteer for the Alzheimer’s Society here.

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