Vascular Dementia

Vascular dementia is widely considered the second most common type of dementia. It develops when impaired blood flow to parts of the brain deprives cells of food and oxygen.

The diagnosis may be clearest when symptoms appear soon after a single major stroke blocks a large blood vessel and disrupts the blood supply to a significant portion of the brain. This situation is sometimes called “post-stroke dementia.”

There is also a form in which a series of very small strokes, or infarcts, block small blood vessels. Individually, these strokes do not cause major symptoms, but over time their combined effect becomes noticeable. This type used to be called “multi-infarct dementia.”

Symptoms of vascular dementia can vary, depending on the specific brain areas deprived of blood. Impairment may occur in “steps,” where there is a fairly sudden, noticeable change in function, rather than the slow, steady decline usually seen in Alzheimer’s disease.

The person may have a past history of heart attacks. High blood pressure, high cholesterol, hardening of the arteries, diabetes, or other risk factors for heart disease are often present.

Symptoms

• Memory problems may or may not be a prominent symptom, depending on whether brain regions important in memory are affected.
• Confusion, which may get worse at night.
• Difficulty concentrating, planning, communicating and following instructions.
• Reduced ability to carry out daily activities.
• Physical symptoms associated with strokes, such as sudden weakness, difficulty speaking or confusion.
• Magnetic resonance imaging (MRI) of the brain may show characteristic abnormalities associated with vascular damage.

Treatment

Because vascular dementia is closely tied to diseases of the heart and blood vessels, many experts consider it the most potentially treatable form.

Monitoring of blood pressure, weight, blood sugar and cholesterol should begin early in life. Managing these risk factors, avoiding smoking and excess alcohol, and treating underlying diseases of the heart and blood vessels could play a major role in preventing later cognitive decline for many individuals. In some cases, active management of these factors in older adults who develop vascular dementia may help symptoms from getting worse.

Once vascular dementia develops, there are no drugs currently approved by the U.S. Food and Drug Administration (FDA) to treat it.

Most of the drugs used to treat cognitive symptoms of Alzheimer’s disease have also been shown to help individuals with vascular dementia to about the same extent they help those with Alzheimer’s. However, in March 2006, Eisai Co. Ltd.,manufacturer of donepezil (Aricept), reported that in a clinical trial of donepezil for vascular dementia, a significantly greater number of deaths occurred in study participants receiving donepezil than in those taking the placebo.

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