Treating vascular dementia

There are various ways to treat vascular dementia without using medication. The goal is to improve the person’s mental performance and their ability to do things for themselves. In Germany, statutory health insurers don’t cover the costs of all these treatments. Your insurer will be able to tell you whether you’re covered.

The word “cognitive” is used to describe anything to do with mental ability, such as perception, thinking and memory. Cognitive stimulation therapy involves various mental exercises for people with mild to moderate dementia. They include things like mental arithmetic, orientation exercises, conversation, and creative work such as painting, handicrafts, and pottery. The exercises take place on a one-to-one basis or in groups, often once or twice a week for 30 to 90 minutes.

The important thing is that cognitive exercises need to be adapted to the person’s individual abilities and needs, and supervised by professionals.

The word “reminiscence” comes from the Latin word for remembering. This type of therapy gives people an opportunity to talk about things like their childhood, school days or previous jobs. It is done in individual or group settings. The aim is to improve mental skills (like memory and communication) and quality of life. Research suggests that reminiscence therapy can lift people’s mood and slightly improve their mental ability. It is recommended for all stages of the disease.

Occupational therapy is an effective way to practice the skills a person needs in day-to-day life, like getting dressed and doing housework. Occupational therapists help people lead as independent a life as possible. They do this through various exercises and activities, giving advice and suggesting changes to make life easier. Occupational therapy sometimes also includes concentration and memory training.

As with many other diseases, physical activity provides a range of health benefits for people with vascular dementia. It is important that they stay active because that stops them becoming bed-ridden, for instance. Studies have shown that people with dementia can stay mobile for longer if they take part in exercise programs. Combined programs to increase strength, suppleness and balance can help people do things for themselves for longer. The programs may include things like walking, strength-building and endurance exercises. The sessions are held roughly two to three times per week and last 30 to 60 minutes.

Exercise and sports can sometimes be too much for people and lead to injuries, so it’s important to adapt exercise programs based on a person’s abilities and needs.

Music therapy takes place in individual (tailored) or group sessions. It involves either actively making music (singing, for example) or listening to music, depending on the program and what’s possible. Research has shown that music therapy helps to lift people’s mood and make them feel calmer.

Medication can help prevent further strokes and additional brain damage. The following categories of medication are often used, depending on the underlying disease:

Too high blood pressure can cause damage to blood vessels, resulting in further strokes and bleeding in the brain. But blood pressure can be kept under control with certain medications. These include ACE inhibitors, angiotensin receptor blockers (ARBs), beta blockers, diuretics and calcium channel blockers (CCBs).

Statins are drugs that can prevent strokes and heart attacks. They are also described as cholesterol-lowering drugs or lipid-lowering drugs because they reduce the level of certain fats (LDL cholesterol) in the blood.

• Antiplatelets: If the underlying condition is arteriosclerosis (narrowing of blood vessels), antiplatelets can lower the risk of blood clots causing damage to the blood vessels in the brain. These drugs are also called platelet aggregation inhibitors. They include acetylsalicylic acid (the drug in medicines like Aspirin) and clopidogrel.
• Oral anticoagulants (OACs): OACs have a stronger effect than antiplatelets do. They are used to prevent clotting in people with atrial fibrillation, for example. This type of irregular heartbeat is associated with a high risk of stroke. Examples of OACs include vitamin K antagonists like warfarin and phenprocoumon (better known under the trade name “Marcumar”) and direct oral anticoagulants (DOACs).

People who have diabetes have an increased risk of stroke. To prevent further brain damage and slow down the vascular dementia, it’s important that they keep their blood sugar at a good level.

In Germany, drugs for Alzheimer’s (anti-dementia drugs) haven't been approved for the treatment of vascular dementia. There is only little research into the benefits of drugs such as acetylcholinesterase inhibitors or memantine for people with vascular dementia. The research suggests that these drugs can help to do things like adapt to changes in day-to-day life for a while. But they’re still only recommended in isolated cases (off-label use). People who have Alzheimer’s as well as vascular dementia can use anti-dementia drugs, though.

There is some weak evidence that high doses of Ginkgo biloba extract can improve a person’s ability to think clearly for some time. Ginkgo has been approved for the treatment of vascular dementia (at certain doses). It can be considered as a treatment option. But it can also increase the risk of bleeding. So it’s important to discuss the potential benefits and side effects with your doctor. In Germany, statutory health insurers will pay for Ginkgo extract products if they’ve been prescribed by a doctor.

If the dementia has an effect on somebody’s personality and behavior, both medication ( psychotropic drugs) and non-medication treatment options are possible. The first step is to get an accurate assessment of the person’s situation. The aim is to identify any factors in their immediate environment, like conflict or noise, that can be dealt with so the distress is reduced. Psychotropic drugs are only considered if other interventions haven't helped. But they can be given immediately if there’s an acute risk of the person harming themselves or others.

People who are close to someone with vascular dementia are offered practical support and training. The aim is to help them understand the disease better and cope with it in day-to-day life. The practical support includes information about services covered by health insurance and nursing care insurance, as well as information about the financial support available. The psychosocial counseling offered helps family members deal with applications and difficult situations that arise when they’re providing care.

It is helpful for family members if they’re involved in the diagnosis process and planning the treatment. Looking after someone with vascular dementia can be difficult, so there are programs to teach them how to cope. The aim of this training is to lessen the emotional burden, benefiting both the family member(s) and the person they’re caring for. Family members can get support in person, on the phone or by video call – depending on what suits them better. Apart from getting advice from experts, it can also be helpful to talk with other families so you can share practical tips and support each other.