Your mother had a small stroke last year and seemed to bounce back. But since then, she gets lost driving to the grocery store, struggles to follow her favorite recipes, and seems flat and uninterested in things she used to love. Her doctor orders a brain scan and says the words "vascular dementia." You wonder how it's different from Alzheimer's and what it means for the years ahead.
Vascular dementia is the second most common cause of dementia after Alzheimer's disease in people over 651. It happens when reduced blood flow damages parts of the brain, most often through a series of small strokes1. Unlike some other dementias, much of what drives it, such as high blood pressure and diabetes, can be treated. This guide explains what families need to know. It's general information. Your parent's doctors will guide treatment. For other types, see Lewy body dementia, frontotemporal dementia and early signs of dementia.
What causes vascular dementia
The brain needs a steady supply of blood. When blood flow is blocked for more than a few seconds, brain cells can die, causing permanent damage1. Vascular dementia is most often caused by a series of small strokes. Some are "silent," causing no obvious symptoms on their own. Over time, as more areas are damaged, dementia appears1. Larger strokes can also lead to dementia1.
Risk factors include high blood pressure, diabetes, hardening of the arteries, heart disease, smoking and a history of stroke1. Many of these are common in older adults, and many can be treated. Managing high blood pressure is one of the main ways to lower risk.
Early symptoms of vascular dementia
Symptoms depend on which areas of the brain are damaged1. Early signs can include1:
- Trouble with tasks that used to be easy, such as balancing a checkbook, playing cards or learning new routines.
- Getting lost on familiar routes.
- Trouble finding words for familiar objects.
- Losing interest in favorite activities, or a flat mood.
- Misplacing items.
- Mood changes, irritability or aggressive behavior.
- Personality changes and loss of social skills.
Slower thinking, trouble planning and problems with attention are often more noticeable early on than memory loss. Physical signs of past strokes, such as weakness on one side or trouble walking, may also be present1.
Later symptoms
As vascular dementia worsens, symptoms become more obvious and self-care declines1:
- Changes in sleep, often waking at night.
- Trouble with basic tasks like preparing meals, choosing clothes or driving.
- Forgetting recent events and, later, details of one's own life.
- Delusions, depression, agitation or hallucinations.
- Poor judgment and not recognizing danger.
- Using wrong words or speaking in confusing sentences.
- Withdrawing from social contact.
Our guides to dementia anger and aggression and sundowning can help with behavior changes.
Stages: the step-by-step pattern
Vascular dementia often doesn't follow the slow, steady decline typical of Alzheimer's. Symptoms may develop gradually, or they may worsen suddenly after each small stroke. Some people improve for a while, then decline again after more strokes1. Families often describe it as a staircase: a drop, a plateau, then another drop.
Over time, the overall direction is downward1. Because each step down can come without warning, it helps to have a plan ready: who will check on your parent, who can take time off, and which care options you would turn to. Early on, many people need only reminders and help with complex tasks such as bills and medicines. In the middle period, they need help with daily activities and supervision for safety. Late in the illness, they need full-time care. Families often find it helpful to think in terms of care needs rather than precise stages. See stages of dementia care needs for how support typically grows.
Watching for thinking changes after a stroke
Not everyone who has a stroke develops dementia, and many people recover a great deal of function with rehab. But changes in thinking after a stroke are common and easy to miss when everyone is focused on walking and speech. Watch for trouble following conversations, slower responses, poor judgment about safety, getting lost, or loss of interest in usual activities.
Mention any changes to the doctor or rehab team. Thinking tests can show which skills are affected, and therapists can teach strategies such as checklists, routines and memory aids. Treating depression, which is common after a stroke, can also improve thinking and motivation. Our guide to stroke recovery covers rehab in more detail.
Vascular dementia vs. Alzheimer's
- Cause. Vascular dementia comes from damaged blood flow. Alzheimer's comes from abnormal protein build-up in the brain.
- Early symptoms. Vascular dementia often starts with slowed thinking, planning problems or mood changes. Memory loss is usually the earliest symptom in Alzheimer's1.
- Pattern. Vascular dementia often worsens in steps; Alzheimer's declines more steadily1.
- Treatment. Medicines for Alzheimer's haven't been shown to work for vascular dementia, and preventing strokes is central1.
The two often occur together, which doctors call mixed dementia1. A careful diagnosis helps guide treatment. See Alzheimer's vs. dementia for how the two compare.
How it's diagnosed
Doctors diagnose vascular dementia with a physical and neurological exam, a medical history, mental status testing and often neuropsychological testing. Brain imaging such as CT or MRI can show signs of past strokes. Tests can also check for other problems that cause or worsen confusion, such as thyroid disease, vitamin deficiency, infection, medicine effects and depression1. Bring a list of medicines and notes about when changes started.
Treatment: preventing more strokes
There's no treatment to repair brain damage from strokes. The main goals are to manage symptoms and correct risk factors so more strokes don't happen1. That usually means:
- Control blood pressure. Ask the doctor for your parent's target and check it at home1.
- Manage diabetes and cholesterol. Following the treatment plan.
- Don't smoke. And limit alcohol1.
- Eat a heart-healthy diet. Lower in saturated fat and salt1.
- Take blood thinners only as directed. Don't start or stop aspirin without the doctor's advice1.
- Stay active. As the doctor allows, to help heart and brain health.
Medicines may be needed for agitation, depression or dangerous behaviors1. Rehab therapies can help with movement and speech problems from strokes. See stroke recovery in older adults.
Know the stroke warning signs
Life expectancy and complications
Vascular dementia usually gets worse over time, though there may be short periods of improvement1. How long a person lives depends on age, the extent of brain damage, and other health problems such as heart disease. Common complications include more strokes, heart disease, pneumonia, pressure sores, skin infections and urinary tract infections1. Good control of blood pressure and other risk factors can make a real difference. Keeping up with vaccines, moving regularly to protect the skin, and watching for signs of infection such as fever or new confusion can help prevent some of these complications. Ask your parent's doctor what to expect for them.
Daily care at home
The goals of home care are to manage behavior, confusion and sleep problems, remove safety hazards and support caregivers1.
- Keep routines steady. Regular times for meals, medicines and sleep reduce confusion.
- Break tasks into small steps. Since planning and starting tasks can be hard.
- Make the home safe. Remove trip hazards and lock up medicines. See fall prevention.
- Help with medicines. Blood pressure and diabetes medicines are critical. Use an organizer and reminders.
- Watch mood. Depression is common and treatable. See depression in older adults.
- Stay engaged. Simple activities, music and social contact help.
For approaches that reduce distress, see person-centered dementia care.
Driving, money and hospital stays
Slowed thinking and poor judgment can make driving unsafe, even if memory seems fine. Talk with the doctor about a driving evaluation. See when should an older adult stop driving. Planning problems also make it easy to miss bills or fall for scams, so set up automatic payments and keep an eye on accounts. See managing an elderly parent's finances.
Hospital stays can bring on sudden confusion. Bring a list of medicines and a short summary of your parent's usual abilities, stay with them when you can, and ask the team to check for infection, dehydration or medicine effects if confusion worsens. See hospital discharge planning.
Talking with your parent
Many people with vascular dementia understand what's happening, especially early on. Speak with your parent directly, include them in decisions, and focus on what they can still do. Changes in mood and personality are part of the illness, not a choice, which can help family members respond with patience rather than frustration. Encourage your parent to stay connected with friends and activities they enjoy, adapting them as needed.
Choosing care as needs grow
Many people with vascular dementia live at home with family support and paid help for years. A sudden decline after a new stroke can change needs overnight, so it helps to plan ahead. Learn about local memory care communities and nursing homes before a crisis. See how to choose memory care and signs it's time for memory care.
Late-stage care and planning
In late stages, people may lose the ability to walk, speak or care for themselves1. Palliative care can help at any stage, and hospice when a doctor certifies six months or less to live34. Medicare contractors consider things like the ability to walk, speak and eat when judging hospice eligibility for dementia5. See hospice for dementia.
Plan early while your parent can take part. Put an advance directive and powers of attorney in place6. See power of attorney for an elderly parent and caregiver burnout.
