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Another thing to notice is general attitude. “Someone affected by subcortical vascular dementia will seem to lose the will to do the things they used to. It’s not so much that the person isn’t physically capable of doing a certain thing – they just haven’t got the energy or volition to do it,” says Prof Ballard.
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If you or a loved one is experiencing any of the symptoms above, or you are concerned about your (or their) cognitive health, particularly if over 65, you should make an appointment. Keep a symptom diary and take someone with you to see the GP.
When it comes to the right time to consult a professional, the consensus is that the earlier you can be seen the better. “If someone is showing signs of dementia, it is important to get an accurate diagnosis so that adequate advice, support, and services can be put in place for them,” says Edwards. “The earlier the better because there are things you can monitor and lifestyle changes you can make to slow down the progression,” agrees Prof Ballard.
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As a progressive disease, vascular dementia does have stages of decline. Early stage, meaning mild cognitive decline, middle stage, with moderate decline and later stage, meaning severe decline.
In the early stages the individual might experience slowed thinking, have difficulty following instructions or making plans. In the mid-stages speech may become less fluent, the person may begin to struggle with daily tasks and forget self-care routines.
In later stage vascular dementia, characterised by moderately to severe cognitive decline, the individual will need an increasing amount of assistance in everything from dressing to eating and drinking. They will need constant supervision and may need full-time care. However, both experts are keen to state the unpredictable nature of the disease and the need to avoid generalising.
“Vascular dementia is often described as having a ‘stepped’ progression, meaning that symptoms can fluctuate, then stabilise for a time and then worsen rapidly, particularly if further underlying physical health issues have occurred,” says Edwards. “This makes it difficult to attribute symptoms to stages of the disease. It is advisable to monitor the person’s condition and if there are any rapid changes in symptoms, visit the GP.”
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There is increasing evidence to suggest that managing risk factors such as blood pressure, cholesterol and weight can make a big difference. While management of these risk factors might not prevent vascular dementia, it will lessen your chance of developing the disease. Edwards points to a hopeful study: Dementia prevention, intervention, and care: 2020 report of the Lancet Commission analysed the 12 modifiable risk factors of dementia, including: hypertension, smoking, obesity, depression, physical inactivity, diabetes, low social contact and excessive alcohol consumption. Findings showed that modifying those risk factors might prevent or delay up to 40 per cent of dementias and advised that the medical community should be “ambitious about prevention”. The study stated that prevention is a two-prong approach about policy and individuals. “Contributions to the risk and mitigation of dementia should begin early and continue throughout life, so it is never too early or too late,” says Edwards.
Prof Ballard agrees. “Proactive screening of risk factors among a younger portion of the population would make a massive difference,” he says.
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Once you’ve taken the step to see a doctor, getting a correct diagnosis for vascular dementia can be tricky. GPs have to rule out other conditions such as vitamin deficiencies, depression or anaemia first, and they are also hampered by short appointment times which make it difficult to get the complete picture about a patient’s health. People under 65 often find it particularly difficult as GPs tend to look for common conditions based on age, so younger patients can find early on-set dementia ruled out in favour of other diagnoses such as stress, anxiety or depression.
Perseverance is key. There is no one test for dementia. Your GP will usually take a history, will try to rule out other possible causes and you may then be offered a mental agility test. With vascular dementia this could show up as a slower speed of thought and difficulty thinking things through, which are more common than memory loss.
If vascular dementia is suspected, you should be referred to a specialist for further neurological testing and a CT or MRI brain scan.
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The answer here can seem bleak. Drugs for Alzheimer’s are less effective for vascular dementia. “There are no specific treatments for vascular dementia at present,” says Prof Ballard, “although medication may be given for associated depression or underlying conditions such as high blood pressure, high cholesterol, heart problems or diabetes.” Addressing these risk factors, says Prof Ballard, is vital, because the management of these will substantially reduce progression. There are a lot of studies which prove this – particularly those led by Florence Pasquier at the University of Lille.
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Evidence suggests that people with vascular dementia live for around five years after their symptoms begin. However, both experts agree that various factors can influence this. “As with so many other conditions, it is not always possible to provide a definitive on life expectancy,” says Edwards.
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Unlike with Alzheimer’s which can be caused by the inheritance of a single gene, there is no single gene which causes vascular dementia: “There is an inherited condition called CADASIL that causes strokes in young people, leading to dementia,” says Prof Ballard. “But that’s very rare – only a handful of families in the UK are affected. For most people with dementia the answer is no, it’s not directly hereditary.”
However, although there are no direct genes that cause dementia, many of the risk factors for vascular dementia are hereditary. “There are genes that cause risk for high blood pressure, genes that cause risk for high cholesterol, genes that cause increased risk for diabetes,“ warns Prof Ballard. “There is not a single dementia gene but there are genetic factors which contribute to the risk of developing vascular dementia.” Those with a family history of high blood pressure, high cholesterol and diabetes should therefore pay even more attention to these risk factors with regular health checks and careful lifestyle choices.
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With no current treatment for vascular dementia it is easy to feel anxious about any possible diagnosis. However, it is a form of disease where taking responsibility for and proactively managing risk factors, can make a huge difference to outlook.
There are also glimmers of hope for the future as after years as a sidekick to Alzheimer’s, research focus is gradually shifting towards vascular dementia.
The UK Dementia Research Institute (UKDRI), for example, has vascular dementia as one of its seven research themes, and is focusing on understanding the mechanisms behind vascular and blood-brain barrier dysfunction during ageing and disease.
“At Exeter, one of the things we’ve been looking at is the effect of beetroot juice extract on the vascular system,’ says Prof Ballard. “It helps improve oxygen extraction from blood vessels, helping the system get more oxygen out of the blood into the organs. There’s emerging evidence it could be helpful in people with vascular disease. It’s still very much an embryonic research area, but it’s looking promising.”
The Manchester University study is also giving hope, as by revealing the way in which high blood pressure disrupts messaging within artery cells in the brain, causing them to constrict and limiting blood flow to the brain, there is hope that drugs will be identified to restore this communication, improve blood supply to affected areas and slow the progression of vascular dementia.
For more information about vascular dementia: https://www.dementiauk.org/information-and-support/types-of-dementia/vascular-dementia/
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