Vascular dementia (VaD) is a common post-stroke complication characterized by the loss of cognitive function or thinking abilities. VaD occurs when brain tissue is damaged because of reduced blood flow to the brain during a stroke or a series of strokes. As a result, the damaged brain tissue makes it difficult for the stroke survivor to process information. This can lead to memory loss, confusion, decreased attention span and problems performing everyday activities.

Approximately 20 percent of stroke survivors have cognitive impairments after a stroke; the prevalence of post-stroke VaD is roughly 25 to 30 percent. The rate of VaD has declined in recent decades due to improved acute stroke care. However, the incidence of VaD increases with age, making stroke survivors aged 65 and over at a greater risk.

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Learn more about how to manage stroke risk using this easy-to-understand interactive guide that explains 26 of the more common risk factors for stroke.

Risk Factors

Stroke doubles a person’s chance for VaD. Some of the risk factors for VaD are the same as for stroke, such as:

The risk for VaD increases with every stroke.

Symptoms

Symptom severity often increases with each recurrent stroke. The following are cognitive symptoms of VaD that result from neurological damage and affect thinking and movement:

Memory loss
Confusion
Language problems (aphasia)
Difficulty paying attention or following a conversation
Difficulty planning and organizing tasks
Difficulty with calculations, making decisions, solving problems
Visual orientation problems, hallucinations
Impaired motor skills

According to the American Psychiatric Association, 90 percent of people with dementia also exhibit some form of mental or behavioral issues over the course of the disease.

Patients can experience:

Depression
Agitation
Aggressive behavior
Anxiety
Apathy
Suicidal thoughts
Sleep disruptions
Weight loss/gain
Mood swings and personality changes

In some instances, the onset of VaD is gradual and healthcare professionals have difficulty distinguishing it from Alzheimer's disease. In these cases, VaD is likely the result of chronic inadequate blood circulation in the brain that can cause small, silent strokes, or TIAs. Depending on the location and size of damaged brain area, the onset of dementia following a stroke differs from person to person.

Left-hemisphere strokes are commonly associated with VaD. This side of most people’s brains controls language. Damage to the left hemisphere can lead to difficulty with speaking and understanding what others say. Left-hemisphere strokes can also cause memory problems similar to those from right-hemisphere strokes.

The right hemisphere of most people’s brains controls cognitive functioning (thinking skills). Damage to the right hemisphere can lead to cognitive-communication issues that include the symptoms of absent-mindedness, memory loss or trouble paying attention and decision making.

Brain stem strokes can be devastating and lead to problems with speaking while strokes that occur in the cerebellum can result in movement problems that include coordination and balance. The VaD symptom of impaired motor skills can be linked to these types of strokes.

Diagnosis

A healthcare professional should conduct a complete medical and patient history evaluation in order to determine the presence or risk for VaD. An evaluation for VaD usually includes a neurological exam and neuroimaging with a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan. These imaging tests can help healthcare professionals better evaluate the patient and determine the most appropriate treatment plan.

Watch the iHOPE webinar on medication adherence to learn about specific drugs that help treat risk factors for stroke and about patient assistance programs that help with financial costs.

Treatment

There is currently no known cure for VaD. However, medications for Alzheimer’s disease are commonly used to treat VaD. Antidepressants can help with depression and anxiety as well. Consult a healthcare professional to determine if and what medications are appropriate. Clinical trials are currently underway to test drugs that may treat patients with VaD by decreasing cognitive deterioration.

Recommended treatment strategies focus on managing risk factors for stroke to prevent recurrent stroke. Treating the risk factors that lead to VaD can also slow the progression of the disease. Medications can help prevent VaD from getting worse by treating underlying conditions such as diabetes, hypertension and high cholesterol.

Management

Stroke survivors with VaD may become more dependent on family members or caregivers for assistance with activities of daily living due to physical and behavioral changes, but there are many practical strategies to manage VaD that will help improve post-stroke recovery outcomes.

For memory problems—create lists, take notes and establish a regular routine.
For cognitive (thinking) symptoms—work with a speech therapist, play card games and use puzzles and crosswords. To learn about managing aphasia, watch iHOPE: Aphasia.
To manage risk factors (hypertension, diabetes, high cholesterol)—maintain a healthy diet. To learn more about taking steps to prevent another stroke, watch iHOPE: Preventing Another Stroke.

To regain and maintain independence—work or consult with a physical or occupational therapist. To learn some useful strategies for continuing rehabilitation at home, watch iHOPE: Rehabilitation at Home.
To improve social functioning—attend a stroke support group to connect with others, practice social skills and seek advice. To find a support group in your area, visit the national Stroke Support Group Registry.
To manage depression and other emotional issues, seek out a counselor or social worker. To learn more about treatment and management, watch iHOPE: Depression and Emotional Issues Post-Stroke.

If VaD impacts functioning at work, discuss your needs with your employer. Get more information on returning to work.

Stroke survivors with severe VaD may not be able to maintain financial responsibilities or make medical decisions. A Medical Power of Attorney is a legal document that designates a person to make healthcare decisions for the stroke survivor if he or she is unable to. Living wills and advance directives are also legal documents that outline the patient’s preferences if he or she is unable to communicate them. Not all stroke survivors with VaD will need this type of assistance.