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Vascular dementia
Last reviewed: 12.07.2025
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Vascular dementia is an acute or chronic decline in cognitive function resulting from a diffuse reduction in blood supply to the brain or local infarctions, which in most cases are associated with cerebrovascular diseases.
In the United States, vascular dementia is the second most common disorder after Alzheimer's disease. In some other regions of the world where stroke rates are very high, vascular dementia is more common than Alzheimer's disease. Various criteria have been proposed for the diagnosis of vascular dementia, including the NINDS-AIREN, ADDTC, DSM-IV (American Psychiatric Association, 1994), and ICD-10 criteria. The DSM-IV and ICD-10 criteria are intended for clinical practice and are more sensitive than the criteria developed for research (NINDS-AIREN).
The above criteria for vascular dementia differ significantly, which leads to wide variability in its diagnosis. Several studies have compared the criteria in the same groups of patients. As a result, it turned out that only a small proportion of patients meet all the criteria simultaneously. The diagnostic criteria differ in sensitivity and specificity and are not interchangeable. In some studies, the diagnosis was made taking into account neuroimaging criteria in addition to clinical ones. Only a few criteria have been validated pathologically. The lack of uniform criteria complicates the study of issues of differential diagnosis, epidemiology, prognosis and treatment.
Causes of vascular dementia
Vascular dementia is the second leading cause of dementia in older people. It occurs mostly in men, usually after the age of 70. It is most common in people with vascular risk factors (including hypertension, diabetes, hyperlipidemia, smoking) and in those who have had multiple strokes. Many patients have a combination of vascular dementia and Alzheimer's disease.
Vascular dementia occurs when cerebral infarctions (or sometimes hemorrhages) result in the loss of so many neurons or axons that the brain no longer functions. Vascular dementia results from disease of the small vessels (lacunar disease) or the medium-sized vessels (multi-infarct dementia).
Binswanger's dementia (subcortical atherosclerotic encephalopathy) is a rare variant of dementia that occurs against the background of damage to small vessels of the brain, associated with severe poorly controlled arterial hypertension. In the development of the disease, multiple lacunar infarctions occur in the white and gray matter of the deep parts of the cerebral hemispheres.
The symptoms of vascular dementia are similar to those of other types of dementia. However, since vascular dementia is based on cerebral infarctions, the disease tends to develop discretely; each episode is accompanied by further intellectual decline, sometimes following a moderate recovery. In case of disease progression, deficit neurological symptoms often develop, which are represented by an increase in deep tendon reflexes, extensor plantar phenomena, gait disturbances, weakness of the limb muscles, hemiplegia, pseudobulbar palsy with forced laughter and crying syndrome, extrapyramidal disorders. However, in case of ischemic brain damage against the background of damage to small vessels, this deterioration is gradual. Cognitive functions may suffer selectively. Patients with incomplete aphasia may be largely aware of their deficit, so depression may develop more often with this type of dementia than with others.
[ Diagnosis of vascular dementia
The diagnosis of vascular dementia is similar to that of other types of dementia. If there is focal neurological symptoms or evidence of cerebrovascular disease, a thorough evaluation for stroke is mandatory.
CT and MRI may reveal bilateral multiple infarcts in the hemispheres and limbic system, multiple lacunar cysts, or periventricular white matter lesions extending deep into the hemispheres. In Binswanger dementia, neuroimaging reveals leukoencephalopathy in the area of the centrum semiovale adjacent to the cortex, often with lacunae affecting deep gray matter structures (including the basal ganglia, thalamus).
In the differential diagnosis of vascular dementia and Alzheimer's disease, the use of the Khachinsky ischemic scale may be useful.
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Treatment of vascular dementia
The 5-year mortality rate is 61%, higher than for most other types of dementia, probably due to associated atherosclerotic complications.
In general, treatment is the same as for other dementias. However, vascular dementia is preventable and its progression can be slowed by lowering and controlling blood pressure, cholesterol-lowering therapy, regulation of blood glucose levels (from 90 to 150 mg/dL), and stopping smoking.
The effectiveness of cognitive enhancing drugs, including cholinesterase inhibitors, has not been established. However, because many patients also have Alzheimer's disease, these drugs may be of some benefit. Additional drugs to treat depression, psychosis, and sleep disorders are helpful.
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