Vascular dementia

The symptoms of vascular dementia are similar to those of Alzheimer’s, although there are sometimes differences. The condition is caused by blood flow problems in the brain, which is why it’s called “vascular dementia” (from the Latin word “vas” for “blood vessel”). Typical symptoms include the following:

• Reduced ability to think clearly: The person becomes less able to pay attention, remember things and concentrate, and their thinking slows down. They have more trouble finding their way around.
• Changes in behavior: The person might become lethargic and indifferent, have frequent mood swings, and sometimes depression or anxiety.
• Communication problems: Their vocabulary shrinks and they have more trouble finding words.
• Abstraction problems: The person’s sense of time, judgment, mental agility and spatial vision (ability to judge how close or far away things are) get worse. Their behavior can become “rigid.”
• Physical symptoms: The person might develop walking or swallowing problems, vertigo (dizziness), problems when urinating (peeing) or paralysis in their face muscles.

The symptoms differ in type and severity depending on which parts of the brain are damaged, and how much. They often come and go over the course of the illness, and may get noticeably worse in phases.

Certain symptoms are more common in vascular dementia than in Alzheimer’s. These include reduced attention span and reduced ability to concentrate. Vascular dementia is also more likely to cause physical symptoms or unusual behavior such as laughing or crying for no reason. In the initial stages of vascular dementia, forgetfulness is not as common or severe as it is in Alzheimer's.

The two types of dementia can occur together. These combined forms can have a stronger impact and progress more quickly.

Vascular dementia is usually caused by a series of small strokes. But it can be caused by a brain hemorrhage too. In both cases, some parts of the brain don’t get enough oxygen (ischemic stroke). This can result in damage to the brain tissue, which can lead to dementia symptoms.

Depending on which part of the brain is damaged, even one-off, small strokes or minor bleeding in the brain can cause major symptoms. Elderly people’s brains often have traces of numerous past strokes, which can be seen when they have MRI or CT scans for instance.

Factors that increase the risk of a (further) stroke or vascular dementia include:

• Old age
• High blood pressure
• Blood fat (lipid) levels being too high
• Smoking
• Diabetes
• Being extremely overweight, lack of exercise
• Some types of heart disease, like atrial fibrillation

About 1.6 million people in Germany have dementia. Most of them are women. This is mainly because women live longer than men on average, and the disease is more common after the age of 80.

Dementia mainly occurs in older people:

• Between the ages of 65 and 69, just over 1% of men and women have the disease.
• Between the ages of 85 and 89, it affects roughly 16% of men and 25% of women.

Alzheimer’s and vascular dementia are the most common forms. They can also occur together. This combined form happens more often in people of an advanced age.

It is estimated that roughly 1 in 10 people who have a stroke develop dementia symptoms in the course of the next year. People who have had several strokes or one major stroke have a higher risk, with about one third developing vascular dementia.

One of the factors that determine the course of the disease is the parts of the brain that have been damaged. Treatment and rehabilitation also play a key role. Some people’s symptoms improve, depending on the type of brain damage and where it occurs.

Other people’s symptoms get worse over time. The symptoms depend on how far the disease has progressed. In the early stages, the person might experience some difficulties in their day-to-day life but often they’re able to overcome them. Later, the symptoms worsen and the person needs more support. In the late stages of the disease, they need help with basic things too, like meals and personal hygiene.

Doctors diagnose vascular dementia if someone has typical symptoms and an examination has shown that blood vessels in their brain are damaged. A range of diagnostic approaches are needed because imaging techniques like computer tomography (CT) and magnetic resonance imaging (MRI) aren't enough to be able to say whether the person has vascular dementia or not.

The doctor will first ask about the person’s symptoms, problems in everyday life, and general life situation. They will ask whether the person has mood swings or whether their emotional state has changed. Any medication taken, lifestyle, and physical and mental illnesses will also be discussed.

It can be helpful if someone comes along to the appointment for support. This is because family members or friends often notice changes in behavior that the person affected by the disease doesn’t notice. Or the person may be too ashamed or embarrassed to talk about it.

Certain tests can be done to get an idea of how far the disease has advanced and how it might progress. There are short tests where a trained professional asks questions and gives the person small tasks to test their memory, judgment, speech and concentration. These tests usually last about 15 minutes.

The tests commonly used in Germany are the Montreal Cognitive Assessment (MoCA), the Mini-Mental Status Examination (MMSE), the Dementia Detection Test (DemTect) and the “clock-drawing test.” They help the doctor decide whether the person’s symptoms come from dementia and how severely affected they are. To get a more exact diagnosis, though, neuropsychological testing is often needed. This is more extensive.

There are various examinations that can help to diagnose vascular dementia or rule out other causes such as depression or thyroid problems. They include scans like computer tomography (CT) or magnetic resonance imaging (MRI) scans, electrocardiograms (ECGs), blood pressure checks and blood tests. Neurological examinations check things like the ability to coordinate movements. Sometimes the doctor will take fluid from the lumbar (lower) spine to test it for other causes, such as inflammation or Alzheimer’s. Positron emission tomography (PET) scans are sometimes used as a diagnostic tool too. In certain situations – for example, if the person being diagnosed is young – doctors might do a genetic test for hereditary vascular dementia.

Treatment for vascular dementia has two main goals:

• To stop the blood supply to the brain getting any worse in order to prevent further brain damage.
• To reduce existing symptoms and slow down the progression of the disease.

The choice of medication to prevent further brain damage will depend on the person’s risk factors and any other health problems they have. Medication to reduce high blood pressure and cholesterol levels might be used, for instance. Atrial fibrillation can be treated with blood thinners to prevent clotting. People who smoke can try out various products to help them kick the habit.

Examples of symptom-reducing treatment without medication include memory training and orientation exercises. The aim is to help the person deal with day-to-day life and maintain or improve their quality of life as much as possible. The treatment given depends on the person’s needs, situation and symptoms. Apart from neurologists, the treatment team often includes healthcare professionals from other fields, like nurses, psychologists, occupational therapists and physiotherapists.

Family members usually find it helpful to get some training on how to help and support the person in everyday life. In Germany, the nursing care insurance funds (Pflegekassen) offer special, free training courses for relatives of people with dementia as well as advice and courses on caring for them. There are also many local Alzheimer’s societies that provide information about where those affected by vascular dementia can get free advice and training.

If someone has a stroke or several strokes, the usual recommendation is for them to have rehabilitation therapy as soon as possible. But there are also rehabilitation programs especially for people with vascular dementia. Rehabilitation therapy usually takes place at rehabilitative care centers, mostly in the form of an inpatient program. But there are also outpatient programs and mixed programs.

The aim of rehabilitation therapy is to

• help the person lead an independent life;
• improve their ability to communicate;
• improve their physical fitness and mobility by, for example, treating walking disorders;
• improve their sleep habits;
• help make sure they eat and drink enough and regularly;
• treat mental health problems such as depression and anxiety.

Depending on the person’s needs, rehabilitation programs include cognitive exercises like math tasks, puzzles, reminiscence therapy, and speech training. But they may also include physical, exercise, and sports therapy. In occupational therapy, the person learns how to be as independent as possible despite having physical problems. Rehabilitation is particularly important for people who’ve had a stroke because it helps them to lead an independent life again.

Research has shown that it’s possible to overcome at least some of the problems that come with dementia, especially in mild to moderate cases. This is mainly true for problems to do with physical strength and endurance, walking and taking care of oneself.

Being diagnosed with dementia comes as a shock to most people because it’s a condition that completely changes their life. But sometimes the diagnosis makes it easier to understand previously inexplicable changes in behavior or personality.

Every person who develops vascular dementia experiences their situation differently, and copes with it differently. Some people are able to accept the disease and to go on living an active and satisfying life for as long as possible despite the related problems. Others have a harder time. They may become withdrawn, and are often sad or depressed. Still others will try to ignore the disease and its symptoms. Another aspect is that a lot of people who develop dementia after having strokes worry they might have more strokes in the future.

Over time, they may learn to deal with their problems and fears and to accept their illness. An important part of that is the support they receive from others, and especially from their family.

The strain on family members is usually high, especially in the later stages of the disease, and they typically need support themselves at some point. It is important that both they and the person with the disease are involved in planning the treatment and offered support in line with their personal situation and needs. As well as training, this can include practical matters like financial support and advice on applying for assistance.

Sharing experiences with others affected by the disease and those close to them, for example in a support group, is often considered to be helpful. Learning how others stay active and keep up hobbies like singing, hiking, cooking or painting inspires them to be strong. Taking part in activities also helps them keep their mind off the disease. Many people with dementia are able to maintain a good quality of life and lead a satisfying life for a long time.

When someone has very advanced dementia and needs an increasing level of care, those around them may get to a point where they can no longer manage. Moving to a facility providing professional nursing care, support and medical treatment can then be the best solution for everyone. It is often not easy to make the decision to move into a care home or assisted living facility, particularly because it can take some time to find a suitable place. But there’s an increasing range of good-quality support that caters specifically to the needs of people with dementia.

A wide range of help is available for people with vascular dementia and their families. It includes information centers and support groups that can give advice on various nursing-care-related, financial and psychosocial matters.

Many cities and local communities have special centers that provide information on nursing care, free of charge. Family members can also attend free caregiving courses that cover things like basic nursing skills. Some of these courses are even carried out at the person’s home.

There are many regional differences in how these services are organized, and they're not always easy to find. So we’ve put together a list of places that you can contact to find out where to get help locally in Germany.

Germany’s Federal Ministry of Health has published a book that covers key questions concerning dementia, the support available, and caregiving by family members and professionals. The book is in German and it's called “Ratgeber Demenz.” The Federal Ministry for Family Affairs, Senior Citizens, Women and Youth runs a (German-language) website called “Wegweiser Demenz,” with information about the disease and how to contact others affected and specialized healthcare professionals.