Vascular dementia (VaD) is the second most common type of dementia after Alzheimer's and is responsible for up to 25% of all dementias. VaD, previously known as multi infarct dementia, like Alzheimer's, is caused by brain damage. The crucial difference is that in VaD the damage is due to strokes. Between 500,000 and 700,000 Americans have a stroke each year. Scientists believe that after three months approximately 25% to 30% (125,000 people) will develop dementia.
Strokes can affect the cortical and sub-cortical areas of brain tissue, so symptoms tend to vary depending on the stroke location. However, because the brain and its nerve pathways are so complex, this is not always so. This also means that some mental abilities may not be as reduced as in Alzheimer's disease.
Risk Factors for Vascular Dementia
Risk factors for VaD include people who are more susceptible to cardiovascular disease. For example, people with diabetes, a history of arteriosclerosis (hardening of the arteries), high blood pressure, smokers, and people who have cardiac arrhythmias (abnormal electrical activity in the heart).
Age of Onset of Vascular Dementia
The age range for getting Alzheimer's is similar to VaD. Cardiovascular disease is tied to stroke. As a result, the rate of vascular dementia increases 200 fold from the age of 60 to 90 years of age. Because VaD does not exclude you getting Alzheimer's disease, there is a certain amount of overlap in these statistics.
Symptoms & Diagnosis of Vascular Dementia
Onset of VaD can be gradual or sudden depending on the cause. A number of mini strokes will lead to gradual symptoms, but a stroke will produce sudden symptoms immediately. Early signs and symptoms of vascular dementia are similar to those of Alzheimer's disease.
Although symptoms can be similar to Alzheimer's there are often associated neurological problems where one-half of a patient's body is paralyzed or weakened (hemiplegia or paresis), Parkinson's type symptoms.
Doctors can often tell where the damage from the stroke/strokes occurred by symptoms and by neuroimaging tests (MRI or CT scans etc). Diagnosis will also be helped by evidence of cardiovascular disease.
Treatments for Vascular Dementia
Treatment for VaD is to reduce the possibility of stroke so that no further brain damage can occur. This is done by :
- First, reducing the risk factors by life style changes such as a healthy diet, regular exercise, reducing obesity & avoiding tobacco.
- Second, prescribing anticoagulants such as warfarin (Coumadin).
- Surgery for severe cases of vascular disease.
- Prescribing antiplatlet agents such as asprin, ticlopidine (Ticlid), clopidogrel (Plavix), cilostazol (Pletal).
- Prescribing medications that decrease viscosity (blood thickness) such as pentoxifylline (Trental).
- Third, possible use of neuroprotective agents.
- Fourth, as with Alzheimer's disease, using acetylcholinesterase inhibitors such as donepezil (Aricept), rivastigmine (Exelon) ,galantamine (Reminyl) to improve cognition, function and behavior.
Prognosis for Vascular Dementia