Vascular dementia can happen after a stroke. What are the early symptoms, warning signs

The brain is not only the control center for all the skeletal muscles, cranial nerves and many body systems, it is also responsible for thought and memory, and is where our personalities come from. So although the brain accounts for only abut 2% of our total body weight, it understandably uses 20% to 25% of our total blood flow and oxygen.

From this we can see that anything that can affect brain function (including stroke and/or other conditions that may compromise blood flow to the brain) can cause cognitive issues and even dementia.

The National Institute on Aging defines dementia as “the loss of cognitive functioning — thinking, remembering and reasoning — to such an extent that it interferes with a person's daily life and activities. Some people with dementia cannot control their emotions, and their personalities may change.”

Could a stroke even lead to dementia?

Vascular dementia is the syndrome where dementia symptoms are caused or contributed to by impaired blood flow to the brain. Although it is possible that this can have an acute onset of dementia symptoms (and even occur in addition to other stroke symptoms as noted above), it is not uncommon that symptoms have a more gradual onset/fluctuating course (and are noticed in a more gradual way) and progress over time. Vascular dementia is the second most common cause of dementia (behind Alzheimer's disease) and often occurs in addition to other dementia causes (multiple-etiology dementia).

Of course, depending on the region of the brain affected, strokes can also cause the symptoms most people are familiar with, including weakness of the face and/or limbs (particularly on one side of the body), speech issues, balance/walking issues, vision problems and/or many other symptoms.

What are symptoms of vascular dementia?

As with other dementias, early symptoms of vascular dementia may include:

• Memory problems, including misplacing items, getting lost (even in familiar places), word-finding issues and trouble remembering events

• Impaired concentration

• Confusion

• Personality and/or behavior changes (possibly including depression or withdrawal from social interaction).

These symptoms may fluctuate over time, and it's common that many people with early dementia are able to cover up their symptoms, hiding them from family and friends for extended periods. This makes it more difficult for family members and loved ones to identify that there is an issue until it progresses to a point where symptoms interfere with daily life (hence, fulfilling the diagnostic definition noted above).

How many people have vascular dementia?

Vascular dementia affects almost 2% of people at age 65, and the prevalence increases with age. Of patients with clinical dementia, it is responsible for about 10% of cases and is a contributing factor in up 25% to 50% of all cases (multiple-etiology cases).

The history and physical exam are very important in the evaluation of suspected dementia, and will include cognitive and behavioral testing.

How does a patient get diagnosed with vascular dementia?

Imaging of the brain is helpful in making the diagnosis of vascular and other dementias, and may include CT and/or MRI, and possibly Doppler ultrasound of the arteries leading to the brain. Other tests, such as looking for heart conditions (including atrial fibrillation, often called afib) that may increase the risk of emboli (small bits of plaque or other foreign bodies) that may block small arteries in the brain and cause a stroke (possibly including multiple microinfarcts, i.e. very small lesions of ischemic brain, which can lead to multi-infarct dementia) may be indicated.  Certain blood tests may also be ordered to look for other confounding conditions (such as vitamin B12 deficiency, thyroid disease, liver or kidney disease, other conditions).

What are the risk factors of strokes and heart attacks?

Risk factors for vascular dementia are the same cardiovascular risk factors that may lead to a heart attack or other cardiovascular issues, and include advanced age, hypertension, high cholesterol, diabetes, smoking, sedentary life style, obesity, known coronary artery disease and/or afib.

Treatment of vascular dementia focuses on addressing factors that may contribute to it, such as treating hypertension, diabetes, high cholesterol, afib or other suspected embolic sources (such as "blood thinning" medications), etc., as well as addressing other issues by encouraging smoking cessation, starting an exercise regimen, getting to a healthier body weight, etc.

What is the life expectancy of someone diagnosed with vascular dementia?

The five-year survival rate for patients with vascular dementia is only about 40% (in comparison to 75% for age-matched patients without it). This is in large part due to their overall risk of cardiovascular disease, with their cause of death often due to a cardiac event. So if you or someone you love show early signs of dementia, see your health care provider so appropriate treatments can be initiated.

Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.

This article originally appeared on MetroWest Daily News: The early symptoms and causes of vascular dementia