Vascular dementia (VD) is a condition that interferes with the thinking capacity of individuals. People, suffering from this condition, keep forgetting very minute things and are unable to recall them regularly. They cannot perform their day-to-day activities also. As it occurs due to the involvement of blood vessels, this dementia (memory loss) is more specifically called vascular dementia. Stroke that occurs due to multiple reasons such as hypertension, diabetes, obesity, coronary artery disease, and atherosclerosis (abnormal tinning of blood vessels) leads to a decreased blood supply to the brain. This in turn causes brain damage which affects the thought processes of the individuals.
The symptoms of vascular dementia are of two types- behavioral (which occurs due to damage to the brain) and others (which occurs due to the underlying risk factor causing dementia). Among them, the predominant symptoms are:
Delay in the thought process
Difficulty in understanding and planning
Unable to concentrate even on small things
Always in a state of confusion and disorientation
Inability in reasoning, planning, and judgment process
Sudden changes in mood, personality, and behavior
Unable to walk properly and may have poor balance
As the disease progresses, memory loss may l be experienced which leads to depression
Sudden headache occurs due to the underlying stroke which gradually causes unilateral paralysis.
The symptoms of VD closely resemble the symptoms of Alzheimer’s disease (AD). A clinical variant called mixed dementia also exists where the patient has symptoms of both VD and AD together.
Vascular dementia cannot be diagnosed with a single test. Instead, a combination of tests is used which include:
A clinical diagnostic interview: a proper medical, family, and occupational history of the patient is taken and the patient is questioned about the symptoms that the patient is experiencing.
Cognitive and behavioral tests: The presence of symptoms will be confirmed by tests like the Montreal cognitive assessment test, verbal fluency test, and mental state mini-test.
Imaging techniques: Magnetic resonance imaging, computed tomography, and positron emission tomography are used to detect cerebral hemorrhage, which indicates the presence of stroke in the brain. They also help in the differential diagnosis of VD.
Biomarkers: The presence of certain biomarkers like C - reactive protein, homocysteine, and lipoprotein A in blood, pus, and CSF will help to differentiate between VD and AD.
Routine investigations: All routine lab investigations some of which are mentioned here, such as complete blood picture, tests to detect levels of glucose in the blood, lipid profile, thyroid function tests, urine analysis, and vitamin B12 values to check for deficiency can be done to understand the immune status of the patient and the identification of the risk factors.
The primary goal of vascular dementia management is to address the underlying cause to slow down the progression of the disease. Typically, this involves adopting a healthy lifestyle which includes stopping smoking and alcohol habits, taking a healthy diet, and doing physical exercises.
Drugs that are used to control cognitive symptoms are:
Cholinesterase inhibitors: Donepezil is the cholinesterase inhibitor that is most frequently used in VD patients. It works well in diminishing cognitive symptoms, but cannot cure the disease. Constipation, stomach pain, and cramping are typical adverse effects.
Memantine: The NMDA (N-methyl-D-aspartate) receptor which is responsible for the cognitive symptoms is blocked by memantine. It is important to realize that memantine neither prevents nor slows down the course of the disease. When combined with donepezil, memantine is more effective in treating moderate-to-severe VD than mild VD. The drawbacks are side effects which include headaches, dizziness, constipation, and high blood pressure.
Apart from the above drugs, anti-hypertensive, anti-diabetic, anti-lipidemic drugs, and anti-coagulant drugs can be used to control the risk factors associated with this disease. With all these treatment methods, VD can be reduced to an extent, but cannot be completely cured. Adapting a healthy lifestyle helps in the prevention of the disease to a larger extent.