by Alan R

Vascular Dementia

(Binswanger’s Disease; Senile Dementia; Binswanger’s Type; Vascular Cognitive Impairment; Arteriosclerotic Dementia; Atherosclerotic Disease)

Definition

Vascular dementia is a type of dementia. It is caused by disease of the small blood vessels in the brain. Parts of the brain called white matter along with grey matter are injured by multiple small strokes.
Healthy and Injured Brain Blood Vessels
Blood Flow and Lack of Blood Flow to the Brain
Copyright © Nucleus Medical Media, Inc.

Causes

Vascular dementia occurs when cells below the surface of the brain's cortex die because they do not receive enough oxygen and nutrients. This process is due to hardening and narrowing of the blood vessels within the white matter of the brain. This affects the blood supply.

Risk Factors

Factors that may increase your chances of developing vascular dementia include:
  • Increased age
  • High blood pressure—the most closely associated risk factor
  • Alzheimer’s dementia—can occur along with vascular dementia
  • Cardiovascular disease
  • Hardening of blood vessels—atherosclerosis and lipohyalinosis
  • Diabetes
  • Smoking
  • Conditions that cause the blood to clot
  • Genetic disorders

Symptoms

In some people, symptoms appear suddenly with neurologic changes like those caused by a stroke. Sometimes, the small strokes that lead to vascular dementia can happen without other symptoms. This makes the condition difficult to detect.
In some cases, symptoms may stabilize or even improve. However, in most people, the disease continues to progress.
The main symptoms of vascular dementia include:
  • Progressive loss of intellectual abilities, processing speed, and cognitive and motor abilities
  • Progressive memory loss
  • Slow, unsteady walking
Other symptoms that may be present include:
  • Incontinence
  • Personality changes
  • Laughing, crying, or smiling during inappropriate times
  • Difficulty speaking
  • Swallowing difficulties
  • Paralysis or weakness of one or both sides of the body
  • Loss of interest in activities
  • Inactivity
  • Depression
  • Tremors, loss of coordination, loss of trunk mobility
  • Seizures
  • Nighttime confusion
  • Paranoia
  • Disorientation

Diagnosis

The symptoms of vascular dementia can resemble other causes of dementia, such as Alzheimer’s disease.
Your doctor will ask about your symptoms and medical history. A physical exam will be done.
Pictures may be taken of your brain and bodily structures. This can be done with:
  • MRI scan
  • CT scan
  • Single photon-emission computed tomography (SPECT)
  • Ultrasound
Your heart and brain activity may be evaluated. This can be done with:
Your bodily fluids may be tested. This can be done with blood tests.

Treatment

There is no known cure for vascular dementia. Reducing risk factors and symptoms are important in trying to slow disease progression and improve quality of life.
Medications can be given to help limit or control symptoms and possibly slow progression of the disease. These include:
  • Medications to control:
  • Antidepressant medications
  • Nimodipine—may help improve cognitive function in the short-term, but lacks evidence to support its long term use
  • Medications used to treat Alzheimer's disease, such as donepezil and memantine

Prevention

There are no definitive guidelines to prevent vascular dementia. However, the following may help reduce your risk:
  • Don’t smoke. If you smoke, talk to your doctor about how you can successfully quit.
  • Eat a diet that is low in fat and low in salt.
  • If you drink alcohol, do so only in moderation. Moderate alcohol intake is two drinks per day for men; one drink per day for women.
  • Have your blood pressure and blood cholesterol levels checked at least once a year.
  • If you have diabetes, maintain your blood glucose in your target range.
  • Avoid low blood pressure. If you get lightheaded when you stand up, or have a history of fainting, talk to your doctor.

RESOURCES

Alzheimer’s Association http://www.alz.org

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

CANADIAN RESOURCES

Alzheimer Society of Canada http://www.alzheimer.ca

Heart and Stroke Foundation of Canada http://www.heartandstroke.com

References

Binswanger’s disease—revisited. Neurology. 1995;45: 626-633.

Kirschner H. Vascular dementia: a review of recent evidence for prevention and treatment. Curr Neurol Neurosci Rep. 2009;9(6):437-442.

Roman GC. Brain hypoperfusion: a critical factor in vascular dementia. Neurol Res. 2004;26:454-458.

Roman GC, Erkinjuntti T, Wallin A, et al. Subcortical ischaemic vascular dementia. Lancet Neurology. 2002;1:426-436.

Smith EE. Leukoariosis and stroke. Stroke. 2010;41(10 Suppl):S139-143.

Tomassoni D, Lanari A, Silvestrelli G, Traini E, Amenta F. Nimodipine and its use in cerebrovascular disease: evidence from recent preclinical and controlled clinical studies. Clin Exp Hypertens. 2008;30(8):744-766.

Vascular dementia. Alzheimer's Association website. Available at: http://www.alz.org/dementia/vascular-dementia-symptoms.asp. Accessed July 29, 2013.

Vascular dementia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 8, 2013. Accessed July 29, 2013.

Vascular dementia: a resource list. National Institute on Aging website. Available at: http://www.nia.nih.gov/alzheimers/vascular-dementia-resource-list. Accessed July 29, 2013.

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