Vascular Dementia

Medically Reviewed by Shruthi N, MD on November 13, 2024
10 min read

Vascular dementia is the second most common cause of dementia in older people. Dementia is a group of conditions that affects brain functions such as thinking, memory, and reasoning. Vascular dementia happens when the brain’s blood vessels become damaged, narrowed, or blocked, preventing blood from reaching the brain properly. This disruption causes brain tissue damage, and your brain stops working well.

Because it's less well-known than Alzheimer's, many people don't think of vascular dementia if their forgetfulness becomes problematic. It's also difficult to diagnose, so it's hard to know precisely how many people have vascular dementia. Current estimates suggest that 15%-20% of dementia cases in older adults are due to vascular dementia.

Finding the root cause can help figure out the best action plan. If it's vascular dementia, certain lifestyle changes can help prevent further damage. 

Vascular dementia vs. Alzheimer's

Compared to Alzheimer's disease, which happens when the brain's nerve cells break down, vascular dementia occurs when part of the brain doesn't get enough blood carrying the oxygen and nutrients it needs.

Though they happen in different ways, it is possible to have both vascular dementia and Alzheimer's disease. Discouraging as this sounds, there are ways to control the risk factors that lead to vascular dementia. Allowing the condition to run its course without intervention can make Alzheimer's disease worse.

​​Vascular dementia vs. Lewy body dementia

Lewy body dementia is another type of dementia. It happens when abnormal proteins called "Lewy bodies" build up in the brain. This disturbs the brain’s chemical messengers and affects how the brain works.

When you have Lewy body dementia, your symptoms might include difficulty concentrating, having ideas that aren’t sound, movement problems such as loss of coordination, vision problems, sleep problems, and hallucinations (perceiving things that appear real only to you). It is often diagnosed in people 50 or older, and they tend to live for about five to eight years after getting the diagnosis.

Vascular dementia, on the other hand, happens when your brain doesn't get enough blood. It may cause you to have symptoms that look like those of Lewy body dementia, including having trouble focusing and hallucinations. But you might also experience forgetfulness, faulty decision-making, and difficulty learning and following instructions. Most cases of vascular dementia are diagnosed at the age of 65, and people live for about five years from the time of diagnosis. 

You can have vascular dementia, Lewy body dementia, or even both at the same time. Your doctor will look at your medical history, do a physical exam, and run lab tests and scans to confirm which type you have.

Vascular dementia has many types, including:

Subcortical vascular dementia. This type results from having damaged areas under your brain cortex or outer brain layer. It involves problems with smaller blood vessels.

Single-infarct dementia. With this type, a single stroke damages your brain to the point that you develop vascular dementia. You’re likely to have single-infarct dementia with a stroke when the stroke happens on the left side of your brain, which is the part involved in memory, called the hippocampus. 

Multi-infarct dementia (MID). This dementia is when you have many small strokes — involving medium-sized blood vessels — and damaged areas, called infarcts, in your brain that eventually cause vascular dementia symptoms.

Vascular dementia occurs when vessels that supply blood to the brain become blocked or narrowed. Strokes take place when the supply of blood carrying oxygen to the brain is suddenly cut off. However, not all people with stroke will develop vascular dementia.

Vascular dementia can occur over time as "silent" strokes pile up. Quite often, vascular dementia draws attention to itself only when the effects of multiple strokes add up to significant disability. Avoiding and controlling risk factors such as diabetes, high blood pressure, smoking, and high cholesterol can help curb the risk of developing vascular dementia.

Catching the condition early also helps limit its impact and severity. Early detection requires being aware of risk factors and, more importantly, making efforts to keep them under control. If you're concerned you have symptoms of vascular dementia, talk with your doctor.

Symptoms of vascular dementia depend on what part of the brain is affected and to what extent. Like Alzheimer's disease, the symptoms of vascular dementia are often mild for a long time. They may include:

  • Problems with short-term memory
  • Wandering or getting lost in familiar surroundings
  • Laughing or crying at inappropriate times
  • Trouble concentrating, planning, or following through on activities
  • Trouble managing money
  • Inability to follow instructions
  • Loss of bladder or bowel control
  • Hallucinations or delusions

Symptoms that suddenly get worse often signal a stroke. Doctors look for symptoms that progress in noticeable stages to diagnose vascular dementia. Alzheimer's, by comparison, progresses at a slow, steady pace. Another clue is impaired coordination or balance. In vascular dementia, problems with walking or balancing can happen early. With Alzheimer's, these symptoms usually occur late in the disease.

Sundowning is a symptom of vascular dementia. It involves feeling confused, restless, agitated, irritable, anxious, or sleepless, especially as the sun goes down at night.

It often happens as changes in the brain worsen. But no one knows exactly how or why it happens. Sundowning symptoms might happen with dementia if you’re:

  • Physically and mentally tired
  • In a new or confusing environment
  • In pain
  • Have depression symptoms
  • Have an internal body clock that is active at night and tired during the day
  • See shadows at night that cause you to feel confused, agitated, or hallucinate
  • Don’t sleep as much as you need to 
  • Dreaming during sleep
  • Hungry or thirsty
  • In a place with low-lighting
  • Have an infection such as a urinary tract infection (UTI)
  • Bored

Vascular dementia affects people differently depending on the areas of the brain involved. It may take years for your symptoms to move from mild to severe. Or your symptoms may even get better and then worse again. You could also suddenly have severe symptoms after having a major stroke.

Mild symptoms may occur in the early stages. They include difficulty thinking, making decisions, and following instructions. As the damage to your brain increases, your symptoms can become moderate or severe, leading to increased confusion, mood swings, hallucinations, and memory problems.

Some risk factors for vascular dementia can be managed, while others, such as age and gender, cannot. Among all factors, high blood pressure carries the greatest risk because vascular dementia rarely occurs without it.

Likewise, being at high risk of stroke goes hand in hand with the risk for vascular dementia. One-quarter to one-third of strokes are thought to result in some degree of dementia. People who smoke, drink too much alcohol, have diabetes, or have heart disease also have a higher rate of the condition.

Vascular dementia most commonly occurs in people between the ages of 60 and 75. Men seem to be more vulnerable than women, and the condition affects African Americans more often than people of other races. People whose age, sex, or race puts them at increased risk of vascular dementia have that much more reason to manage risk factors within their control.

Neurologists or doctors specializing in brain and nervous system disorders, psychiatrists specializing in treating older adults, psychologists specializing in brain health, and doctors trained to treat older people can diagnose dementia.

Your doctor will look at your medical and family history, ask about your symptoms and the medications you’re taking, and do a physical exam, mental status tests, lab tests, and a CT scan or MRI to diagnose you with dementia. These tests will also help confirm that you have vascular dementia and not some other type. 

Mental status testing

Your doctor might ask you simple questions or tell you to do simple tasks to see how you do them. You might have to do a more detailed test called a neurocognitive test. It takes about one to three hours. It checks how well your brain works as well as your mood, testing skills like problem-solving, learning, language, planning, reasoning, judgment, and memory. 

CT scan or MRI

These imaging tests check if you’ve had a stroke that may have resulted in your vascular dementia symptoms. They produce an image of your brain, and if you’ve had a stroke, the image might show bleeding, tumors, and fluid in your brain.

Lab tests

These tests will check if you have diabetes, high cholesterol levels, or other health problems that might make you more likely to have a stroke. You might also do blood tests to check your nutritional status and confirm that a deficiency (such as lacking vitamin B12) isn’t causing your symptoms. Blood tests could help your doctor check if other conditions, such as an infection, are causing your symptoms.

Your doctor may diagnose you with vascular dementia if:

  • The mental status or neurocognitive testing indicates you have vascular dementia or cognitive problems.
  • The MRI or CT scan shows you’ve had a stroke recently.
  • Other tests suggest that your symptoms are not from other causes or conditions.

Currently, no available treatments can repair the damage of vascular dementia once it's happened. Nonetheless, a diagnosis provides the opportunity to prevent further damage.

Prevention typically involves bringing high blood pressure under control through exercise, diet, and medication. The same goes for diabetes if it exists. Patients should stop smoking and curb the use of alcohol.

While medical options are limited, behavioral interventions such as cues and reminders can improve the quality of life for everyone involved. Family members and friends can place notes in visible locations around the house to help the person with vascular dementia. These notes can include daily plans and instructions for how to use basic items. Stepping up communication by reminding the person with vascular dementia what day it is, where they live, and what is going on in the family can help keep them connected to the here and now.

If the conditions that cause vascular dementia go untreated, the prognosis is not good. A person with vascular dementia may seem to improve for certain periods until another stroke limits brain function, memory, and independence. Untreated vascular dementia usually ends in death from stroke, heart disease, or infection.

Although vascular dementia is a serious condition, catching it early and preventing further damage are the best medicines. People with vascular dementia can work with their doctors and families to detect and manage the condition.

Vascular dementia life expectancy

The life expectancy of somebody with vascular dementia is around five years. It has the lowest life expectancy compared to other types of dementia, including Alzheimer’s, which is around 8-10 years. That's because people with vascular dementia may die from a stroke or a heart attack rather than the vascular dementia symptoms.

Vascular dementia has no cure. Your symptoms can worsen with time, but you might also have periods where your symptoms feel the same. Your physical and mental symptoms might also affect your ability to do everyday tasks, so you might need the help of loved ones or a caregiver. 

Ask your doctor about a care plan that explains the care you’ll get now and later as your symptoms change or worsen. It will also explain how to manage changes that happen with dementia. 

Your care plan could include:

  • Your current treatment
  • Eating or exercise plan
  • Health and fitness-related goals, such as quitting smoking
  • Your support needs
  • Your immediate point of contact when you’re unwell

You can review your plan yearly or more frequently as needed so it’s up-to-date for your case.

As the disease gets worse, you might need extra support and specialized care. You might also need to start living in a long-term care facility for people with dementia. 

In the meantime, you can develop habits that help you live better and feel supported with dementia. These habits include:

  • Staying connected with loved ones and the people around you. You could have family dinners, daily calls, and texts with those who don’t live nearby.
  • Sleep more, eat a healthy, balanced diet, walk or do other physical activities that interest you daily, and stay hydrated.
  • Express your feelings by starting a journal or engaging in hobbies that allow you to have an outlet, such as painting, drawing, or taking images.
  • Join a support group to surround yourself with people who can relate to you and help you feel less isolated in your experience. You can find support groups for people with dementia at the Alzheimer’s Association and Alzheimer’s Foundation of America.
  • Engage in activities that make life more meaningful, such as volunteering, mentoring, or spending more time on hobbies.
  • Take time during the day to be still and check your mood. You can meditate, take nature walks, or disconnect from social media. 
  • Do activities that stimulate your mind and help you build mental skills, such as taking quizzes, completing puzzles, going to a museum, or learning a new skill.

Vascular dementia often happens after several small strokes or a major stroke, when your brain isn't getting enough blood, oxygen, or the nutrients it needs. Your symptoms may start slowly, or they can be sudden after a major stroke. These symptoms include forgetfulness, hallucinations, difficulty following instructions, and struggling to learn new things. If your doctor believes you have vascular dementia, they will likely suggest medicines to manage underlying health conditions that affect blood flow. They may also suggest lifestyle changes to help slow the progression of the disease.

How does a person with vascular dementia act?

A person with dementia may become forgetful, have mood changes, struggle with learning new things or following instructions, hallucinate, wander, and laugh and cry inappropriately or uncontrollably.

Can you recover from vascular dementia?

Vascular dementia is a lifelong condition. Treatment, lifestyle changes, and support from your loved ones and care team can help you manage your symptoms with the condition.

Is vascular dementia worse than Alzheimer's?

Everybody experiences vascular dementia and Alzheimer’s differently, and one isn’t necessarily worse than the other. But vascular dementia generally has a shorter life expectancy, averaging about five years, unlike Alzheimer’s, which could range from 8-10 years.