KYN’s Guide to Vascular Dementia

Vascular dementia is the second most common type of dementia in the UK after Alzheimer's disease, affecting around 150,000 individuals. Unlike other forms of dementia, it develops due to issues with blood supply to the brain.

If you or a loved one has received a diagnosis of vascular dementia, it's important to understand what this means and how to access the right care and support. At KYN, our specialist dementia care team provides guidance to help residents navigate each stage of their journey.

In this guide, we will explore the causes, symptoms and diagnosis of vascular dementia. We'll also discuss the various treatment options available and provide advice on living well with the condition.

Understanding Vascular Dementia

Vascular dementia develops when blood flow to the brain becomes impaired. This damages and kills brain cells, leading to the symptoms associated with the condition. There are several potential underlying causes of reduced blood flow, including:

Stroke

Where a blocked or burst blood vessel suddenly cuts off oxygen to part of the brain. Around 20% of stroke survivors go on to develop vascular dementia.

Transient Ischaemic Attacks (TIAs)

TIAs, or “mini-strokes”, are similar to strokes but smaller and less serious. Experiencing multiple TIAs can cause widespread damage to the brain over time, leading to multi-infarct dementia.

Small vessel disease

Also called subcortical vascular dementia, this involves narrowing of the tiny capillaries deep in the brain, often caused by high blood pressure or diabetes. This stops enough oxygen reaching brain tissue.

Cardiovascular problems

Irregular heartbeat, heart failure, narrowed arteries and other heart issues can cause blood clots leading to blocked vessels.

High blood pressure

Excess pressure strains the blood vessel walls over time, making them more likely to become blocked or burst.

Diabetes

Can damage the lining of blood vessels if blood sugar levels are consistently high. This damage can occur in both type 1 and type 2 diabetics.

Amyloid angiopathy

Build up of amyloid protein in artery walls, making them fragile.

Autoimmune disorders

Conditions like lupus can sometimes trigger inflammation of blood vessels. Some of the most common autoimmune disorders which could contribute to vascular dementia include:

• Addison disease
• Celiac disease
• Dermatomyositis
• Graves disease
• Hashimoto thyroiditis
• Inflammatory bowel disease
• Multiple sclerosis
• Myasthenia gravis

Blood clotting disorders

These increase the risk of clots forming and travelling to the brain. Some of the most common blood clotting disorders include:

• Deep Vein Thrombosis (DVT)

• Pulmonary Embolism (PE)

• Arterial Thrombosis

In most cases, vascular dementia occurs due to a combination of these factors. For example, someone may have high blood pressure and a minor stroke, resulting in cumulative damage. Understanding the underlying cause helps guide appropriate treatment.

Recognising the Symptoms

The symptoms of vascular dementia relate to the death of brain cells in areas that have been starved of blood and oxygen. In the early stages, people often experience issues with planning, judgement, concentration and information processing. This is because vascular dementia typically damages the brain's 'executive functions'. Other common early symptoms include:

• Memory problems, particularly recalling recent events

• Taking longer to perform routine tasks

• Struggling to follow conversations or TV programmes

• Getting lost in familiar places

• Changes in mood and behaviour

As vascular dementia progresses, people may develop additional symptoms such as:

• Increasing confusion about time and place

• Difficulty understanding or producing speech

• Personality changes

• Problems controlling the bladder

• Physical weakness or paralysis on one side of the body

• Vision disturbances such as blurred or lost vision

• Hallucinations, delusions, agitation and restlessness

• Difficulty walking or coordinating movements

The speed of symptom progression depends on the severity of the underlying blood vessel damage.

Diagnosing Vascular Dementia

If you notice potential symptoms of dementia in yourself or someone close to you, it's advisable to see a doctor as soon as possible. They will first rule out other possible explanations, like medication side effects, vitamin deficiencies or thyroid problems. To confirm a diagnosis of vascular dementia, the GP will likely refer you to a memory clinic or specialist service for further assessment. This may involve:

• Physical and neurological examinations to check reflexes, balance, coordination, vision etc.

• Blood and urine tests to look for signs of cardiovascular disease, diabetes or infection

• Cognitive testing to assess thinking skills and memory

• Brain imaging such as CT or MRI scans to reveal areas of damage to blood vessels

• Assessment of family medical history for clues about inherited risk factors

Where available, single photon emission CT (SPECT) scans can show reduced blood flow in specific brain regions. Identifying the location of cell damage helps distinguish vascular dementia from other types. The tests should provide the medical team with enough information to determine the underlying cause. This then allows appropriate treatment options to be considered.

Current Treatments for Vascular Dementia

While there is no cure for vascular dementia, certain treatments can help slow its progression and manage symptoms more effectively. Many treatments aim to protect the remaining healthy brain tissue by improving blood vessel health. This may involve medications to:

• Lower high cholesterol and triglyceride levels

• Reduce high blood pressure

• Prevent blood clots forming

• Regulate heart rhythm

Making lifestyle changes like doing regular exercise, eating a balanced diet, stopping smoking and losing excess weight also helps circulation.

It is also important to stimulate the brain to strengthen unaffected neural pathways. Recommended activities include puzzles, learning new skills, arts and crafts. Music therapy and cognitive behavioural therapy can provide benefits too.

There are also medications that can temporarily alleviate problems like depression, sleep disturbance and agitation. However, these only treat the symptoms rather than the dementia itself.

Adjusting the home environment, using memory aids and establishing fixed daily routines also enables people to retain independence and cope better with symptoms. Care homes specialising in dementia, like KYN, are equipped to provide all of this support.

Rapid Deterioration with Vascular Dementia

Unlike other dementia types that involve gradual decline, vascular dementia can sometimes involve lengthy periods of stability punctuated by stepwise deteriorations.

This occurs when a person experiences further strokes or instances of impaired blood flow. Each incident causes additional damage to the brain, leading to an observable sudden decline in cognitive function, mobility or communication ability.

Deteriorations may be preceded by transient ischemic attacks (also called mini-strokes). These short lapses in blood flow don’t cause permanent damage but warn of heightened risk.

Any sudden worsening of vascular dementia symptoms should be urgently evaluated. Doctors can check for new areas of damage and address any treatable causes.

While not all declines can be prevented, proper management of stroke risk factors gives the best chance of avoiding deterioration episodes. This may involve medication, lifestyle changes, therapy and rehabilitation exercises.

Specialist nursing care, memory aids and routine simplification also help overcome new disabilities. With dedication and support, quality of life can still be preserved.

Stages of Dementia:

Vascular dementia progresses at different rates in each individual. However, most people pass through a similar series of stages from initial mild symptoms to advanced dementia.

Early stages

Difficulty concentrating, planning, making decisions and processing information. Potential mood changes and communication issues. Memory loss is uncommon in the early stages of vascular dementia.

Mid stages

Increasing memory loss, confusion about time and place and difficulty reading, writing and speaking. Vision issues are common, as are depression and anxiety. Mobility problems may emerge.

Late stages

Symptoms continue to develop, with disorientation, memory loss, mood changes and communication difficulties becoming more severe. Hallucinations are not uncommon. Individuals may experience limited mobility, incontinence and problems swallowing, and usually require full-time care and assistance with activities of daily living.

Vascular Dementia Care from KYN

Here at KYN, we provide specialist residential, nursing and dementia care tailored to each individual. Our dementia-friendly homes offer:

• 24/7 support from highly trained carers and nurses

• Regular assessments from specialist dementia nurses and doctors

• Personalised care plans informed by the latest dementia research

• Cognitively stimulating activities from music therapy to art classes

• Adapted environments with appropriate lighting, signage and clear layouts

• Dietary menus designed around each resident’s nutritional needs

• Regular coordinated reviews of dementia medication and treatment

We also support loved ones through the transition into residential dementia care. Our dementia specialists provide expert practical and emotional guidance at every stage. To find out more about the outstanding dementia and residential care we provide, contact KYN today.