Vascular dementia

In the case of vascular dementia, mental degradation occurs. The cause are circulatory disorders in the brain. More about symptoms, risk factors, course and therapy

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What is vascular dementia - briefly explained

Vascular dementia is an increasing loss of mental abilities (dementia), which are triggered by changes in blood vessels and a lack of blood flow in the brain. It is not always possible to reliably differentiate between Alzheimer's disease and vascular dementia; mixed forms of both types of dementia are also possible. Risk factors for developing vascular dementia are high blood pressure, smoking, unfavorable blood lipid levels, diabetes mellitus, various heart diseases and, above all, old age. The diagnosis is made through medical history, physical examination, and neurological tests, and imaging techniques are also used. The therapy of vascular dementia is mainly based on the underlying disease, such as lowering high blood pressure or adjusting sugar levels. If necessary, special anti-dementives are used. The course of dementia is very different. Since dementia can be very stressful for both those affected and their relatives, it is important to find out more early on and seek help.

What does vascular dementia mean?

There are different forms of dementia. What they all have in common is that this leads to mental degradation, which significantly affects everyday life. So the memory decreases, the ability to think and judge decreases. Many of those affected sooner or later suffer from orientation difficulties. They can no longer find their way around in their familiar surroundings. And they have problems with normal everyday activities.

The most common form of dementia is Alzheimer's disease. Vascular dementia is the second most common group of dementias. Vascular dementia is caused by circulatory disorders, particularly in the small vessels in the brain. The name is also derived from this: The medical term "vascular" means something like "vascular, circulatory, affecting the blood vessels".

What is dementia?

Around 1.2 to 1.5 million mostly elderly people in Germany suffer from dementia. This umbrella term includes various diseases. What they all have in common is that this leads to mental degradation, which significantly affects everyday life. So the memory decreases, the ability to think and judge decreases.

Many of those affected sooner or later suffer from orientation difficulties. They can no longer find their way around in their familiar surroundings. And they have problems with normal everyday activities. Quite a few get speech disorders. Relatives also notice that those affected have changed in their personality, that they sometimes react inappropriately aggressively or fearfully, that mood swings are more common.

Forms of dementia:

  • Alzheimer's dementia (AD)
  • Vascular dementia (VD)
  • Mixed dementia (mostly AD / VD, also AD / Lewy bodies)
  • Frontotemporal dementia
  • Parkinson's disease dementia
  • Lewy body dementia

Vascular obstruction or cerebral hemorrhage can trigger vascular dementia. To see the complete graphic, please click on the magnifying glass at the top left

© W & B / Szczesny

Causes: How does vascular dementia occur?

Vascular dementia should be understood as a symptom. This means that it is noticeable through a cognitive (thinking, perceiving and cognizing) impairment in performance. The cause of this form of dementia is damage to the brain caused by the blood flow. Like all organs, the brain must be supplied with oxygen-rich blood without any gaps. This happens via the large cerebral arteries, which branch out into many small blood vessels in the brain. If supply bottlenecks arise, brain cells receive too little oxygen. They take damage or die.

A reduced supply of the blood vessels in the brain occurs either due to diseases of the blood vessels themselves, or because a blood clot is carried into the brain vessels and stops the blood flow behind them. In diseases of the blood vessels themselves, arteriosclerotic changes, especially of the small vessels, can be found. Therefore, risk factors that can lead to vascular dementia are the same as those that generally cause arteriosclerotic wall changes in the vessels.

Risk factors for vascular dementia are:

  • Older age
  • High blood pressure (arterial hypertension)
  • Diabetes mellitus
  • Poor blood lipid levels (especially high LDL cholesterol, low HDL cholesterol)
  • Smoke
  • Overweight and underweight
  • Sedentary lifestyle

Some heart diseases also increase the risk of developing vascular dementia, for example coronary artery disease (CHD). Vascular dementia is not caused by the disease of the coronary arteries, but it is the expression that the small vessels in the heart are changed - and thus probably other vessels in the body as well. Another risk factor are cardiac arrhythmias - especially so-called atrial fibrillation. In this widespread arrhythmia, the auricles no longer pump properly, which changes the blood flow in the heart. The blood can clump more easily, so that "blood clots" (thrombi) form in the heart. If they are flushed into the arteries of the brain with the bloodstream, the thrombi get stuck there and block the bloodstream (embolism). In the case of atrial fibrillation, the doctor often prescribes anticoagulant medication as a preventive measure.

A stroke (either caused by a burst vessel in the brain or a blocked vessel, see above) cuts off an area of ​​the brain from the blood supply. Many nerve cells perish within a short time. A stroke usually results in significant deficits such as paralysis, visual disturbances or speech disorders. Vascular dementia can develop as a result of a stroke.

However, there are also risks that cannot be influenced, such as older age or changes in the genetic make-up, which can be a (co-) trigger of vascular dementia.

Summary: causes of vascular dementia

In vascular dementia, changes in the vessels or reduced blood flow lead to an insufficient supply of brain cells and thus to the development of dementia.

  • Changes in the blood vessels

This is mainly found in the small blood vessels in the brain. Calcification (arteriosclerosis) occurs on the vessel wall, favored by age, increased blood lipid levels, diabetes mellitus, high blood pressure or obesity.

  • Change in blood flow

A stroke is often the cause of decreased blood flow in the brain. A stroke can result either from the rupture of a blood vessel in the brain (so-called hemorrhagic stroke, around 20 percent of cases) or from a blockage of a blood vessel (so-called ischemic stroke, around 80 percent of cases). Both forms have in common that the subsequent flow area cannot be supplied with blood and thus dies.

Many small infarct areas (multi-infarct events) that occur in damaged small vessels can also cause vascular dementia. Since the small vessels are close to each other, many damaged areas can flow together (confluence) and thus also cover large areas over time.

Symptoms: how does vascular dementia manifest itself?

Symptoms of dementia rarely appear suddenly - for example in connection with a stroke. More often, the disease is creeping up. The complaints can be varied. The following signs, among other things, indicate dementia:

  • Difficulty thinking, poor judgment: For example, the father suddenly has difficulties filling out a simple transfer slip, although he used to be able to handle complicated banking transactions without any problems.
  • Disorientation: For example, the mother suddenly no longer knows that she is currently in her son's apartment - even though she has often been to visit there. Another example: the husband can no longer correctly name the season.
  • Memory disorders: In particular, recent events and newly learned facts no longer stay in the memory. Those affected tell stories several times in a row or ask certain questions over and over again. Memories of your own childhood and adolescence are usually still easy to call up.
  • Problems with everyday activities: For example, a housewife suddenly no longer knows exactly what to do to switch on the washing machine - although she has taken care of the laundry countless times in her life.
  • Speech disorders: The language can sound less clear, the vocabulary is limited, those affected spend a long time looking for the right word.

More symptoms

In addition, movement and coordination disorders often occur in vascular dementia - for example, unsteadiness when walking. Those affected easily fall. Circulatory disorders in the brain can also lead to neurological deficits such as paralysis or visual disturbances or a bladder disorder with incontinence as a result. Epileptic seizures also occur. Sometimes symptoms such as stiffness of the muscles, walking in small steps and slowing movement are reminiscent of the symptoms of Parkinson's disease.

Important to know: There are no "proving" symptoms for vascular dementia. All of the symptoms mentioned can also have other causes - including metabolic disorders, vitamin deficiencies or chronic infections. In case of doubt, the doctor should therefore be asked for advice.

Course: how does vascular dementia work?

While Alzheimer's disease usually begins very gradually and worsens continuously, vascular dementia can also reappear relatively abruptly - for example in connection with a stroke. Vascular dementia also sometimes remains stable for longer periods and then worsens again relatively suddenly. So it often takes an intermittent, "step-like" course of the disease. There are also episodes with slight improvement. Sometimes the disease stops at a certain point, so it doesn't get worse.

However, even with vascular dementia, the symptoms can become so pronounced that those affected are no longer able to cope with their everyday lives independently, but are dependent on outside help around the clock. In the late stages of the disease, patients are bedridden. They no longer recognize close relatives and need support with simple activities such as washing and eating. Swallowing disorders can cause additional problems. Most sufferers lose control of their bladder and bowels at some point.

-> Are you caring for a relative? You can find help, tips and experience reports on the online focus "At your side" on our partner portal Senioren-Ratgeber.de

When to the doctor

Where are my glasses? Where did I put my house key again? Everyone knows small, harmless memory dropouts like this one. The older we get, the more mental performance can fluctuate. External factors such as sleep disorders or stress affect brain performance more quickly than before.

Many are unsettled when they notice that their ability to think is more prone to failure and their memory is deteriorating. For some, it is the relatives who notice changes and are concerned. What is still normal and where does the disease begin?

When in doubt, this question should always be directed to the doctor. Because early diagnosis is particularly important in the case of vascular dementia. This is the only way to identify and treat risk factors such as increased blood pressure, diabetes mellitus or increased blood lipid levels at an early stage. This not only has a positive effect on the course of the disease. The risk of dangerous circulatory disorders in other parts of the body - for example in the form of a heart attack - can also be reduced in this way. An early diagnosis is also important because many therapeutic approaches take effect especially in the early stages and thus stress and the need for care can be delayed. It is now assumed that a consistent treatment of risk factors could prevent a third of dementias (not just vascular ones).

Certain symptoms should make you prick up your ears and should be clarified quickly by a doctor:

  • You have difficulty orientating yourself in familiar surroundings: For example, you suddenly get lost in a part of the city that you have known for a long time.
  • You always have problems finding frequently used words. Instead of "I would like another cup of coffee!", For example, you are forced to use the sentence: "I would like another cup of this ... brown drink!"
  • You find yourself doing things that don't make any sense - like accidentally putting your phone in the refrigerator instead of on the dresser. Or you want to leave the house, but don't put on your winter coat, but your bathrobe.
  • You notice sudden loss of memory, unsteady gait, blurred vision, temporary numbness or paralysis. Then there may be another disease that should be clarified quickly. If in doubt, notify the ambulance service (Tel: 112) immediately!

Diagnosis: how is vascular dementia diagnosed?

The first point of contact is usually the family doctor. If necessary, he can refer to a specialist - usually the neurologist or psychiatrist. Many clinics offer special reminder consultations or outpatient departments that specialize in the diagnosis and treatment of dementia.

The doctor will first inquire about the patient's symptoms and personal medical history. Have you had a stroke in the past? Are there risk factors for vascular dementia - such as smoking, high blood pressure, diabetes mellitus or heart disease? If the answer is "yes", this already draws suspicion to the disease. It is also of interest which medication the person concerned is taking. Because some drugs can disrupt brain functions.

If the person concerned agrees, the doctor will also talk to his relatives. You can describe what caught your eye from their point of view.

Physical examination

A physical exam will follow. The doctor will pay particular attention to whether there are indications of circulatory disorders in the brain - for example, whether coordination is impaired, symptoms of paralysis, sensory disorders or other failures can be detected.

Test procedure

A series of simple, standard tests can help the doctor assess the patient's mental capacity. This includes, for example, the mini mental status test (MMST). In it the doctor asks a series of standardized, uncomplicated questions ("What day of the week is today?"). And he gives the patient small, easy tasks - for example, the person concerned should draw a simple geometric figure. The clock drawing test according to Suhlmann is also frequently used. During this examination, the patient draws the face of a clock at a specific time on a piece of paper.

Healthy people can usually do the exercises without any major problems. If difficulties arise, they indicate certain disorders. Among other things, the ability to orientate, remember, attentiveness and language comprehension are tested. The tests also help the doctor assess the severity of the impairment. The mentioned test procedures are generally used to determine dementia.

Important to know: There is no single test that could prove dementia. The diagnosis is always based on the result of many different examinations. Daily form, level of education, medication and accompanying illnesses can influence the test result and are taken into account accordingly. According to the definition, symptoms must have persisted for at least six months for a definite diagnosis of dementia. However, this does not mean that you have to wait six months before examinations or treatments can take place.

The doctor doesn't just have to find out whether dementia is present, what type it is and how severe it is. He must also rule out other illnesses that are also possible causes of the symptoms - for example physical illnesses and disorders, neurological illnesses such as Parkinson's disease, or mental illnesses such as depression. This usually requires further examinations.

Laboratory tests

Blood and urine tests will help reveal severe vitamin deficiencies, liver and kidney diseases, anemia, or thyroid disorders. They also provide clues about chronic infections that could affect the brain. The doctor may also order an examination of the nerve fluid, a so-called liquor puncture. This is increasingly coming to the fore and can help distinguish between vascular dementia and dementia of the Alzheimer's type.

Imaging procedures

Imaging processes such as magnetic resonance imaging (MRT) or computed tomography of the head (CCT) are important components of diagnostics. They provide evidence of circulatory disorders as a possible cause of dementia. The images can also provide clues as to the cause of the dementia, since different patterns are found in Alzheimer's disease than in vascular dementia. Mixed forms are also common.

Depending on the findings, further examinations may be useful to diagnose vascular dementia. These can be, for example: a long-term blood pressure measurement, an EKG to record cardiac activity, an EEG to measure brain waves, ultrasound examinations of the heart (echocardiography) and the cervical and cerebral vessels (Doppler and duplex sonography), x-ray examinations of the Chest (chest x-ray) and the cervical and cerebral vessels (angiography).

Therapy: How is vascular dementia treated?

If the brain is already damaged, it usually cannot be reversed. Early therapy is nevertheless important in order to have a favorable influence on the course of the disease and to maintain the quality of life of those affected for as long and as good as possible.

To ensure this, close cooperation between doctors, nurses, social workers, physiotherapists and other professionals is important. The caring relatives and close confidants of the dementia patient also play a decisive role.

From memory training and physiotherapy to medication - there is a wide range of therapy and support options for vascular dementia. What helps the person affected best should be decided with the doctor on a case-by-case basis based on the severity of the symptoms and the individual circumstances.

The following treatments are possible for vascular dementia:

  • Physiotherapy (physiotherapy)
  • Occupational therapy
  • Speech therapy (speech therapy)
  • Special memory training
  • Music therapy, memory therapy, and other procedures
  • Accompanying psychotherapy

To treat the circulatory disorder in the brain and prevent further ischemic strokes, the doctor may prescribe different drugs depending on the case:

  • Acetylsalicylic acid / ASA or clopidogrel, among others: These drugs make the blood platelets less likely to adhere to one another. The remedies have a "blood-thinning" effect, thus preventing new strokes. Possible side effects include gastrointestinal problems.
  • High blood pressure is often treated with medication.
  • The doctor can also prescribe tablets for high blood lipid levels.
  • Increased blood sugar (diabetes, diabetes mellitus) should be reduced to an individually optimal value, for example with medication.
  • Sometimes coumarins are also used. They slow down blood clotting. In doing so, you reduce the risk of blood clots forming, which block the blood vessels.

Specific drugs that are often prescribed for Alzheimer's dementia (cholinesterase inhibitors, memantine) can be considered for the treatment of vascular dementia in individual cases, especially if a mixed form of Alzheimer's and vascular dementia is suspected.

Important: A healthy lifestyle with a balanced diet and plenty of exercise supports the therapy. A lot of social contact is also an important factor.

Tips for relatives:

Dementia is a major challenge not only for those affected, but also for their relatives. It is difficult for them to see that the loved one is increasingly mentally and physically deteriorating and may ultimately be in need of care. Daily attention and care takes a lot of strength and patience. The following tips may be helpful for relatives in everyday life:

  • Find out more about vascular dementia: Accompany the dementia patient to the doctor's visit, obtain literature on the subject and exchange ideas with other sufferers - for example in self-help groups.
  • Ensure consistency and habit: A regular daily routine and the familiar surroundings give the sick person security and support.
  • Be patient, even if the person with dementia has mood swings every now and then and confronts you with uncontrolled outbursts of anger and unjustified accusations. Remember: these are part of his illness and are not directed against you personally.
  • Avoid discussing differences with the person suffering from dementia and trying to convince them with arguments. Rather, try to distract him or turn to him lovingly.
  • Try to encourage the sick person's independence for as long as possible and do not "mother" them while they can still do certain things (like dressing, cooking, eating) themselves.
  • Think about yourself too: allow yourself enough breaks, let yourself be helped - for example by outpatient care services - and do something good for yourself more often. This saves your energy and helps you and your relatives in need of care.

A lot of information and advice on topics such as outpatient assistance, short-term care, long-term care insurance benefits and exchanges with other affected persons are offered by self-help groups or the German Alzheimer Society e.V., online at: www.deutsche-alzheimer.de

(www.apotheken-umschau.de is not responsible and assumes no liability for the content of external websites).

Prevention: Can Vascular Dementia Be Prevented?

Unfortunately, it is not always possible to prevent vascular dementia. There are also risk factors that cannot be influenced - for example, older age. At some points, however, countermeasures can be taken and thus the risk of illness can be reduced.There are many things that the doctor can improve, such as medication-based blood pressure adjustment, but also many things that the patient can do, such as promoting mental activities, doing sports in an individually appropriate setting and reducing weight. Good cooperation is also a great advantage here.

Blood pressure: high blood pressure puts a strain on the blood vessels. High blood pressure often goes unnoticed for a long time, because the disease initially causes hardly any symptoms. It is therefore advisable to have your blood pressure checked every now and then - for example at the pharmacy or at the doctor's as part of the check-up 35. This check-up is available every three years to those with statutory health insurance from the age of 35. If high blood pressure (arterial hypertension) is detected, therapy with close controls should be carried out.

Blood lipids, blood sugar: An unfavorable composition of blood lipids also increases the risk of arteriosclerosis ("vascular calcification") and thus also of circulatory disorders in the brain. Higher LDL cholesterol levels and low HDL cholesterol levels in particular pose a risk. High blood sugar levels also damage the arteries in the long term. Therefore, blood lipid values ​​and blood sugar should also be checked and - if necessary - therapy should be started, for example with medication.

Smoking: Tobacco smoke is harmful in many ways. Quitting smoking is therefore never a bad thing. Quitting smoking lowers, among other things, the risk of vascular dementia.

Weight: Carrying too many pounds around with you puts a strain on your cardiovascular system and increases the risk of developing vascular dementia. A healthy, balanced diet and, above all, plenty of exercise help to reduce excess weight and achieve and maintain a healthy weight.

Exercise: If you regularly incorporate sport and physical activity into your everyday life, you lower your risk of vascular dementia. As a precaution, older newcomers should clarify with the doctor which sporting activity they can safely expect.

Mental Activity: Challenge Your Brain. If you stay curious and inquisitive, you will keep the desire to learn. The more "trained" the brain, the more reserves it can draw on.

Social contacts: Joint social activities promote mental health. Meeting up with friends on a regular basis, joint activities, hobbies and tasks keep fit. Maintaining duties also contributes to mental health.

Prof. Günther Deuschl

© W & B / private

Our advisory expert:

Prof. Dr. Dr. h.c. Günther Deuschl is a specialist in neurology and former director of the neurological clinic at Christian-Albrechts-Universität Kiel, University Medical Center Schleswig-Holstein, Campus Kiel. He received his training in Munich, Freiburg and Washington and completed his habilitation in Freiburg in 1988. His clinical and scientific focus is on neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease. He helped develop the new treatment method of deep brain stimulation for Parkinson's disease and other movement disorders. A special focus is on the diagnosis and treatment of dementia. He is currently a Senior Prof. and emeritus of the Clinic for Neurology on Campus Kiel as well as past-President of the European Academy for Neurology.

Swell:

  • Eric Smith, MD; Clinton B Wright, MD, MS. Etiology, clinical manifestations, and diagnosis of vascular dementia. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (accessed March 18, 2020)
  • Eric Smith, MD; Clinton B Wright, MD, MS. Treatment of vascular cognitive impairment and dementia. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (accessed March 18, 2020)
  • AWMF (Association of Scientific Medical Associations eV), S3 guideline "Dementia", long version - January 2016. Online: https://www.awmf.org/uploads/tx_szleitlinien/038-013l_S3-Demenzen-2016-07.pdf ( accessed on March 18, 2020)

Important: This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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