The pattern of symptoms across time that people experience are usually different in AD and Vascular Dementia. Even though memory problems are a symptom of Vascular Dementia, memory loss often occurs later in the disease compared to when it emerges in people with Alzheimer's. Typically, people with AD notice memory problems first. In contrast, people with Vascular Dementia usually experience problems with reflexes, gait, and muscle weakness first.
In addition, the courses of the two diseases are different. Vascular Dementia usually progresses in a "step-wise" fashion. In other words, people with Vascular Dementia "level out" (i.e., not experience much decline in functioning) for a period of time, then suddenly get much worse, then continue to alternate between stable periods and sudden drops in functioning. Individuals with AD can have good and bad days, but for the most part, this disease progresses in a more gradual, steadily downward fashion.
Diagnosis of Vascular Dementia
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As with Alzheimer's Disease, the first step in assessing for Vascular Dementia is to a complete a thorough diagnostic workup in order to rule out other possible causes of the dementia-like symptoms. Vascular Dementia is usually identified through imaging procedures (non-invasive procedures that produce detailed pictures of the brain) such as CT scans and MRIs, which show characteristic brain changes (narrowed or blocked arteries). For more information about these types of procedures, click here to return to our previous discussion.
CT and MRI scans can reveal whether one large stroke or a series of TIAs have occurred in the brain. An MRI angiogram, which is a special type of MRI, can also be used to detect narrowed or blocked arteries. Sometimes, a Doppler ultrasound (a technique that uses high frequency sound waves to detect blockages or narrow places in arteries) will also be ordered to investigate arteries in the neck that feed the brain. Neuropsychological tests, such as the ones described in the section on Alzheimer's disease, may also be conducted to determine the nature and extent of cognitive impairment.
Treatment of Vascular Dementia
No drugs have been approved by the FDA specifically to treat the symptoms of Vascular Dementia, but medications approved to treat Alzheimer's disease sometimes help people with Vascular Dementia as well. Doctors often prescribe a combination of a cholinesterase inhibitor (a drug that increases the level of acetylcholine in the brain, such as donepezil, rivastigmine, or galantamine; click here to return to our discussion of these medications) and memantine to treat Vascular Dementia. These drugs adjust neurotransmitter (chemicals that transmit messages throughout the brain and nervous system) levels in the brain that affect memory, judgment, and the processing of information.
Managing cardiovascular problems through medication and/or lifestyle changes may help slow the worsening of Vascular Dementia symptoms. Therefore, a person's blood pressure, pulse, cholesterol, blood sugar/diabetes, and body mass index/weight will be monitored, and if necessary, treated with medication, lifestyle and dietary interventions, and exercise as part of the treatment regimen for Vascular Dementia. For more information about treatments and lifestyle changes used for heart disease, please see our associated topic center. All of these strategies can improve brain health and ease blood flow throughout the brain.
Behavior management strategies - which are mentioned in the section on Alzheimer's and are discussed in more detail later - are also useful for managing the challenging behavioral symptoms (e.g., confusion, agitation, apathy) of Vascular Dementia.
Prognosis for Vascular Dementia
Because Vascular Dementia is currently "irreversible," there is no cure. Unfortunately, the prognosis for those with Vascular Dementia is generally poor. As mentioned above, people with this type of dementia frequently show a pattern of decline where periods of stability are interrupted by sudden episodes of worsening of symptoms. Life expectancy for someone with Vascular Dementia is highly individual and depends on the nature of the cardiovascular problems that are causing the dementia, along with the person's age and other medical conditions.