Stroke Impact: Dementia-Like Symptoms And Their Causes

A light stroke can indeed mimic dementia, as both can affect similar cognitive functions. Vascular dementia is caused by impaired blood flow to the brain, often as a result of a stroke blocking an artery or a series of small strokes over time. This reduced blood flow can lead to brain damage and subsequent issues with memory, communication, concentration, and other cognitive functions. While a stroke may not always cause vascular dementia, it can increase the risk and lead to similar symptoms, including problems with reasoning, planning, judgment, and other thought processes. These symptoms can vary depending on the severity and location of the stroke, as well as individual factors such as age, sex, and family history.

Vascular dementia and stroke

Vascular dementia is a general term for the decline in reasoning, planning, judgment, memory, and other thought processes caused by brain damage from impaired blood flow to the brain. It is commonly associated with left-hemisphere strokes, which affect the same functions as vascular dementia. However, not all strokes cause vascular dementia, and whether a stroke affects cognitive functions depends on its severity and location.

Vascular dementia can occur when a stroke blocks an artery in the brain, but it can also be caused by other conditions that damage blood vessels and reduce circulation, depriving the brain of oxygen and nutrients. These conditions include atherosclerosis, where fatty deposits called plaques build up in the arteries, narrowing them and reducing blood flow to the brain. This can lead to permanent brain cell damage and increase the risk of vascular dementia over time.

The symptoms of vascular dementia vary depending on the part of the brain affected by impaired blood flow. They often overlap with those of other types of dementia, especially Alzheimer's disease dementia. However, unlike Alzheimer's, vascular dementia tends to affect speed of thinking and problem-solving rather than memory loss. Symptoms can include trouble paying attention and concentrating, a reduced ability to organize thoughts or actions, and difficulty with decision-making and communication.

Vascular dementia can also develop gradually over time, with symptoms appearing in noticeable steps following a series of strokes or mini-strokes. In some cases, it may be caused by multiple small "silent" strokes that are undetected by the individual. These silent strokes can still increase the risk of vascular dementia, and the risk increases with the number of strokes that occur.

People who have had a stroke have a significantly higher risk of developing dementia than those who have not. About 1 in 4 people who have experienced a stroke will go on to exhibit signs of dementia. Vascular dementia is more prevalent in older individuals and is more common in men than in women.

Symptoms of vascular dementia

Vascular dementia is the second most common form of dementia after Alzheimer's disease. It is caused by a lack of blood flow to the brain, which damages brain tissue. This can be due to a ruptured blood vessel, a blood clot, or narrowed blood vessels. Vascular dementia is often associated with a left-hemisphere stroke and tends to impact reasoning, planning, judgment, memory, and other thought processes.

The symptoms of vascular dementia vary depending on the location and amount of brain tissue affected. They may appear suddenly after a stroke or major surgery, or they may develop gradually over time. Here are some common symptoms of vascular dementia:

• Problems with planning, organizing, making decisions, and solving problems
• Difficulty following a series of steps, such as cooking a meal
• Slower speed of thought and problems concentrating, including short periods of sudden confusion
• Memory problems, such as recalling names or recent events (although this may be mild)
• Language difficulties, such as reduced fluency of speech
• Mood changes, including depression, anxiety, irritability, or apathy
• Behavioural changes, such as increased agitation or aggression, or acting in ways that seem out of character
• Delusions and hallucinations
• Problems with movement and balance
• Urinary issues, such as urgency or incontinence
• Increased trouble with daily activities due to problems with focus or communication
• Confusion, which may worsen at night (sundown syndrome)
• Stroke-like symptoms, such as sudden weakness and trouble with speech

It is important to note that these symptoms can vary and may overlap with other types of dementia. Vascular dementia tends to primarily affect speed of thinking and problem-solving rather than memory loss, which is more commonly associated with Alzheimer's disease.

Risk factors for vascular dementia

Vascular dementia is caused by impaired blood flow to the brain, which can be the result of a blocked artery or other conditions that damage blood vessels and reduce circulation. The risk factors for vascular dementia are similar to those for heart disease and stroke.

The biggest risk factor for vascular dementia is increasing age. The risk of developing vascular dementia rises as people grow older, and it is rare for those under 65 to be diagnosed. The risk doubles every five years after the age of 65, and rises substantially by the time a person reaches their 90s. Men are at a slightly higher risk of developing vascular dementia than women.

People with a history of heart attacks, strokes, or ministrokes are also at greater risk of vascular dementia. The brain damage that occurs during a stroke or ministroke (transient ischemic attack) can increase the risk of developing dementia. Atherosclerosis, or the abnormal aging of blood vessels, is another risk factor. This condition narrows the blood vessels, reducing the flow of blood to the brain.

High cholesterol, specifically elevated levels of low-density lipoprotein (LDL), is associated with an increased risk of vascular dementia. High blood pressure can also lead to vascular dementia as it puts extra stress on blood vessels, increasing the risk of vascular problems in the brain.

Diabetes is another risk factor, as high glucose levels damage blood vessels throughout the body, including in the brain. This increases the risk of stroke and vascular dementia.

Lifestyle factors such as smoking, obesity, physical inactivity, an unhealthy diet, and excessive alcohol consumption are also associated with a higher risk of vascular dementia.

Diagnosis of vascular dementia

A light stroke can indeed mimic dementia, as vascular dementia is caused by reduced blood flow to the brain, which can be the result of a stroke. Vascular dementia is a general term for reasoning, planning, judgment, memory, and other thought-process problems caused by brain damage from impaired blood flow.

There is no single test for vascular dementia, and a diagnosis may be based on a combination of factors. Diagnosis usually starts with a conversation with a GP, who will make an initial assessment and refer the patient to a local memory service for a more detailed assessment by specialists. These specialists will have expertise in dementia and can arrange more detailed tests and brain scans if needed. Sometimes, a GP will make the diagnosis if it is very clear that the person has dementia, and they will not need to be referred to a specialist.

The diagnosis is based on a combination of things, including:

• Taking a 'history' – the health professional talks to the patient, and ideally someone who knows them well, about their problems and how they are affecting the person's daily life.
• Physical examination and tests (e.g., blood tests) to rule out other possible causes of the symptoms.
• Mental ability tests (e.g., memory and thinking) – these are generally carried out by a nurse, occupational therapist, or doctor, and sometimes more specialist tests are done by a neuropsychologist. For someone with vascular dementia, these tests might show a slower speed of thought and difficulties thinking things through, which are often more common than memory loss.
• Brain scans, such as an MRI or CT scan, to look for any changes that have occurred in the brain. Brain scans cannot identify vascular dementia on their own, but they can be used along with other information to help confirm the diagnosis.

Doctors can almost always determine that a person has dementia, but there is no specific test to confirm vascular dementia. The doctor will make a judgment about whether vascular dementia is the most likely cause of the symptoms based on the patient's medical history, the information provided, and the results of tests that may help clarify the diagnosis.

Treatment of vascular dementia

Vascular dementia is caused by a lack of blood flow to the brain, which damages brain tissue. While vascular dementia cannot be cured, treatments can help slow its progression and prevent further damage to the brain.

Treatment Options

Medication

Medications can be used to treat the underlying causes of vascular dementia and prevent further decline. These may include:

• Lowering blood pressure
• Reducing cholesterol levels
• Preventing blood clots and clearing arteries
• Controlling blood sugar for those with diabetes
• Antipsychotic medicines for those showing aggression or extreme distress
• Alzheimer's medications may also be used in certain cases

Lifestyle Changes

Making healthy lifestyle changes can be an important part of treating vascular dementia. This may include:

• Eating a healthy, balanced diet, such as a low-salt diet to manage high blood pressure
• Losing weight if overweight
• Reducing alcohol consumption
• Regular physical activity
• Maintaining a normal weight
• Social activities
• Challenging the brain with games, puzzles, and new activities

Therapies and Support

There are several therapies and support options that can help improve quality of life for those with vascular dementia:

• Occupational therapy to identify and solve problems in everyday life
• Speech and language therapy to improve communication
• Physiotherapy to help with movement
• Psychological therapies, such as cognitive stimulation
• Relaxation techniques, such as massage, music, or dance therapy
• Social interaction and leisure activities, such as support groups

Procedures

In some cases, procedures may be necessary to improve blood flow to the brain, such as carotid endarterectomy, angioplasty, and stenting.

Frequently asked questions