Vascular Dementia

Vascular dementia is the second most common type of dementia and it occurs when the blood supply to the brain is damaged. The cells in the affected area of the brain start to die because they are not getting enough oxygen.  There are three  main types of vascular dementia. Subcortical dementia is thought to be the most common type of vascular dementia. It is caused by diseases of the very small blood vessels that are in the inner parts of the brain.  Multi-infarct dementia is a type of vascular dementia that is caused by small strokes. The strokes can be so tiny that no-one notices them happening, but the person may get worse quite suddenly and then not change again until the next stroke happens. As a result, the progression of this dementia is often described as happening in steps rather than steady gradual changes, such as in Alzheimer’s disease.  Vascular dementia can also be caused when somebody has a stroke. This is called stroke related dementia . When a person has a stroke, the blood supply to a part of the brain is cut off, damaging and killing brain cells. Some stokes are worse than others, and the damage can vary from person to person.

There is no one test used to diagnose a type of dementia. Rather, the diagnosis involves a range of assessments and tests and this can mean that confirming a diagnosis can take time, particularly in the early stages.

A diagnosis of dementia usually begins with a General Practitioner, GP.  It can be helpful to make a note of the changes causing concern before your visit to help you to talk to the GP about them. Perhaps keep a diary to help you to do this.

The GP will generally begin an assessment by ruling out other possible causes of symptoms you are experiencing; this may involve running some tests including blood tests and memory tests as well as an overview of your general health. Some other possible causes of the symptoms you are experiencing include thyroid disorders, vitamin deficiency and side effects of some medication.

The GP may refer to a consultant who will conduct a full assessment to try to establish the cause of the symptoms.   You can download our factsheet, Who’s who in Dementia care  to understand the different professional involved in the dementia journey. If you want a physical copy, you can ring our National Helpline on 1800 341 341 and we can post it out to you.

If you are under 65, you will be referred to a neurologist or a memory clinic. If you feel a referral to a specialist would be helpful you can discuss this with the GP.

The consultant will conduct a full assessment to try to establish the cause of the symptoms. They usually work with a specialist team and you may see a number of people from this team. This process usually includes

• Blood tests,
• A full history of family medical background,
• A physical examination,
• An assessment of memory, thinking and activities of daily living,
• A brain scan (CT, MRI) to identify any changes taking place in the brain which may form part of the assessment, but this may not be required for every case.

The doctors will work directly with the person who is experiencing changes. The doctor may also ask family members to talk about any changes they see or any concerns they may have.

After the assessment, the consultant will draw together all the results and determine what is happening. It may be that the assessment is repeated at a later date in order to identify further changes and confirm a diagnosis.

What if a diagnosis is made?

A diagnosis of dementia can come as a shock, no matter how much it is expected. It is hard for everyone concerned and reassurance and support are vital. The most important thing is to try to be positive and to know that you are not alone. There are people you can talk to and supports and services that can help.

Your GP will be an important person to support you to live well with dementia. You can talk to them about your dementia, about any medications and treatments you may be prescribed, about areas such as driving and about any symptoms that may emerge.  You can contact our National Helpline on 1800 341 341 for information on services and supports available . You can also read our factsheet Early symptoms and diagnosis.

Progression of vascular dementia 

Vascular dementia is generally caused by a stroke or a series of small strokes. As a result this type of dementia may progress in a ‘stepped’ manner, which differs from the more gradual progression of Alzheimer’s disease. Symptoms may appear to suddenly worsen due to a stroke and then remain level for a period of time. It may be months or years until the next stroke occurs and symptoms can then worsen. Where vascular dementia is caused by a series of small strokes, then symptoms can emerge in a more gradual way.

People with vascular dementia tend to maintain their personality and emotional responsiveness until the later stages of the condition. This can mean that people are more aware of their condition and can be more prone to depression than people with Alzheimer’s disease.

In general people with vascular dementia live for around five years after symptoms begin. In many cases, the person’s death will be caused by a stroke or heart attack.

People with vascular dementia often need medications for underlying conditions such as stroke, high blood pressure, diabetes, high cholesterol or heart problems. Controlling these conditions and adopting a healthy lifestyle by not smoking, drinking only in moderation, taking regular exercise and eating a balanced diet may help to delay the progression of this dementia.

People with dementia may be prescribed a range of medications to help relieve behavioural symptoms and depression. These medications can include

• sleeping tablets
• tranquillisers
• anti-anxiety drugs
• antipsychotic drugs
• anti-depressants

Not every person with dementia will need these medications; there are other methods to help manage these symptoms. Some people may need medication for a short period.

A decision to prescribe these medications should involve a full assessment of the person with dementia, their physical health and well-being. A Psychiatrist of Old Age may be introduced to carry out this assessment and help manage the symptoms. Areas such as unrecognised pain, eyesight, hearing and dental health should be explored to see if there are any other causes for the behaviour. It may be possible that the behaviour results from something in the environment triggering a response.

Talk to the doctor about daily routines, likes and dislikes so they can build a complete picture and help to identify what is triggering the behaviour. There are many ways to manage symptoms and behaviours that may emerge, and medication is one option that may or may not be suitable.

Managing medication

With all medication, it is important to understand what drugs are being prescribed, why they are being prescribed, what benefits they are supposed to bring, and what side-effects may emerge. Where possible, it is important for the person with dementia and a trusted person to discuss this with the prescribing doctor. In 2019 the Department of Health launched a national clinical guideline for the “appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia”. A guide for people with dementia was published and is available HERE

If a person with dementia is unable to participate in a discussion about medication, it is vital that their family or carer understand what is being prescribed and why. Talk to the doctors and ask questions. Ask them to provide information about the medications and to write out dosages and times to take them. It is also important to give doctors feedback on any changes experienced when taking the medication, both positive and negative.

You can talk to your doctor or pharmacist about issues that may arise.  Your pharmacist may be able to provide the medications in a blister pack or a medication box which arranges medication by day and time or log onto www.dontforget.ie. Building a relationship with a pharmacist can be helpful. You can also get electronic blister packs, which are set to a timer, and only open up at certain times of the day. For more information contact your local Memory technology resource room. click HERE or you can contact our National Helpline on 1800 341 341 and our Helpline team can provide you with details of your local resource room.

It may also be helpful for another family member or friend to know the medication routine and the name of the doctor and pharmacist you work with. The HSE have created a leaflet for people to keep track of their medication. You can bring this to any medical  appointments you may have. You can view the leaflet HERE 

Treatment 

There is currently no cure for vascular dementia. Some treatments can sometimes help to slow down the progression of vascular dementia. This can include:

•  Being more physically active
•  Stopping smoking
•  Maintaining a healthy weight
• Eating a balanced diet
• Cutting down on alcohol
• Taking medication if you have high blood pressure, or high cholesterol.
• Keeping your diabetes stable if you have diabetes.