Can stay healthy to reverse Alzheimer's

Vascular dementia

Symptoms, course, causes and therapy

Vascular dementia is a possible consequence of strokes (Illustration: Tumisu | Pixabay)


In this article:


The essentials in brief:

  • Dementia is a progressive decline in brain performance that affects the everyday life of those affected.
  • After Alzheimer's dementia, vascular dementia is the second most common form of dementia.
  • It is caused by repeated circulatory disorders of the brain tissue, either chronically or as a result of strokes.
  • The first symptoms of vascular dementia often appear insidious and are initially not noticed by those affected.
  • Those affected suffer from cognitive, psychological and neurological abnormalities.
  • The reliable diagnosis of dementia is based on many individual examinations and on the presence of symptoms for 6 months.
  • Vascular dementia cannot be cured, but the course of the disease can be positively influenced by early therapy.
  • The risk of vascular dementia can be reduced by treating risk factors such as high blood pressure and cardiovascular disease early on.

According to the German Alzheimer Society e.V.1 are around 1.6 million people in Germany affected by dementia. Dementia is understood as the progressive decline in brain performance, which affects the everyday life of the person affected. There is a decline in memory and disorders of the ability to think and judge.

There are different types of dementia such as Alzheimer's disease or vascular dementia, with the majority of those affected suffering from Alzheimer's disease. Vascular dementia is the second most common form of dementia.

What is vascular dementia?

Vascular dementia is a form of dementia that is caused by disorders of the blood flow in the brain tissue. The medical term “vascular” stands for “concerning the blood vessels”.

There are different forms of dementia, including multi-infarct dementia and subcortical vascular dementia. Vascular dementia is often confused with dementia of the Alzheimer's type.

What is the Difference Between Alzheimer's Disease and Vascular Dementia?

According to the health knowledge foundation2Around 250,000 people in Germany suffer from vascular dementia. That is 0.3 percent of the population. It is the second most common form of dementia after Alzheimer's dementia. Vascular dementia predominantly occurs in old age.

Differentiating it from Alzheimer's disease is not always clear. As with Alzheimer's dementia, the onset of vascular dementia is often insidious and gradually progresses.

However, the symptoms are slightly different. Most of the time, it is not the memory disorders that are in the foreground, but difficulties in thinking, a slowdown in drive and mood swings.

However, there are mixed forms of both types of dementia. A sub-form of vascular dementia is so-called multi-infarct dementia, in which the brain is damaged by repeated small strokes.

The multi-infarct dementia usually begins suddenly and usually progresses in stages. The symptoms of the disease are very similar to those of Alzheimer's disease, but physical disorders such as numbness or paralysis can also occur. Vascular dementia affects men more often. Patients with vascular dementia often have had one or more previous strokes.

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What causes and risk factors can trigger vascular dementia?

Vascular dementia is caused by circulatory disorders in the brain (= cerebral ischemia). The circulatory disorders destroy nerve cells and die. A distinction is made between various mechanisms of formation of vascular dementia:

Multi-infarct dementia: This form of dementia occurs when there are many small local circulatory disorders, each of which leads to the death of brain cells.

"Strategic infarct dementia": This leads to circulatory disorders in strategically important parts of the brain, such as the thalamus or the basal ganglia. These brain regions are particularly important for behavior and memory.

Amyloid angiopathy: Here there is a coexistence of cerebral infarction and bleeding into the brain tissue. They arise from pathological thickening of the vessel walls of small blood vessels.

What are the risk factors for vascular dementia?

The risk factors for developing vascular dementia are the same as those for vascular disease:

By identifying and treating the risk factors at an early stage, it is principally possible to prevent vascular dementia.

Symptoms of Vascular Dementia

Symptoms of vascular dementia rarely occur suddenly, for example in direct connection with a stroke. Much more often, the symptoms are insidious and are initially not noticed by those affected and their relatives. At the beginning of the disease, the following symptoms are often noticeable:

  • Problems with attention
  • Memory problems
  • Slowing down of thinking
  • Mood swings (changing quickly between laughing and crying)
  • Speech disorders

Symptoms increase as the disease progresses. Depending on which areas of the brain are affected, the following symptoms can occur:

  • Confusion and disorientation
  • Difficulty concentrating
  • Word finding disorders
  • noticeable personality changes
  • depression

Neurological symptoms such as hemiplegia, visual disturbances or epileptic seizures can also occur. Furthermore, a gait disorder can develop with a sedentary lifestyle, small steps and muscle stiffness, which in its nature is reminiscent of Parkinson's disease. Some patients experience incontinence and a constant need to urinate.

Danger: All of the listed symptoms can also have other causes; there is no “certain” or “conclusive” symptom for vascular dementia. Since there may be other causes behind the complaints (e.g. vitamin deficiency, metabolic disorders), a medical assessment and appropriate diagnosis should be carried out in the event of corresponding symptoms.

How is vascular dementia diagnosed?

If vascular dementia is suspected the doctor will try to find out more about the patient's symptoms and medical history during the anamnesis interview. The doctor will find out about any previous illnesses. The focus here is primarily on cardiovascular diseases, diseases of the cerebral vessels, high blood pressure and diabetes, alcohol and nicotine consumption.

Information about the medication you have taken is also important. A detailed anamnesis is followed by a physical examination that includes both the cardiovascular system and a neurological examination. For this, motor skills, sensation of touch, sense of balance, coordination and reflexes are tested.

The brain performance is checked by a so-called neuropsychological examination. This usually includes various tests to check orientation, memory, perception and concentration.

Imaging diagnostics using CT (computed tomography) or MRI (magnetic resonance imaging) is important to rule out another underlying disease that is similar to dementia. Examples are brain tumors, inflammation of the brain tissue or bleeding. In addition, tissue changes may be found that give an indication of the form of dementia.

With the help of ultrasound examinations constrictions (stenoses) of the blood vessels supplying the brain are recognized. Laboratory tests are also carried out. Blood sugar, liver values, thyroid values ​​and the blood salts are either risk factors for vascular diseases, or abnormalities in these values ​​can simulate symptoms of dementia.

A nerve fluid test, i.e. a lumbar puncture to obtain cerebrospinal fluid, can rule out an inflammatory disease of the brain as the cause.

The general rule: There is no research that can "prove" dementia. The diagnosis of dementia is based on many individual tests. Symptoms must have persisted for at least 6 months for a definite diagnosis of dementia. However, this does not mean that investigations may only be initiated after this time. On the one hand, the doctor's task is to diagnose dementia. On the other hand, other causes and diseases that “mimic” the symptoms of dementia but have to be treated completely differently are excluded.

How is vascular dementia treated?3

Dementia diseases and thus vascular dementia cannot be cured. An already existing brain damage can no longer be reversed. Nevertheless, the course of the disease can be favorably influenced with early therapy.

aim is to maintain the quality of life of the person affected for as long as possible and to ensure independence for as long as possible. Close cooperation between the family carers, attending physicians, caregivers and therapists is important.

The pillars of therapy are on the one hand drug treatment and on the other hand non-drug treatment. Depending on the severity of the symptoms and the personal circumstances of the person affected, individual treatment should be initiated.

Medical therapy

The aim of drug therapy for vascular dementia is to prevent further cerebral infarctions. This is done, among other things, through the control and therapy of the vascular risk factors.

Antihypertensive drugs: Untreated high blood pressure is a major risk factor for stroke and can accelerate the progression of dementia. Blood pressure values ​​below 140/90 mmHg are optimal.

Blood sugar lowering drugs: untreated or poorly controlled diabetes mellitus (blood sugar disorder) is a risk factor for strokes. Treatment can include diet changes, tablets, or insulin injections.

Medicines that reduce high levels of fat in the blood: Increased cholesterol values, especially increased LDL values, should be reduced if there is also calcification of the vascular wall (arteriosclerosis).

Blood thinning medication: they prevent platelets from clumping together or delay blood clotting and thus protect against clot formation in the blood. Which preparation is suitable for the patient is discussed with the attending physician.

For specific drugs (so-called "anti-dementia"), which are used in particular in the treatment of Alzheimer's dementia, no benefit in the treatment of vascular dementia could be demonstrated. They can still be used if there is a suspicion that it is a hybrid of Alzheimer's and vascular dementia.

Non-drug therapy

  • Physiotherapy (physiotherapy)
  • Occupational therapy
  • Speech therapy (speech therapy)
  • Memory training
  • Memory therapy, music therapy
  • psychotherapy

The general rule: A healthy lifestyle with plenty of exercise and conscious nutrition as well as maintaining social contacts are important for the progression of dementia.

Course and prognosis

Dementia diseases do not show a uniform course. The form of dementia and the brain regions that are most affected by the damage are decisive. The disease is incurable and always progressive. In vascular dementia, the symptoms can remain completely stable over long periods of time, improve briefly, and worsen again relatively quickly.

What is the life expectancy with vascular dementia?

In general, it is not easy to make predictions about the life expectancy of a person suffering from dementia or to provide binding information about it. The actual dementia does not lead to death, but concomitant diseases and their complications that arise in the course of the dementia.

In addition, people who suffer from dementia are usually older. Statistically, the life expectancy of a person with dementia is reduced. Dementia patients over 85 years of age, for example, have a three times higher mortality than people of the same age who do not suffer from dementia.

What matters is:

  • At what age was the diagnosis of dementia made?
  • What form of dementia is it?
  • How fast is dementia progressing?
  • What comorbidities are there?

Tips for patients:

The development of vascular dementia cannot be prevented, but it can be prevented. The following factors are worth noting:

Have regular check-ups with your family doctor (check-up) in order to identify and treat high blood pressure and cardiovascular diseases at an early stage.

  • Eat a healthy and balanced diet.
  • Quit smoking
  • Don't drink too much and don't drink alcohol regularly.
  • Make sure you get enough and regular physical exercise.
  • Reduce your weight if you are overweight.
  • Maintain social contacts and do activities with others.
  • Challenge your brain, stay curious, learn new things and train your brain.

How can relatives support the patient?

Relatives of patients with vascular dementia suffer in common with those affected. The disease affects the entire family. It is very difficult to see a loved one become progressively degraded, mentally and physically, and completely change.

Many relatives experience emotional chaos of pain and compassion, but also helplessness, anger, anger and sadness. Caring for someone with dementia requires a lot of patience and strength. The support of the relatives is extremely important. Only when the relatives are doing well can the dementia patient be well!

The following tips can be helpful in everyday life:

information: learn to understand the disease. Accompany your relatives when they visit a doctor, find out about the disease (literature, internet) and visit a self-help group. Here you can exchange ideas with other affected relatives.

patience: try to be patient even if the person with dementia is unsteady, reproachful, blaming you or showing angry outbursts. This behavior is part of the illness and is not directed against you personally.

dispute: Avoid discussions, arguments, or arguments when there is a disagreement. It is better to distract the person concerned.

daily routine: ensure a regular daily routine with fixed meal times, activities and rest times and a familiar environment. That gives those affected security.

independence: maintain and promote the independence of the person concerned for as long as possible, do not patronize or "mother" them. Washing, dressing, eating and cooking should be carried out independently for as long as possible.

Take care of yourself: take help, take breaks, do something good for yourself. This gives you the physical and mental strength you need to care for the dementia patient. Don't feel guilty about accepting help and taking care of yourself.

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Author


with the cooperation of stud. med. Sedef Kuecuekuncular

Dr. med. Christina Rückert is Specialist in neurology and geriatrics and has been working as a senior physician at the Oberschwabenklinik in Ravensburg for over 10 years. Your professional activity also includes the deputy medical management of the central emergency room.

One focus of her work is the acute care of neurologically ill patients, primarily the Care of patients with acute stroke. [more]

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  1. The frequency of dementias - German Alzheimer Society e.V. - Url: https://www.deutsche-alzheimer.de/fileadmin/alz/pdf/factsheets/infoblatt1_haeufigkeit_demenz Krankungen_dalzg.pdf
  2. Health Knowledge Foundation: Vascular Dementia - Health Knowledge Foundation - Url: https://www.stiftung-gesundheitswissen.de/wissen/vaskulaere-demenz/ Background
  3. Treatment and support of vascular dementia - Alzheimer's Society - Url: https://www.alzheimers.org.uk/about-dementia/types-dementia/treatment-and-support-vascular-dementia