Generality
Vascular dementia is a cognitive deficit caused by an "impaired blood circulation in the brain, which deprives some areas of the organ of blood, leading to the progressive and irreversible death of brain cells.
The symptoms of vascular dementia can be very different from patient to patient, depending on the parts of the brain affected by the disease.
The diagnosis must be carried out very carefully, since establishing the extent of the brain deterioration allows to plan the best therapy; currently, this therapy is only able to improve the symptoms, but not to stop their inevitable worsening.
What is vascular dementia?
Vascular dementia is a form of cognitive disorder, caused by "impaired cerebral blood circulation and the consequent progressive death of brain cells.
DEFINITION OF DEMENTIA
There are various types of dementia, but all can be considered, in general, a progressive and irreversible worsening of cognitive functions, caused by the death of brain cells.
Following a dementia, memory, language, judgment, thinking, behavioral skills etc. are distorted.
PREMONITIVE SIGNS: COGNITIVE VASCULAR DETERIORATION
Very often, vascular dementia is preceded by another disorder, the so-called vascular cognitive impairment, which can be considered a real warning sign or an early stage of the disease.
EPIDEMIOLOGY
Dementias are typical disorders of old age. In fact, according to one of the most reliable English scientific journals, they affect 5-7% of the world population over the age of 60 and even 30% of those over 80 years of age. .
These percentages have grown over the last few decades and will tend to increase further as people live longer and longer.
Vascular dementia is no exception and is fully in line with the above values. In addition, it has a predilection for Asian populations and blacks of Caribbean origin, who, in both cases, are very likely to suffer from hypertension (high blood pressure). It is also more common among men than among women.
After Alzheimer's disease, vascular dementia is the most common form of dementia in the world.
Causes
The cause of vascular dementia and the death of brain cells is a reduced circulation of blood inside the brain. In fact, as blood flow is reduced, the supply of oxygen and nutrients, which serve to keep the structures of the brain alive, ceases to exist. brain.
But what are the precise pathological causes that give rise to vascular dementia? The following:
- Small blood vessel disease
- Stroke
- Mixed dementia
- Multi-infarct dementia
- Atherosclerosis
THE MAIN CAUSE: THE DISEASE OF SMALL BLOOD VESSELS
The most common cause of vascular dementia is undoubtedly the so-called small blood vessel disease.
Small blood vessel disease is also known as subcortical vascular dementia.
THE OTHER CAUSES
Stroke, mixed dementia, multi-infarct dementia and atherosclerosis are considered minor causes of vascular dementia, as they are less frequent.
Stroke is caused by an interruption in the blood supply to the brain and can be due to numerous causes, including atherosclerosis (occlusion, due to fibro-adipose accumulations, of medium and large caliber arteries).
Mixed dementia is the result of the partnership between Alzheimer's disease and stroke, or between Alzheimer's disease and small blood vessel disease. Mixed dementia affects about 10% of people with dementia.
Finally, multi-infarct dementia is the result of several mini-strokes, which are characterized by affecting many small brain areas.
RISK FACTORS
Vascular dementia seems to be favored by risk factors of a different nature: some are linked to genetics, others to a bad lifestyle.
- Genetic factors. There are populations more predisposed than others to suffer from hypertension; this is one of the main risk factors of stroke, therefore also of vascular dementia. It should also be noted that, as regards the disease of small blood vessels, it seems that it derives from a genetic mutation that alters the structure and caliber of the wall This last pathological condition is also known as CADASIL (acronym for Autosomal Dominant Cerebral Arteriopathy with Subcortical Infarcts and Leukoencephalopathy).
- Bad lifestyle. Having the wrong diet, being overweight, smoking and not keeping blood pressure under control: these are all factors that greatly expose you to stroke, atherosclerosis and many cardiovascular and neurodegenerative diseases.
Symptoms and Complications
For further information: Symptoms Vascular dementia
Premise: the human brain is made up of many parts.
The symptoms of vascular dementia can be very varied and different from patient to patient. In fact, they depend on which brain areas, once damaged, go to death.
All possible ailments are:
- Severe slowness of thought
- Severe sense of disorientation and confusion
- Memory loss (more or less continuous amnesia) and difficulty concentrating
- Difficulty finding words
- Severe and sudden changes in personality (for example, the patient goes from calm to aggressive)
- Depression, mood swings and apathy
- Difficulty walking and balance
- You need to urinate often, even if you do not suffer from any specific urinary tract disorder
- Suffering from hallucinations, i.e. hearing or seeing things that don't exist.
PROGRESSION OF SYMPTOMS
Once vascular dementia arises, it progresses inexorably and leads to the death of a "brain area that is gradually more and more extended.
However, this worsening is not the same for all patients: for some, in fact, it is very rapid, while, for others, it is very slow and suddenly accelerates following a certain event (which can be a heart attack, a transient ischemic attack, heart disease of various kinds, etc.).
HOW TO RECOGNIZE COGNITIVE VASCULAR DETERIORATION
As mentioned, in many cases vascular dementia is anticipated by the so-called cognitive vascular deterioration, which is a milder and above all reversible mental disorder.
Its characteristic symptoms can be very different from each other and consist of: slow thinking, decision-making difficulties, memory loss, slurred speech, mood swings, personality changes and, ultimately, depression.
Precisely the latter, depression, represents the most significant sign from the diagnostic point of view.
COMPLICATIONS
No particular complications are reported, except the fact that the disease and symptoms tend to worsen gradually, with no possibility of recovery. In fact, once the brain cells die, the affected area of the brain is irreparably damaged.
Diagnosis
Promptly diagnosing vascular dementia allows you to better slow down its progression; even, identifying its early form (ie the cognitive vascular deterioration) could prevent its onset.
Therefore, at the first appearance of one of the aforementioned symptoms (memory loss, speech difficulties, etc.) it is advisable to immediately contact your doctor, being accompanied by a relative or a close friend. The latter, in fact, will help the doctor in the diagnosis, remembering events or symptoms that the patient may have inadvertently forgotten.
EXAMINATIONS AND TESTS
The diagnostic process foresees that the following controls and instrumental tests are carried out:
- Physical examination. The doctor observes the symptoms, if the patient reveals them during the examination, or asks to describe them to the relative or friend accompanying the patient. Timing is very important, i.e. knowing how long the disturbances have been appearing.
- Complete investigation of the patient's medical history. The doctor can draw diagnostic conclusions of some relevance if the patient suffers or has suffered in the past from some heart disease (for example, a heart attack) or stroke. Also in this case, the patient may not remember his own clinical history, therefore the contribution of the person who accompanied him is needed.
- Verification of the drugs taken by the patient. Some medications used for depression can cause hallucinations and other symptoms similar to those of vascular dementia, among other side effects. Therefore, knowing if and which medicines the patient is taking can be fundamental to take into consideration the hypothesis of vascular dementia. Once again, the contribution of the carer is important.
- Examination of cognitive faculties. This exam is based on the so-called Montreal Cognitive Assessment (MoCA), a sort of evaluation test, ideal for mild cognitive impairment, which assesses: attention and concentration, memory, language, abstraction, calculation and orientation. The duration of the MoCA is approximately 10 minutes.
- Blood analysis. They are used to rule out the possibility that the symptoms are due to vitamin deficiencies or other similar pathologies. For example, a diet deficient in vthiamine B3 can cause ailments similar to those of vascular dementia.
- CT scan and magnetic resonance imaging (MRI) of the brain. By clearly showing the brain anatomy, these radiological examinations reveal which areas are affected by the disorders and the triggering cause. Vascular dementia could, in fact, be mistaken for a brain tumor.
WHAT IS THE UTILITY OF AN ACCURATE DIAGNOSIS?
Beyond the timeliness, the accuracy of the diagnosis is also very important, as it allows the doctor to plan the most appropriate therapy. In fact, each patient is a separate case and shows different disorders, depending on the brain area concerned. .
Treatment
Unlike vascular cognitive impairment, vascular dementia cannot be cured. However, it can slow down its progression and limit its symptoms.
To obtain these results, however, it is necessary to resort to various therapeutic treatments: from drugs for hypertension or Alzheimer's to specific therapies for dementia.
Starting from how to avoid the negative evolution of vascular cognitive impairment, all the possible treatments for vascular dementia will be reported below.
TREATMENT FOR COGNITIVE VASCULAR DETERIORATION
The best thing to do when suffering from so-called cognitive vascular impairment is to change your lifestyle and take on a healthier one. In fact, very often, this disorder is caused by cigarette smoking, an unbalanced diet, overweight, hypertension and poor physical movement.
Correcting all these bad habits prevents, or at least reduces, the risk that the situation evolves towards the onset of vascular dementia.
TREATMENT OF VASCULAR DEMENTIA
Premise: before describing each single therapeutic treatment, it should be specified that correcting a wrong lifestyle does not stop the progression of vascular dementia, but it is still an excellent advice
Treating vascular dementia is by no means simple and requires the support of various experts, such as neurologists, psychologists, physiotherapists and speech therapists.
Remembering that each patient is a case in itself, here are the pharmacological therapies, those specific for dementia and rehabilitative ones.
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