Cognitive health: Vascular dementia
Alzheimer’s disease may be the most widely known type of dementia – which perhaps is unsurprising, since it’s also the most common type in Western countries. The second most common type, however, is less well known. This type is called vascular dementia.
Caused by reduced blood flow to the brain, vascular dementia is thought to affect around 17 per cent of all people with dementia in the UK (i). To put that in even more perspective, estimates suggest around 150,000 people in the UK have vascular dementia (ii). In some parts of Asia, on the other hand, vascular dementia is the most common type of dementia (i).
According to the Alzheimer’s Society, on average someone with vascular dementia will live for about five years after their symptoms start – though this often varies greatly from one person to another (iii).
What is vascular dementia?
Like Alzheimer’s, vascular dementia is a progressive condition, which means it tends to get worse over time – though it’s sometimes possible to slow it down. The rate of progression isn’t necessarily a gradual one either, as vascular dementia symptoms can suddenly get worse then remain stable for a while. This pattern of progression isn’t easy to predict, however.
The way symptoms progress also depends on the type of vascular dementia that’s causing them. There are several different types, each of which causes different sorts of damage to different parts of the brain (and therefore different symptoms, though many symptoms can be similar between the different types):
Subcortical vascular dementia is thought to be the most common type of vascular dementia (iv). Sometimes also called small vessel disease or Binswanger’s disease, it’s caused by changes to small blood vessels found deep within the brain. Most people affected don’t notice these changes at first, but they tend to cause symptoms over time.
Stroke-related vascular dementia happens when the blood supply to the brain is suddenly cut off during a stroke. According to the Alzheimer’s Association, not everyone who has a stroke will develop vascular dementia. However it’s estimated that around one in five people who has a stroke develops post-stroke dementia within six months (iv).
Single-infarct and multi-infarct vascular dementia are caused by either one or a number of smaller strokes (including mini-strokes, or transient ischaemic attacks – TIAs – to give them their medical name). Infarct is the name for a small area of tissue in the brain that dies when its blood supply is interrupted for more than a few minutes.
Mixed dementia is when changes caused by both vascular dementia and Alzheimer’s disease are found in the brain. At least 10 per cent of people with dementia are thought to have mixed dementia (iv).
Meanwhile, according to Alzheimer’s Research UK, the blood vessel damage that causes vascular dementia can also cause memory and thinking problems that aren’t severe enough to be diagnosed as dementia. When this happens, the name of the condition is vascular cognitive impairment (v).
What are the symptoms?
Vascular dementia causes problems with cognitive abilities as well as some physical abilities often in the later stages. The symptoms vary from one person to another, depending on which type of vascular dementia they have. They can start suddenly – after a stroke, for example – or develop much more gradually, as with subcortical vascular dementia.
The early signs can be mild, which may explain why some people don’t notice them or even mistake them for something else, such as depression. The symptoms can also vary widely, as they depend on the part of the brain that’s affected. In general, however, early symptoms can include:
Slow thinking, such as taking more time than usual to process information
Problems with understanding
Struggling to plan things out
Mood and behaviour changes
Memory and language problems (though these are much more common in someone with Alzheimer’s disease)
Physical symptoms of a stroke in cases of post-stroke dementia, such as paralysis or weakness or an arm or leg, or problems with vision or speech
Many of these symptoms can become more severe in time, either gradually or suddenly every now and then. Later symptoms can also include movement difficulties, such as frequent falls, difficulties with walking and balance, as well as bladder weakness problems. Someone in the later stage of vascular dementia may also be affected by personality changes, such as becoming aggressive, more emotional or generally lacking interest or enthusiasm for anything. They may feel increasingly disorientated and confused, and may also struggle to carry out daily activities. Memory and concentration problems may also become worse.
If you think you may have the early symptoms of vascular dementia, it’s important to see your GP, especially if you’re aged 65 or older. That’s because getting an early diagnosis can be helpful, as you may receive treatment to slow down or stop your symptoms getting worse.
What causes vascular dementia?
Brain cells need a healthy supply of blood that brings oxygen and nutrients to stay healthy. When this blood supply is reduced or blocked, the brain cells become damaged and eventually die, causing the symptoms of vascular dementia. All cases of vascular dementia are caused by a lack of blood supply to the brain, though the cause of the reduced or blocked blood supply varies for each type of the disease:
Subcortical vascular dementia
If you have small blood vessel disease the walls of some of the blood vessels deep within your brain become thick, stiff and twisted. This makes the blood vessels narrower, which makes it more difficult for the blood to flow through them and for oxygen to reach the brain tissue.
Subcortical vascular dementia can cause other damage to the brain too, including damage to the bundles of nerve fibres that transport signals around the brain as well as infarcts near the base of the brain.
Stroke-related vascular dementia
A major stroke is caused by the blood supply to part of the brain being cut off suddenly. This usually happens because a blood vessel in the brain becomes narrow or becomes blocked by a clot, which may or may not have formed in the brain (sometimes clots can also form in other parts of the body – the heart, for instance – and can be carried to the brain).
Sometimes a stroke is caused by a blood vessel bursting and bleeding into the brain, which interrupts the blood supply. This, however, is thought to happen far less often than a stroke caused by a clot. Either way the damage can cause a range of symptoms, including post-stroke dementia.
Single-infarct and multi-infarct vascular dementia
Smaller single strokes and ‘mini’ strokes are also caused by clots in a large or medium-sized blood vessel in the brain. Often the clot can clear itself quickly, which explains why some people may not even notice they’ve had a problem. But the blockage in the blood supply doesn’t have to last for much longer than a few minutes to cause an infarct. If this infarct develops in an important part of your brain it can cause single-infarct vascular dementia.
More commonly, however, having a series of mini-strokes over a period of time causes lots of little but widespread infarcts in different areas of the brain, leading to multi-infarct vascular dementia.
With mixed dementia, symptoms are caused by both vascular disease and Alzheimer’s disease. To find out more about what causes Alzheimer’s, read our guide.
Are you at risk?
There are several risk factors that increase your chances of developing vascular dementia. Some of these risk factors can’t be controlled. For instance, age is the strongest risk factor, which means the older you get, the more likely you are to develop vascular dementia.
According to the Alzheimer’s Society, vascular dementia isn’t common in people under the age of 65, with fewer than 8,000 people of that age affected in the UK (vi). But for every five years you live after your 65th birthday, your risk doubles. Men also have a slightly higher risk of developing vascular dementia than women.
Certain medical conditions can increase your chances of having vascular dementia too. According to the Alzheimer’s Society, if you’ve had a stroke, diabetes or heart disease, you’re approximately twice as likely to develop vascular dementia as someone who hasn’t had any of these conditions (vi). Having high blood pressure, high cholesterol and a type of irregular heartbeat (arrhythmia) [ADD LINK] called atrial fibrillation also increases your vascular dementia risk, not just because they can raise the risk of damage to blood vessels in your brain but also because they can cause blood clots to form inside the blood vessels.
On the other hand, the risk factors for vascular dementia you can do something about include:
Eating a poor diet
Not getting enough exercise
Being overweight or obese
Drinking too much alcohol
Is vascular dementia hereditary?
You also can’t do anything about your genes or your ethnicity, both of which can affect your chances of developing vascular dementia. It’s thought that your genetic background may play a part in whether or not you’ll develop vascular dementia, though any such risk is very small. For instance, an inherited disorder called cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) can cause vascular dementia. If you have this disorder, you will usually have a family history or vascular problems such as strokes.
Genes may also play a part in the fact that people from certain ethnic groups are more likely to develop vascular dementia – people from an Indian, Pakistani, Bangladeshi or Sri Lankan background who are living in the UK have a significantly higher risk than white Europeans, for instance. People of African-Caribbean descent may also have a higher risk.
How is vascular dementia treated?
There’s currently no cure for vascular dementia, which means any damage in the brain that’s causing it will be permanent. The good news is there are treatments that can often help prevent any more damage being done and, in some cases, help slow down the progression of the disease.
Lifestyle changes: These are often recommended to help keep you as healthy as possible if you have vascular dementia. Examples include eating healthily (including following a low-salt diet if you’ve been diagnosed with high blood pressure), taking the right amount of exercise, losing weight if you need to, giving up smoking if you’re a smoker, and cutting back on alcohol if you drink more than the recommended amount (see below for more details).
Medicines: Depending on the underlying cause of vascular dementia, there are medicines that may help stop it getting worse. If it’s caused by a stroke, for instance, it may be treated with medicines that help manage things that can cause strokes such as high blood pressure and high cholesterol. Other medicines help reduce the risk of blood clots, which may prevent further strokes, such as aspirin and anticoagulants like warfarin. Similarly medicines that treat diabetes may help slow down the progression of vascular dementia where diabetes is the underlying cause.
People with mixed dementia may also be treated with medicines for Alzheimer’s disease. However these medicines only treat Alzheimer’s and have not been found to be effective for vascular dementia on its own.
Therapies and activities: Besides medicines, there are lots of other things that are recommended for people living with vascular dementia. These include:
Cognitive stimulation therapy (this may help improve memory and problem-solving skills)
Occupational therapy (for practical help with everyday difficulties)
Cognitive behavioural therapy (to treat depression)
Music and art therapy
Speech and language therapy
Relaxation techniques (including massage and aromatherapy)
Structured exercise programmes
Adaptations to make your home safer and easier to get around
Social interaction (for instance, at activity groups organised by the Alzheimer’s Society
Can vascular dementia be prevented?
Adopting measures that help keep your heart healthy is also thought to help lower your risk of vascular dementia. According to Arthritis Research UK, this may be particularly important for people in their forties and fifties who want to reduce their dementia risk (vii). This includes making healthy lifestyle changes, such as:
Giving up smoking (read our guide for tips on giving up)
Eating a healthy diet with plenty of ‘brain-healthy’ foods such as berries, beans, soya, lentils, fish, nuts, green leafy vegetables, olive oil and whole grains, while limiting foods considered to be less healthy such as butter, cheese, fried foods, fast foods, pastries, sweets and red meats (viii)
Making sure your blood pressure and cholesterol stay in the normal range, as well as treating any other long-term health conditions you have and keeping them under control (this includes having regular health care checks and taking any medication your GP has prescribed for you)
Drinking alcohol in moderation: aim for no more than 14 units of alcohol each week on a regular basis, and spreading your drinking evenly over three or four days if you do drink that much (if you’re concerned about the amount you drink, find more information here)
Staying physically active by doing at least 150 minutes of moderate exercise each week (moderate means your heart will beat faster and you’ll feel warmer, but you won’t be out of breath)
Keeping your weight healthy (for more on weight management, click here)
Staying socially active and stimulating your brain with activities such as music, learning a new language, painting, woodwork and other hobbies
What supplements help dementia and support brain health?
There are also a number of nutritional supplements that may support heart health – you can read about them in our guides to cardiovascular disease, blood pressure and cholesterol. However there are many supplements that may help support brain health too – here are some of the main ones (read more about them and the scientific evidence that supports their use for cognition support in our guide to nutrition for the brain). [ADD LINK]
High-strength fish oils: Supplements made from oily fish that contain the omega-3 fatty acids EPA and DHA are thought to be good for your brain, so they may be particularly beneficial if you don’t like eating fish. If you’re a vegetarian or vegan you can now get these important omega-3s in a veggie/vegan-friendly formulation – look for omega-3 supplements that contain algae, which supply fish with omega-3s in the first place.
Turmeric (curcumin): Curcumin is one of the many active ingredients found in the curry spice turmeric, and may be helpful for cognitive decline. You can add turmeric to your food, or take a turmeric supplement if that’s more convenient. Consider trying a good-quality supplement that provides a high percentage of curcuminoids (curcumin is a type of curcuminoid).
Ginkgo biloba: Nutritional therapists often use the herb ginkgo biloba to treat memory problems and cognitive function in older people.
B complex: Some of the B vitamins – including vitamin B6, B12 and folate (or folic acid) – may help slow down cognitive decline. B vitamins are widely available in our diet, but many people may not get enough of them. You can take individual B vitamin supplements, but it’s often considered more convenient to take a B complex supplement or a multivitamin formula with good levels of the Bs.
Astaxanthin: Antioxidants may be helpful in supporting cognitive health, especially if your levels are already less than decent. A particularly potent antioxidant found in a type of freshwater algae, astaxanthin can be found in supplement form as well as in foods such as salmon, lobster, crawfish, rainbow trout and crab. As a supplement it is usually suitable for vegetarians and vegans (check the label – some capsules can contain non-vegetarian and non-vegan ingredients).
Iodine: If you’re deficient in this essential mineral it can lead to an underactive thyroid, which can affect your cognition. You can get iodine in fish, eggs and other dairy products, as well as in nutritional supplements such as multivitamins.
Rosemary: Both the scent and compounds found in rosemary may be beneficial for memory problems. Add some of this fragrant herb to your food, or look for a nutritional supplement that contains it. You can also release the smell of rosemary essential oil in a heat-based diffuser.
Iron: This essential nutrient helps with blood flow, including blood flow to the brain, and is thought to help with cognitive health especially in those who are deficient in it. If you don’t eat a lot of iron-rich foods – such as red meat, liver, beans and nuts – you can get it in a single supplement or as part of a multivitamin formulation.
Zinc: This essential nutrient is found in high levels in the brain. You can get it in foods such as meat, nuts and dairy products, or if you don’t get much in your diet try a zinc supplement or multivitamin that has good zinc levels.
Phosphatidyl serine: Found in foods such as egg yolks, soya beans, fish and meat, phosphatidyl serine is often sold as a brain health supplement, as some experts think it may help boost memory and cognition.
Ashwagandha: One of the most widely used herbs in Indian Ayurvedic medicine, ashwagandha contains compounds called withanolides that some think are good for the brain. It’s widely available as a supplement, though not all brands contain beneficial levels of withanolides (look for a product that contains at least 1.5 per cent withanolides).
Vitamin C: Like the B vitamins, vitamin C is widely found in foods – yet some people may not be getting enough of it in their diets. Some scientists even believe it may help with cognitive functioning. You can get vitamin C supplements in many forms, including tablets, capsules and powder.
Magnesium: Found in foods such as dark chocolate, nuts, seeds, legumes, milk, oily fish, red meat and leafy green vegetables, magnesium may be beneficial if you want to give your brain a boost. However, despite the fact that it’s in many different foods, some people may have low levels of magnesium. If you want to try a supplement, look for magnesium in a more absorbable form, such as magnesium citrate.
Green tea: If you like drinking green tea, your brain may already be getting a supply of certain helpful compounds. If you’re not a fan of the taste, however, you can try a green tea supplement – choose a product with a good level of active antioxidant ingredients called polyphenols.
Available online: https://patient.info/doctor/vascular-dementia
Available online: https://www.nhs.uk/conditions/vascular-dementia/
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.