Vascular Dementia is Not Alzheimer's Disease
Alzheimer’s disease is the most common form of dementia, and there’s so much discussion about it that it’s easy to overlook the second most common one—vascular dementia. A recent report in Diabetes Care brought to light the importance of understanding vascular dementia, as it’s been shown that women with type 2 diabetes are at higher risk of developing this form of dementia—rather than Alzheimer’s—than are men.
First of all, dementia is not a disease—it is a group of symptoms that have a negative impact on cognitive functions such as memory, reasoning, and decision making. Approximately 60 to 80 percent of dementia cases are Alzheimer’s disease, while vascular dementia accounts for about 10 percent, according to the Alzheimer’s Association.
What is vascular dementia?
Although both forms of dementia involve a decline in thinking skills, the reasons for it differ: vascular dementia is associated with a reduction in blood flow to the brain, usually because of small strokes, whereas in Alzheimer’s disease, there is an accumulation of abnormal proteins (amyloid-beta and tau), and the nerve cells in the brain die. It is possible to suffer from both forms of dementia.
Because vascular dementia is associated with a blockage of blood vessels in the brain, changes in thinking sometimes occur suddenly. However, they also may appear as mild changes that gradually get worse as the individual experiences a series of transient ischemic attacks (TIAs), or mini-strokes. (Note: Not everyone who has a stroke or TIA develops vascular dementia.)
Depending on which blood vessels are blocked and the severity of the blockage, a person with vascular dementia may or may not experience significant memory problems. Symptoms of vascular dementia are most obvious when they appear after someone has a major stroke, in which case they include confusion, difficulty speaking or understanding speech, disorientation, and vision problems.
When someone has a series of TIAs, you may notice gradual changes in their ability to make decisions or plan, uncontrolled crying or laughing, difficulty in finding the right words or participating in social situations, and a declining ability to focus their attention.
Diagnosing vascular dementia
Experts from the American Stroke Association and American Heart Association, with endorsement by the American Academy of Neurology and the Alzheimer’s Association, have identified three criteria that suggest the greatest likelihood that someone with mild cognitive impairment (MCI) or dementia has vascular dementia:
- Results of neurocognitive tests (which involve testing of planning, judgment, reasoning, memory, and problem-solving) confirm MCI or dementia
- Brain imaging results (typically using magnetic resonance imaging [MRI]) show evidence of recent stroke or changes in blood vessels that are consistent with the cognitive impairment seen in the neurocognitive testing
- Lack of evidence of other factors contributing to the person’s decline in cognitive functioning
In Alzheimer’s disease, clinicians also use neurocognitive testing and are still searching for definitive biomarkers and brain imaging techniques that will help them better diagnose the disease. Thus far, for example, shrinkage of the hippocampus area of the brain, the significance of amyloid plaque in the brain, and reduced activity in certain areas of the brain are being researched.
Managing and treating vascular dementia
No FDA-approved drugs specifically for vascular dementia are available, but limited evidence has suggested some drugs approved for Alzheimer’s disease may be somewhat helpful. The main focus of management of vascular dementia, however, is preventing new TIAs or strokes, which includes optimal management of conditions such as high cholesterol, high blood pressure, and diabetes, all of which increase the risk of more blood vessel damage.
Managing these conditions also includes controlling lifestyle factors associated with them. Individuals with vascular dementia should exercise regularly, eat a nutritious diet (e.g., Mediterranean style), not smoke, avoid or limit alcohol, maintain a healthy weight factors.
Among the medications used to manage and treat vascular dementia are antiplatelet drugs such as aspirin, which has been shown to slow disease progression; pentoxifylline, to increase cerebral blood flow; nicardipine, a calcium channel blocker; and neuroprotective drugs such as nimodipine, propentofylline, and posatirelin (currently being studied).
One natural remedy that has been studied specifically for vascular dementia is sailuotong, a Chinese herbal combination. Previous studies have shown the remedy to be effective in treating cognitive impairment and memory problems in patients with vascular dementia, and their success has prompted a new phase III study underway as of this writing.
In cases of vascular dementia, individuals may improve during recovery and rehabilitation after a stroke or TIA as the brain makes new brain cells and blood vessels near the damaged areas. In Alzheimer’s disease, there is a progressive decline in cognitive functioning over time, although the rate of that decline varies.
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Chatterjee S et al. Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia. Diabetes Care 2015 Dec 17. Online before print
eMedicine. Vascular dementia