Vascular dementia refers to a form of cognitive decline caused by issues related to the blood vessels in the brain. When parts of the brain don’t receive enough oxygen and nutrients due to damaged or blocked blood vessels, brain cells may be injured or die, which can lead to changes in thinking and memory.
How it differs from other dementias
In contrast to some other types of dementia which may begin with prominent memory loss, vascular dementia more commonly presents with changes in thinking speed, planning, and judgment. The pattern of decline may be more step-wise (especially after a stroke) rather than the gradual continuous decline that accompanies Alzheimer’s disease.
Many people may have mixed dementia, such as vascular dementia and Alzheimer’s disease. These overlapping conditions mean that vascular dementia does not always occur on its own.
Causes and risk factors
Vascular dementia arises when blood vessels in the brain are damaged or become blocked, reducing the supply of oxygen and nutrients to brain tissue. Common causes include a major stroke, multiple smaller “silent” strokes, or the narrowing of small blood vessels deep inside the brain (often related to hypertension, diabetes, or aging).
Several risk factors increase the likelihood of vascular dementia. Known risk factors include:
- Older age (risk increases after age 65)
- Family history of vascular or heart disease
- High blood pressure
- High cholesterol
- Diabetes
- Atrial fibrillation
- Smoking
- Obesity
Many of the risk factors above overlap with cardiovascular disease risk. That’s because risk factors such as high blood pressure, diabetes, high cholesterol, and smoking all damage blood vessels and raise stroke risk, which in turn increases the risk of vascular-related cognitive decline.
Common symptoms of vascular dementia
Because the areas of the brain affected can vary widely, symptoms of vascular dementia also vary person to person. Some common patterns include:
- Slowed thinking
- Difficulty organizing thoughts
- Problems following plans
- Trouble finding the right words
- Diminished attention
- Apathy, restlessness, agitation, or depression
- Unsteady gait and poor balance
- Urinary incontinence
These symptoms may appear suddenly after a stroke, or more gradually when many tiny vessel injuries accumulate over time. The step-wise drop in cognitive ability is more typical in vascular dementia than the smoother decline seen in Alzheimer’s disease.
Treatment and management
While there is currently no cure for vascular dementia, there are meaningful opportunities to slow progression and manage symptoms. Treatment for vascular dementia may include addressing underlying vascular causes (e.g., controlling diabetes, treating irregular heart rhythms like atrial fibrillation, or quitting smoking) to prevent further brain damage. It may also include management of symptoms through therapies (such as cognitive therapy) and support.
When it may be time to talk with a professional
Early evaluation and intervention matter for brain health and vascular risk reduction. If you or a loved one notice one or more of the following, it’s important to consult a qualified clinician, such as a neurologist, geriatrician, or other dementia-experienced healthcare professional:
- Sudden changes in the ability to think clearly, organize tasks, or make decisions after a stroke or transient ischemic attack (TIA)
- Noticeable decline in planning skills, attention, or processing speed that you suspect may be related to your vascular risk factors (e.g., high blood pressure, diabetes, prior strokes)
- Frequent falls, balance issues, or urinary changes that are new and appear alongside cognitive changes
- Diagnosis of stroke, atrial fibrillation, heart disease or other vascular conditions and new concerns about memory or thinking
- Anxiety, depression, or other mood symptoms that accompany cognitive changes
- Worsening symptoms that interfere with daily living
Timely assessment and proactive brain health management offer the best pathway toward preserving cognition and quality of life.