How fast does vascular dementia progress?

Vascular dementia

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 differentiate reliably 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, poor 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
  • Dementia in Parkinson's disease
  • Lewy body dementia

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 washed 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 drugs 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. Calcifications (arteriosclerosis) develop 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 form even though 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 are no longer remembered. Those affected tell stories several times in a row or ask certain questions over and over again. Memories of one's own childhood and adolescence are usually easy to call up.
  • Problems with everyday activities: For example, a housewife suddenly doesn't know what to do to turn on the washing machine - even though she has done 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. Epileptic seizures also occur. Sometimes symptoms such as muscle stiffness, walking in small steps and slowing movement are reminiscent of the symptoms of Parkinson's disease.

Important to know: There are no "conclusive" 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 over longer phases, only to worsen 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.

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 influence 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. Today it is 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 to have another cup of coffee!", For example, you are forced to use the sentence: "I would like to have 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