Dementia is a loss of brain function that occurs with certain diseases. It affects one or more brain functions such as memory, thinking, language, judgment, or behavior.
Vascular dementia is caused by a series of small strokes over time.
Vascular dementia is the second most common cause of dementia after Alzheimer disease in people over age 65.
Vascular dementia is caused by a series of small strokes.
A stroke is brain damage due to a blockage of the blood supply to any part of the brain. A stroke is also called an infarct. Multi-infarct means that more than one area in the brain has been injured due to a lack of blood.
If blood flow is stopped for longer than a few seconds, the brain cannot get oxygen. Brain cells can die, causing permanent damage.
When strokes affect a small area, there may be no symptoms. These are called silent strokes. Over time, as more areas of the brain are damaged, the symptoms of dementia appear.
Not all strokes are silent. Larger strokes that affect strength, sensation, or other brain and nervous system (neurologic) function can also lead to dementia.
Symptoms of dementia may also be caused by other types of disorders of the brain. One such disorder is Alzheimer disease. Symptoms of Alzheimer disease can be similar to those of vascular dementia. Vascular dementia and Alzheimer disease are the most common causes of dementia, and may occur together.
Symptoms
Symptoms of vascular dementia may develop gradually or may progress after each small stroke.
Symptoms may begin suddenly after each stroke. Some people with vascular dementia may improve for short periods, but decline after having more silent strokes. Symptoms of vascular dementia will depend on the areas of the brain that are injured due to the stroke.
Early symptoms of vascular dementia can include:
Difficulty performing cognitive tasks that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines
Getting lost on familiar routes
Language problems, such as trouble finding the name of familiar objects
Losing interest in things you previously enjoyed, flat mood
Misplacing items
Personality changes and loss of social skills as well as behavioral changes
Mood changes leading to aggressive behavior
Poor performance of job duties
As dementia worsens, symptoms are more obvious and the ability to take care of oneself declines. Symptoms may include:
Change in sleep patterns, often waking up at night
Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving
Forgetting details about current events
Forgetting events in your own life history, losing awareness of who you are
Having delusions, depression, or agitation
Having hallucinations, arguments, striking out, or violent behavior
Having more difficulty reading or writing
Having poor judgment and loss of ability to recognize danger
Using the wrong word, not pronouncing words correctly, or speaking in confusing sentences
Withdrawing from social contact
Nervous system (neurologic) problems that occur with a stroke may also be present.
Exams and Tests
A skilled health care provider can often diagnose vascular dementia using the following:
Complete physical exam, including nervous system exam
Asking about the person's medical history and symptoms
Mental function tests (mental status examination)
Neuropsychological testing
Tests may be ordered to help determine whether other medical problems could be causing dementia or making it worse, such as:
There is no treatment to repair damage to the brain caused by small strokes.
An important goal is to control symptoms and correct the risk factors. To prevent future strokes:
Avoid fatty foods. Follow a healthy, low-fat diet.
Do not drink more than 1 to 2 alcoholic drinks a day.
Keep blood pressure lower than 130/80 mm/Hg. Ask your provider what your blood pressure should be.
Keep LDL (bad) cholesterol lower than 70 mg/dL.
Do not smoke.
Your provider may suggest blood thinners, such as aspirin, to help prevent blood clots from forming in your arteries. Do not start taking aspirin or stop taking it without talking to your provider first.
Contact your provider if symptoms of vascular dementia occur. Go to the emergency room or call 911 or the local emergency number if there is a sudden change in mental status, sensation, or movement. These are emergency symptoms of stroke.
Prevention
Control conditions that increase the risk of hardening of the arteries (atherosclerosis) by:
Controlling high blood pressure
Controlling weight
Stopping the use of tobacco products
Reducing saturated fats and salt in the diet
Treating related disorders
References
Budson AE, Solomon PR. Vascular cognitive impairment and vascular dementia. In: Budson AE, Solomon PR, eds. Memory Loss, Alzheimer's Disease, and Dementia. 3rd ed. Philadelphia, PA: Elsevier; 2022:chap 7.
Knopman DS. Cognitive impairment and dementia. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 371.
Peterson RC, Graff-Radford J. Alzheimer disease and other dementias. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 95.
Seshadri S, Caunca MR, Rundek T. Vascular dementia and cognitive impairment. In: Grotta JC, Albers GW, Broderick JP et al, eds. Stroke: Pathophysiology, Diagnosis, and Management. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 18.
Review Date:
4/29/2023
Reviewed By:
Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 02/23/24 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
