Vascular dementia is the end stage of vascular cognitive impairment (VCI), a spectrum of cognitive disorders ranging from mild vascular cognitive impairment to dementia. Like dementia related to Alzheimer’s disease (AD), vascular dementia is diagnosed when cognitive decline robs a person of independence and it is not the consequence of other neurological or psychiatric disorders. Many older adults develop both AD and vascular disease, a combination that leads to worse cognitive decline and more frequent behavioral problems than those seen with vascular dementia or AD alone.
Alzheimer’s and Vascular Dementia
Unlike AD, VCI often begins with symptoms other than the loss of the ability to recall and reexperience specific episodes from one’s past. Researchers have noted that people with VCI often develop more noticeable difficulty with attention, information processing, and executive functioning (which are skills that enable people to plan, organize, remember things, prioritize, or pay attention to tasks) at the outset of the disease. Memory and language effects vary more. Changes in behavior including depression and apathy are common. Recognition of VCI is complicated by the fact that some standard dementia tests are less able to detect the impairment associated with VCI.
Vascular Dementia is a Group of Diseases
VCI and its end-stage of vascular dementia are now considered a group of diseases rather than a single disease. A major stroke is often followed by vascular cognitive impairment, as in Mary’s case. The smaller silent strokes, called lacunar infarcts, can lead to VCI in people who have not experienced larger strokes. But Mary’s father, with his “white matter disease,” is typical of the largest number of people with VCI. His damage is the result of thickening and narrowing (atherosclerosis) of arteries that feed the deep layers of white matter in the brain. Mary’s father’s condition used to be called “Binswanger’s disease” and is now considered a common type of VCI.
VCI can develop in other ways, too. In people who have experienced bleeding into the brain from an aneurysm or other cause, cognitive effects may remain. VCI can also be the result of some rare hereditary disorders such as CADASIL (a condition that causes stroke and other impairments), which stands for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
Resources:
- Alzheimer’s Disease Toolkit (Helpful Information to Understand and Manage Alzheimer's Disease)
- Expert Information on Alzheimer's Disease (Articles)
- Treatment of Vascular Dementia (Article)
- Vascular Dementia: Reducing Risks with a Brain-Healthy Lifestyle (Article)
- Alzheimer’s and Dementia: What’s the Difference? (Article)
- Signs and Symptoms of Dementia (Article)
- What is Dementia? (Article)
- What Causes Dementia? (Article)
- What's the Difference Between Dementia & Alzheimer's Disease? (Article)
Further Reading:
- van der Flier WM et al. Vascular cognitive impairment. Nature Reviews 2018;4:1-16.
- O’Brien J and Thomas A. Vascular dementia. The Lancet 2015;386:1698-1706.
- Chui HC and Ramirez-Gomez L. Vascular cognitive impairment: Diagnosis and treatment. In Geschwind MD and Belkoura CR. Non-Alzheimer’s and Atypical Dementia. John Wiley & Sons, 2016.
