Introduction

Vascular dementia is one of eleven general types of dementia. It is second only to Alzheimer’s Disease as a cause of this condition that affects the elderly in America. Scientists at the Krembil Neuroscience Centre (University Health Network, 2014) may have found one major cause of this type of dementia. And that could lead to effective treatment approaches for the condition.

The intensive study that lead to this discovery focused on damage to the white matter of the brain. This white matter is nerve fibers covered with a fatty insulating material called the myelin sheath. Their hypothesis was that the white matter is affected by a disease called leukoaraiosis and may be the result of numerous small strokes building up over time.

In the study, weekly MRI scans showed new small spots appearing in the subjects’ white matter over a period of 16 weeks. There were no symptoms with these spots that appeared to be the result of small new strokes. The researchers hypothesized that these small strokes would accumulate over time and that their overall effect would be to bring about the white matter disease leading to dementia.

These results should lead to physicians becoming aware of such small strokes and then aggressively treating conditions leading to these strokes. Risk factors like high blood pressure, diabetes, high cholesterol, cigarette smoking, and lack of exercise would be included in these conditions to treat.

What Is Dementia?

It is important to know what this condition we’re discussing is. Dementia is a grouping of symptoms and not really a disease in itself (Lava, 2014). It’s brought on by various diseases or conditions that lead to the typical signs of dementia. These signs include loss of certain mental functions such as thinking, memory, and ability to reason. These signs are usually severe enough to lead to interference with daily functioning. In order to be diagnosed with dementia, at least two major mental functions have to be significantly impaired.

Dementia has been described in aging adults since ancient times (MedicineNet, 2014). The word dementia literally means “deprived of mind”. At one time, it was called senile dementia and was considered a condition of old age.

Much of the time, dementia is a slowly progressing condition, gradually growing worse as a person ages. In the past, it was considered a typical result of normal aging. But better research has shown it to be more than just aging.

There are several types of dementia. Among the types of dementia, Alzheimer’s Disease is the most common type (MedicineNet, 2014). Vascular dementia, the focus of this article, is the second most common type of dementia. Lewy body dementia commonly occurs and overlaps with Alzheimer’s disease. Frontotemporal dementia may be caused by decay of nerve cells in two areas of the brain. It may also have a genetic component. HIV-associated dementia is brought about by an infection of the brain with HIV virus. Huntington’s disease, a hereditary disorder, can bring on severe dementia. Dementia Pugilistica, or Boxer’s syndrome, is typically due to traumatic injury to the brain. Corticobasal degeneration comes about due to progressive nerve cell loss in many areas of the brain. Creutzfeldt-Jakob disease is rare and may be related to a gene mutation leading to fast and fatal brain disease. There are other rare and some secondary dementias, as well.

Even children can develop dementia. Some are caused by the same things that bring on dementia in adults. Others are more unique to kids, including Niemann-Pick disease, Batten disease, Lafora disease, and mitochondrial abnormalities (MedicineNet, 2014).

There are also several kinds of dementia (Lava, 2014). Cortical dementias result when the damage to brain cells occurs mainly in the cortex, or outer layer of the brain. Subcortical dementias happen when damage to the neurons occurs below the cortex. Progressive dementias gradually get worse over time. Primary dementias are those like Alzheimer’s disease that do not come from another disease. Secondary dementias occur because of physical disease or injury.

Symptoms

As mentioned before, dementia is not a disease in and of itself, rather it is a collection of symptoms that come from multiple causes. There are some rather specific symptoms that are very indicative of dementia, however.

Symptoms of this condition affect the core mental functions that allow us to operate successfully in our day-to-day lives (Alzheimer’s Association, n.d.). These core mental functions are memory, communication and language, ability to focus and pay attention, reasoning and judgment, and visual perception.

What does this mean for the person with dementia on a daily basis? He or she may have trouble remembering where they last had their wallet or purse. They may forget to pay bills. Making and planning meals may be very difficult for them. They may forget important appointments. Or they may get lost, even in familiar neighborhoods.

Much of the time, these symptoms gradually grow worse. In some cases, they may even forget who loved ones are.

On the other hand, the symptoms of vascular dementia may come on suddenly and may or may not worsen over time. Since this type of dementia is caused by strokes, whether the condition worsens depends greatly on whether the person has more strokes.

If the vascular dementia does worsen, it is often sudden and in a stepwise manner (MedicineNet, 2014). But if the damage occurs in the mid-brain region, the progression may be more gradual and may be mistaken for Alzheimer’s disease. A very great difference, and a way to differentiate the two conditions, is that those with vascular dementia typically keep their personality functioning and their emotional responsiveness is near normal until late stages of the condition.

Night wandering, depression and incontinence are often seen in people with vascular dementia. Symptoms may be localized to one side of the body or to just one or only a few functions, especially in what is called multi-infarct dementia. This is the type of vascular dementia brought on by many small strokes, affecting the white matter of the brain. This is another difference from Alzheimer’s disease.

Binswanger’s disease, a rare form of dementia, also affects the white matter of the brain. It may bring brain lesions, loss of memory, changes in cognition, and mood changes. Lack of facial expression and speech problems are also common. These symptoms usually happen after the age

In most forms of dementia, psychological and behavioral changes also occur. These may include personality changes, mood changes, especially depression, and behavioral changes including aggression (Lava, 2014). In addition to these psychological changes, the person with dementia may develop paranoid feelings, experience hallucinations, and become agitated (Mayo Clinic, n.d.).

Causes of Dementia

In spite of research uncovering many of the causes of dementia, it remains difficulty to piece together all of the findings to make a clear picture of the cause(s) of dementia (MedicineNet, 2014). Due to the complexity of the human brain and the many factors that can interfere with it’s normal functioning, only one thing seems clear regarding the causes of dementia: all forms of the condition result from the death of nerve cells or the loss of communication between nerve cells.

Inclusions, or abnormal structures in the brain, are found in some kinds of dementias. Whether these inclusions cause the dementias or are a result of the diseases that actually cause them isn’t certain.

Genes are implicated in some kinds of dementia. Not usually a single gene, but from the interaction of genes, lifestyle, and environmental factors.

Any disease process that interferes with the circulation of blood to the brain can lead to vascular dementia. High cholesterol, high blood pressure, diabetes, cigarette smoking, and lack of exercise are a few of the conditions that can lead to lowered blood supply to the brain. If the brain cells don’t get enough blood, they don’t get enough oxygen to continue functioning properly. Too little blood, and the brain cells may die.

Prevalence of Dementia

Age has a great deal to do with the prevalence of this condition. The older the cohort under examination, the more likely dementia will be found.

According to statistics from the U.S. Congress Office of Technology Assessment, possibly as many as 6.8 million people in the U.S. have a form of dementia (Reported in MedicineNet, 2014). In some places, nearly half of people 85 and older have some form of dementia. According to Lava (2014), Alzheimer’s disease is the cause of half or more of the dementias. And some researchers say half of all people over 80 develop Alzheimer’s disease.

Whatever the numbers, it is clear that dementia is a significant condition that affects a great number of people over the age of 60. And it appears to be increasing (Swierzewski, 2011).

Treatment of Dementia

Currently, there are few if any treatment regimens to stop the deterioration seen in most dementias. For others, there are medications and other treatments available to deal with the underlying causes of the dementias.

For example, some medications used to treat Alzheimer’s may slow the deterioration and improve some of the symptoms (MedicineNet, 2014). But deterioration continues. These medications can improve the quality of life for some Alzheimer’s patients and possibly delay entry into a full-time nursing care facility.

Some people with dementia may respond to behavior modification techniques designed to control the inappropriate behaviors sometimes seen with these patients. Other tasks directly targeting the cognitive deficits that come with dementia can help some patients, as well.

With vascular dementia, much of the treatment focus is directed to preventing further damage to the brain by treating the underlying causes of the condition. Medications like cholinesterase inhibitors may improve cognitive functioning in some patients. Preventing strokes and improving blood flow to the brain through medications or surgeries can also help with this type of dementia. The depression seen frequently with vascular dementia can be successfully treated with medications (WebMd, 2014).

The relative lack of treatment options available for vascular dementia makes the research reported at the beginning of this article of more importance. While further research with larger sample sizes is needed, the results of this recent research is promising.

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References

Alzheimer’s Association. (n.d.). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp.

Lava, N. (2014, June 28). Alzheimer’s disease and other forms of dementia.  Retrieved from http://www.webmd.com/alzheimers/guide/alzheimers-dementia?print=true.

Lava, N. (2014, September 20). Types of dementia. Retrieved from http://www.webmd.com/train/types-dementia?print=true.

Mayo Clinic. (2014, May 6). Dementia. Retrieved from http://www.mayoclinic.org/diseases-conditions/dementia/basics/definition/CON-2003439.

Medicine Net. (2014). Dementia. Retrieved from http://www.medicnenet.com/script/main/art.asp?articlekey=9090&pf=2.

Swierzewski, S.J. (2011). Dementia. Retrieved from http://www.healthcommunities.com/dementia/dementia-overview-types.shtml.

University Health Network. (2014, Oct. 30). Possible cause of common dementia found, opening avenues for treatment. ScienceDaily. Retrieved from http://www.sciencedaily.com/releases/2014/10/141030100521.htm.

WebMd. (2014, January 27). Alzheimer’s disease health center dementia – treatment overview. Retrieved from http://www.webmd.com/alzheimers/tc/dementia-treatment-overview?print=true.