Vascular Dementia

Signs and Symptoms

Vascular dementia (VaD) can occur suddenly or progress slowly over time. At times, people with VaD experience long periods without any noticeable changes, or even improvements. However, if another stroke occurs, their symptoms may progress rapidly.

The condition often occurs with Alzheimer's disease, which further complicates its progression. VaD causes similar symptoms to those associated with Alzheimer's disease (AD), such as memory loss. However, memory problems caused by VaD are usually easier to overcome with cues and reminders.

Common symptoms include:

• Difficulty with organization and solving complex problems
• Slowed thinking
• Distraction or "absent mindedness"
• Difficulty retrieving words from memory
• Walking with rapid, shuffling steps
• Speech difficulties
• Difficulty following instructions

Other symptoms may include:

• Mood and behavior changes, such as depression, irritability or apathy
• Hallucinations or delusions, which may be very distressing to the patient and their caregiver
• Balance and movement problems
• Loss of bladder or bowel control
• Symptoms of Parkinson's disease, such as tremors

Diagnosis

At the UCSF Memory and Aging Center, patient evaluations for vascular dementia (VaD) are performed by a specially trained team including neurologists, radiologists, pharmacists, nurses and other health professionals.

The first step in making a diagnosis of VaD is to determine whether a patient has dementia and if so, the cause of dementia in order to plan treatment. It is also important to note that the most difficult part of diagnosing VaD is differentiating it from Alzheimer's disease (AD), since the conditions share many similar symptoms.

Diagnosis for VaD may include the following:

Medical History—Information about a patient's medical history and symptoms will be collected. Patients should be accompanied by a family member or friend who can provide information about the patient's degree of memory loss and functional impairment with respect to daily activities.

Physical Exam—Patients will have a thorough physical exam to check for vascular disease and risk factors, as well as other medical conditions. Blood pressure also will be checked.

Brain Scans—Brain scans will be conducted, particularly to look for signs of prior strokes that may have caused VaD.

Mental Status—An evaluation of memory and a patient's ability to understand, communicate and other cognitive functions will be conducted. A patient will also be asked about depression and emotional behavior changes, since these are often altered in VaD.

Blood Tests—Blood tests are part of the routine evaluation for dementia, including tests of thyroid function and vitamin B12 levels. Tests looking for evidence of diabetes and cholesterol levels will also be conducted.

Magnetic Resonance Imaging (MRI)—MRI is one of the most useful tests in the evaluation of VaD. MRI is very sensitive to changes in the brain caused by stroke.

Treatment

Currently, there is no treatment available that can repair the effects of vascular dementia (VaD). Treatment approaches are aimed at preventing and controlling major risk factors, such as high blood pressure, heart disease, high cholesterol, diabetes, smoking and alcoholism. For instance, high blood pressure and elevated cholesterol can be effectively treated with a combination of medicine, regular exercise and a healthy diet. Evidence suggests that treating these conditions greatly reduces the risk of developing dementia.

Studies are ongoing to investigate whether medications for Alzheimer's disease (AD), such as cholinesterase inhibitors are also effective in treating VaD.