Stroke, Dementia, And The Brain: Understanding The Link

do stroke patients develop dementia

Stroke and dementia are closely linked. Dementia after stroke is fairly common, with 16.5% of people experiencing it at any given time after a stroke, and 18.4% experiencing it within a year. Strokes occur when the blood supply to the brain is cut off, causing brain cells to die from lack of oxygen. This brain damage can lead to vascular dementia, the second most common type of dementia after Alzheimer's. Vascular dementia can also result from other conditions that damage blood vessels and reduce circulation.

The symptoms of post-stroke dementia are similar to those of other types of dementia, but in the early days following a stroke, it can be difficult to distinguish dementia from stroke symptoms. Symptoms of post-stroke dementia include new or worsening memory impairments, problems with decision-making, confusion, problems with self-care, speech issues, and changes in mood or personality.

There is no cure for post-stroke dementia, but preventing additional strokes may slow or stop cognitive decline. People with vascular dementia who have had a stroke have a 5-year survival rate of 39%.

Characteristics Values
Risk factors Older age, family history, genetic variants, low educational status, vascular comorbidities, prior stroke, depressive illness
Symptoms Memory loss, speech issues, confusion, problems with self-care, changes in mood or personality, restlessness, agitation, incontinence, depression, apathy
Treatments Medication to lower blood pressure, reduce cholesterol, prevent blood clotting, control blood sugar; rehabilitative treatments

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What is vascular dementia?

Vascular dementia is a general term for problems with reasoning, planning, judgment, memory, and other thought processes caused by brain damage from impaired blood flow to the brain. It is the second most common type of dementia after Alzheimer's disease.

Vascular dementia can develop after a stroke blocks an artery in the brain, but not all strokes cause vascular dementia. The likelihood of vascular dementia occurring after a stroke depends on the stroke's severity and location. Vascular dementia can also result from other conditions that damage blood vessels and reduce circulation, depriving the brain of vital oxygen and nutrients.

The symptoms of vascular dementia vary depending on the part of the brain where blood flow is impaired. Symptoms often overlap with those of other types of dementia, especially Alzheimer's disease. However, unlike Alzheimer's disease, the most significant symptoms of vascular dementia tend to involve the speed of thinking and problem-solving rather than memory loss.

Symptoms of vascular dementia include:

  • Trouble paying attention and concentrating
  • Reduced ability to organize thoughts or actions
  • Decline in the ability to analyze a situation, develop an effective plan, and communicate that plan to others
  • Difficulty with organization
  • Difficulty deciding what to do next
  • Problems with memory
  • Restlessness and agitation
  • Sudden or frequent urge to urinate or inability to control passing urine
  • Depression or apathy

The symptoms of vascular dementia may be most noticeable when they occur suddenly following a stroke. When changes in thinking and reasoning seem clearly linked to a stroke, this condition is sometimes called post-stroke dementia.

Vascular dementia can also develop gradually, like Alzheimer's disease. In fact, vascular disease and Alzheimer's disease often occur together. Studies show that many people with dementia and evidence of brain vascular disease also have Alzheimer's disease.

The risk factors for vascular dementia are similar to those for heart disease and stroke. These include increasing age, a history of heart attacks, strokes, or ministrokes, abnormal aging of blood vessels (atherosclerosis), high cholesterol, high blood pressure, diabetes, smoking, obesity, and atrial fibrillation.

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What are the risk factors for vascular dementia?

Vascular dementia is caused by conditions that affect the blood vessels in the brain. The risk factors for vascular dementia are similar to those for heart disease and stroke.

Age

The risk of vascular dementia rises with age. The disorder is rare before the age of 65, but the risk doubles every five years from that point on.

Cardiovascular Conditions

People with cardiovascular conditions such as high blood pressure, heart disease, or diabetes have a higher risk of developing vascular dementia. These conditions increase the chances of a clot or bleed in the blood vessels in the brain. People with these conditions are twice as likely to develop vascular dementia.

Cerebral Amyloid Angiopathy (CAA)

CAA is a type of vascular disease that damages the small arteries in the outer regions of the brain, causing them to leak and become prone to bleeding. Many people with CAA develop vascular dementia, either suddenly following a stroke or through gradual disease progression.

Sleep Apnoea

Sleep apnoea is a common condition where a person temporarily stops breathing during sleep. This can cause small blood clots to form in the brain, increasing the risk of high blood pressure, stroke, heart attacks, and vascular dementia.

Lifestyle Factors

Lifestyle choices that increase the risk of cardiovascular disease also increase the risk of vascular dementia. These include physical inactivity, smoking, an unhealthy diet, and excessive alcohol consumption.

Genetics

Most cases of vascular dementia are not inherited. However, there are some rare types of vascular dementia, such as CADASIL, that are caused by gene mutations and passed down through families.

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What are the symptoms of vascular dementia?

Vascular dementia is the second most common form of dementia after Alzheimer's disease. It is caused by impaired blood flow to the brain, which damages brain tissue and brain cells. Vascular dementia can develop slowly over time or suddenly after a stroke or major surgery.

The symptoms of vascular dementia vary depending on the location and amount of brain tissue involved. They include:

  • Increased difficulty in performing normal daily activities due to problems with focus, communication, or the inability to follow directions.
  • Memory problems. Short-term memory may not be affected.
  • Confusion, which may worsen at night (called sundown syndrome).
  • Stroke symptoms, such as sudden weakness and trouble with speech.
  • Mood changes, such as depression or irritability.
  • Changes in stride when walking too fast or shuffling steps.
  • Problems with movement, balance, or both.
  • Urinary problems, such as urgency or incontinence.
  • Trouble paying attention and concentrating.
  • Reduced ability to organise thoughts or actions.
  • Decline in the ability to analyse a situation, develop an effective plan, and communicate that plan to others.
  • Difficulty with organisation.
  • Difficulty deciding what to do next.
  • Restlessness and agitation.
  • Depression or apathy.
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Can vascular dementia be treated?

Vascular dementia is a common type of dementia caused by reduced blood flow to the brain. While there is currently no cure for vascular dementia, there are treatments that can help slow down its progression. The main aim of treatment is to tackle the underlying cause, which may reduce the speed at which brain cells are lost. This often involves a combination of healthy lifestyle changes and medication.

Lifestyle Changes

  • Eating a healthy, balanced diet
  • Losing weight if overweight
  • Cutting down on alcohol

Medication

  • Medicines to treat high blood pressure
  • Medicines to treat high cholesterol, such as statins
  • Medicines to reduce the risk of blood clots and further strokes, such as low-dose aspirin or clopidogrel
  • Anticoagulant medicines, such as warfarin, to reduce the risk of blood clots and further strokes
  • Medicines to treat diabetes

In addition to these treatments, antipsychotic medication may be prescribed in cases where the patient is showing persistent aggression or extreme distress and is at risk of harming themselves or others. Alzheimer's disease medications are not used to treat vascular dementia but may be prescribed if the patient also has Alzheimer's disease.

Support and Therapy

There are also several therapies and practical measures that can help make everyday living easier for someone with vascular dementia, including:

  • Occupational therapy
  • Speech and language therapy
  • Physiotherapy
  • Psychological therapies, such as cognitive stimulation and cognitive behavioural therapy
  • Relaxation techniques, such as massage, music or dance therapy
  • Social interaction, leisure activities, and other dementia activities, such as memory cafes

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How can vascular dementia be prevented?

Vascular dementia is caused by conditions that interrupt the flow of blood and oxygen supply to the brain, which can be the result of a stroke blocking an artery in the brain. The risk of vascular dementia can be lowered by controlling factors that increase the risk of heart disease and stroke, such as:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • Smoking

To reduce the risk of vascular dementia, it is important to maintain a healthy lifestyle. This can be achieved by:

  • Maintaining a healthy blood pressure
  • Preventing or controlling diabetes
  • Quitting smoking
  • Getting regular physical exercise
  • Keeping cholesterol in check

Frequently asked questions

Vascular dementia is a type of dementia that occurs when the brain suffers an injury due to decreased blood flow. It is the second most common type of dementia after Alzheimer's disease.

Symptoms of vascular dementia include problems with memory, communication, concentration, decision-making, confusion, and changes in mood or personality.

A stroke can damage the brain, leading to vascular dementia. If a stroke affects areas of the brain that control cognitive functions, these functions may be permanently compromised.

Risk factors for vascular dementia include elevated blood sugar, language problems, difficulty paying attention, planning or organizing tasks, and impaired motor skills.

There are no approved medications for post-stroke vascular dementia. Doctors may prescribe medications used to treat other types of dementia, such as cholinesterase inhibitors and memantine. Lifestyle changes and self-care strategies may also be recommended.

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