Vascular Dementia: We Can Do More Than You Might Think
By Dr Matthew Lennon1,2,3, Ying Xu1, Perminder S Sachdev1,3
1Centre for Healthy Brain Aging (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney NSW, Australia
2Royal North Shore Hospital, North Shore Local Health District, Sydney NSW, Australia
3Neuropsychiatric Institute, the Prince of Wales Hospital, Sydney NSW, Australia
A diagnosis of vascular cognitive impairment or dementia can leave people and their families feeling that there is little that can be done. But that is not the whole story.
Vascular cognitive impairment and dementia (VCID) is one of the most common causes of cognitive decline in later life. While there is currently no medication specifically approved in Australia to treat VCID itself, research is showing that there are many ways to reduce further brain damage, manage symptoms and support quality of life. That starts with understanding what vascular dementia actually is.
What is vascular dementia?
VCID happens when problems with the brain’s blood supply damage blood vessels and brain tissue. This can happen through strokes, damage to the brain’s small blood vessels, bleeding or changes to the brain’s white matter.
The symptoms can vary considerably from person to person. Memory loss may not be the main problem. Someone might instead become slower at thinking, have difficulty concentrating or making decisions, experience changes in their walking, or become less motivated or more depressed.
Vascular disease and Alzheimer’s disease can also occur together. In fact, many people diagnosed with Alzheimer’s disease have some degree of vascular damage as well. This overlap means that some treatments used for Alzheimer’s disease may also help people with vascular dementia.
What can be done?
One of the most important messages is that preventing further damage matters.
High blood pressure is the biggest modifiable risk factor for VCID. Keeping blood pressure under control, along with managing diabetes, stopping smoking, exercising regularly, maintaining a healthy diet, treating sleep apnoea and addressing obesity, can all help protect brain health.
There is even evidence that some of the changes caused by vascular disease can partially improve. In one study, more than a third of people who had experienced a minor stroke showed a reduction in the amount of white matter damage seen on brain scans over the following year, with improvements particularly evident among those whose blood pressure was well controlled.
Exercise is also an important part of care. It can support thinking and memory, while improving physical health, mobility and mood.
Looking beyond memory
For families, some of the most difficult symptoms can be behavioural and psychological changes, including depression, apathy, anxiety, agitation, sleep problems and psychosis.
These symptoms should not simply be accepted as an inevitable part of dementia. Pain, constipation, infection, poor sleep, hearing or vision problems, medication side effects and an overwhelming environment can all make symptoms worse.
Simple measures such as establishing routines, improving sleep, staying physically active, addressing sensory problems and supporting carers can make a real difference.
There is reason for hope
Research into VCID is moving quickly. Scientists are investigating blood-based biomarkers, more sophisticated brain imaging, artificial intelligence, treatments to improve blood flow, neurostimulation and precision medicine.
There is still much we do not know. But the message for people living with vascular dementia and their families is clear: a diagnosis does not mean that nothing can be done.
Protecting brain health, treating symptoms, supporting carers and maintaining connection, meaning and quality of life all matter. And as research continues to advance, the options available to people living with vascular dementia may look very different in the years ahead.
You can find out more about managing vascular cognitive impairment and dementia by subscribing to the Australian Journal of Dementia Care.