Understanding stroke

Dementia refers to a group of symptoms suggesting cognitive decline. This includes problems with memory, communication, and concentration. Dementia can happen after your brain has been damaged by an injury or disease like a stroke.

A stroke, or a “brain attack,” occurs when blood flow to the brain is interrupted. If this happens because a blood vessel bursts, it’s known as a hemorrhagic stroke. Although this type of stroke is less common, it’s more likely to result in death.

If your stroke happens because a blood vessel is blocked by a blood clot, it’s known as an ischemic stroke. This type of stroke accounts for 87 percent of all strokes.

If blood flow is only interrupted for short time, it’s known as a transient ischemic attack (TIA), or a “mini-stroke.” TIA lasts less than 24 hours before disappearing.

Both ischemic stroke and TIA are associated with vascular dementia. Vascular dementia is the second most common form of dementia.

Can having a stroke increase your risk for vascular dementia?

Vascular dementia can make it difficult for you to process information. Although it’s a common post-stroke problem, not everyone who has a stroke is at risk for vascular dementia. Your risk depends on the location and severity of your stroke. Your age, sex, and family history are also factors.

In a 2012 study, researchers reviewed nine studies on dementia in people who have had a stroke. In total, the study looked at 5,514 people with pre- or post-stroke dementia. Researchers found that rates of post-stroke dementia were between 9.6 and 14.4 percent in people who have had one stroke. This rate increased to 29.6 to 53.1 percent in people with recurrent stroke.

It’s worth noting that adults over age 65 who have a high risk of stroke also have a high risk of dementia unrelated to stroke. In the same 2012 study, researchers found that stroke is a risk factor for dementia, and dementia is a risk factor for stroke.

Rates from nine studies show that about 10 percent of people who have had a stroke will develop dementia within the first year after the stroke.

Are there different types of vascular dementia?

There are four different types of vascular dementia. Three of these types are related to stroke. Each type is in a different part of the brain and results from a different type of damage. Symptoms vary and can progress in different ways.

Single-infarct dementia

An infarct refers to an area of cells that’s died from a lack of blood supply. This typically happens when someone has one large ischemic stroke.

Multi-infarct dementia

This type generally occurs after a person has multiple mini-strokes over time. These mini-strokes can cause tiny spots of damage scattered throughout the brain.

Subcortical dementia

Although this type is caused by small vessel disease, it’s associated with lacunar stroke. Small vessel disease can happen when vessels deep inside your brain become completely blocked as a result of a lacunar stroke. The resulting damage may progress to subcortical vascular dementia.

Mixed dementia

When vascular dementia occurs at the same time as Alzheimer’s disease, it’s known as mixed dementia. One of the two types is generally more apparent. The dominant type will determine the course of treatment.

What are the symptoms of vascular dementia?

The symptoms of vascular dementia can vary from person to person, and type to type. If you’ve had a stroke, you may find that your symptoms develop suddenly. Symptoms typically develop more gradually when vascular dementia is the result of another condition, such as small vessel disease.

Early cognitive symptoms of vascular dementia include:

  • problems with planning or organizing
  • difficulty following directions, such as when cooking or driving
  • feelings of slowness or confusion
  • trouble concentrating

If your vascular dementia is still in the early stages, you may also have trouble with:

  • mild memory loss
  • spatial awareness
  • speech

It’s also common to experience mood changes. These may include:

  • apathy
  • depression
  • anxiety
  • rapid mood swings
  • unusually extreme highs or lows

Diagnosing vascular dementia

Although doctors can generally diagnose dementia, it’s difficult to determine the specific type of dementia. It’s important to take note of any symptoms that you’re experiencing, no matter how minor or infrequent. This can help your doctor narrow down the possible causes and make a more accurate diagnosis.

Your doctor will also look at your complete medical history. If necessary, they will test your:

  • blood pressure
  • blood sugar
  • cholesterol

Your doctor will likely check your overall neurological health. To do this, they will test your:

  • balance
  • coordination
  • muscle tone and strength
  • ability to stand
  • ability to walk
  • reflexes
  • sense of touch
  • sense of sight

They may also order tests to rule out other possible causes of memory loss and confusion, including thyroid disorders or vitamin deficiencies.

Brain imaging tests, such as a CT scan or MRI, may also be needed. These can help your doctor identify any visual abnormalities.

Because vascular dementia is a complex condition that gets progressively worse as time goes by, your doctor may recommend seeing additional specialists.

How is vascular dementia treated?

Although there aren’t any medications specifically for vascular dementia, treatment plans often include medication recommended for people with Alzheimer’s disease. Alzheimer’s disease is the most common type of dementia.

There are two types of drugs used for managing Alzheimer’s disease. Cholinesterase inhibitors boost the levels of a chemical messenger in your brain that’s involved with memory and judgment.

Side effects may include:

  • nausea
  • vomiting
  • diarrhea
  • muscle cramps

Memantine also manages a chemical messenger in the brain. This messenger deals with information processing and memory.

Side effects may include:

  • headache
  • dizziness
  • confusion
  • constipation

Treatment plans for vascular dementia may also include recommendations for lifestyle changes. Lifestyle changes may help prevent future strokes. They may also help improve existing cognitive issues and other post-stroke physical symptoms.

Potential lifestyle changes include:

  • eating a diet rich in fresh fruits and vegetables and low in saturated fats
  • exercising daily
  • quitting smoking
  • addressing feelings of depression or anxiety

Check out: Dementia and Alzheimer’s: What are the differences? »

Are there other risk factors for vascular dementia?

The risk factors for vascular dementia are the same as those for stroke and heart disease. For example, your risk for these conditions increases as you age. Also, vascular dementia rarely occurs before age 65.

Having a history of heart attack or stroke can also increase your risk for vascular dementia.

Other risk factors are more preventable. These include:

  • smoking
  • high blood pressure
  • high cholesterol
  • atherosclerosis
  • obesity
  • diabetes

If you think you’re at risk, talk with your doctor about what you can do to decrease your risk and improve your overall health. They can walk you through your options and help you make a plan of action.

Outlook

Vascular dementia is a progressive disease. Its symptoms generally worsen over time. You may experience a sudden change in symptoms followed by a relatively stable period with consistently predictable symptoms.

Vascular dementia can shorten your overall life expectancy. This is because the condition is associated with many complications, such as pneumonia. But treatment can help improve your quality of life.

You may find it beneficial to:

  • Increase cognitive stimulation to help keep memory and communication active.
  • Break routines into smaller, more manageable steps. This can help decrease frustration, anxiety, and depressive feelings. It may also help increase your sense of confidence and self-worth.
  • Participate in rehabilitation, including physiotherapy and language or speech therapy, to address post-stroke symptoms.

Keep reading: The stages of dementia »