Dementia is a broad term used to describe various symptoms of cognitive decline, such as forgetfulness. It is a condition that affects millions of people worldwide and ranked among the top 5 leading causes of death in many countries.

What is lesser understood is that dementia can come in many forms, each with its own set of characteristics and challenges. Alzheimer's disease is often what many refer to when they talk about "regular" dementia due to its prevalence. However there’s a type of dementia that’s becoming increasingly more common called vascular dementia, which presents with a different set of challenges and characteristics that distinguish it from Alzheimer's and other forms of dementia. 

How Common is Vascular Dementia?

Vascular dementia is estimated to account for approximately 15-20% of dementia cases in older adults, making it the second most common type of dementia after Alzheimer's disease. Because of the higher association with risk factors, vascular dementia tends to be more common in men than in women. However, it's more common for women to have dementia as a cause of death over any other type of metabolic disease. 

Risk Factors For Vascular Dementia

The role of genetics in vascular dementia is less understood than in Alzheimer's disease. While specific genetic factors, such as the APOE ε4 allele, have been linked to an increased risk of Alzheimer's, the genetic predisposition to vascular dementia is more closely related to genes that predispose an individual to cardiovascular disease and stroke.

There are a number of health and lifestyle factors that tend to yield a greater risk of vascular dementia, these include;

• Poorly controlled blood pressure or cholesterol
• Diabetes or poor blood sugar control
• Obesity and/or a lack of physical exercise
• A nutritionally lacking diet
• Heart disease or rhythmic abnormalities
• A history of stroke
• Smoking

The Differences Between Vascular Dementia and Alzheimer’s Disease

Vascular dementia and Alzheimer's disease have different underlying attributes. Alzheimer's disease is characterised by the accumulation of amyloid plaques and tau tangles in the brain, leading to neuronal damage and functional loss to brain and nerve regions. In contrast, vascular dementia is caused by conditions that block or reduce blood flow to the brain, depriving brain cells of essential oxygen and nutrition, which can result in cellular brain damage. This can be due to stroke, ischemic events, or other conditions that impact the brain's blood vessels.

The symptoms of vascular dementia can vary significantly depending on the location and extent of the resulting cellular damage. Common signs include problems with planning, reasoning, memory, and other thought processes. Unlike Alzheimer's, where memory losses are often one of the first symptoms, vascular dementia may first manifest as difficulty with organisation, attention, or problem-solving skills.

Differentiating between vascular dementia and Alzheimer's requires clinical evaluation, including medical history, neurological exams, and imaging studies like MRI or CT scans to detect signs of stroke or blood vessel problems in the brain. Cognitive testing can help determine the pattern of cognitive impairments.

The progression of vascular dementia can be quite variable, depending in part on the underlying cause of the damage to brain regions. Some individuals may experience a staged decline, with periods of stability followed by sudden drops in function related to events such as strokes. In contrast, Alzheimer's typically follows a more gradual, continuous decline.

Prognosis in vascular dementia can vary and is closely tied to the control of the underlying vascular conditions. Controlling risk factors such as high blood pressure, diabetes, and smoking can help to slow the progression of vascular dementia.

Targetted interventions for vascular dementia focus on preventing further damage to the brain by managing the underlying vascular conditions and risk factors. This includes medications and lifestyle support to control blood pressure, cholesterol, diabetes, and antiplatelet drugs to improve circulatory function and prevent stroke. While these treatments can slow progression, they do not reverse the damage that will have already taken place.

In Alzheimer's disease, treatment may include medications aimed at slowing the progression of symptoms, such as cholinesterase inhibitors and memantine, which can also be employed in vascular dementia but primarily address symptoms rather than the cause.

For both types of dementia, supportive treatments such as cognitive therapy, physical activity, and social engagement are important for managing symptoms and improving quality of life. The specific approaches may vary depending on the individual's symptoms and the stage of the disease.

How Is Vascular Dementia Detected?

There is currently no single diagnostic test that you can perform to detect vascular dementia. 

As a proactive preventative health measure, we could consider the value in regular blood tests to check markers of inflammation or cardiovascular or blood vessel disorder risks and staying on top of lifestyle habits that reduce risk, such as eating a diverse, antioxidant and fibre-rich diet, getting daily exercise and fresh air and maintaining healthy blood sugar levels.

If you suspect you, or a loved one may be at risk, speak to a health professional about other targeted testing such as cognitive or memory tests, brain imaging, or scans to assess blood vessels for narrowing or atherosclerosis. 

Is There Evidence for Complementary Medicine Considerations?

It can be challenging to find studies that specify outcomes for just vascular dementia. Many cognitive impairment studies group all forms of dementia under one umbrella term of dementia or cognitive decline. Nevertheless, research looking at the benefit of herbs, nutrients and other natural compounds typically falls into two categories. Interventional - ie. providing a nutrient, herb or natural compound showing positive impacts for vascular dementia, or studies exploring the connection between the deficiency states of specific vitamins, minerals or amino acids that are connected to an increased risk for vascular dementia. 

INTERVENTIONAL EVIDENCE

Ginkgo Biloba Ihl R, et al. In a randomized placebo control trial of 410 patients with mild to moderate dementia (mixed origin) receiving 240mg of a Gingko biloba extract daily, researchers found that Gingko biloba was “significantly superior to placebo in the treatment of patients with dementia with neuropsychiatric symptoms”.

Vitamin E & C Masaki KH, et al. In a longitudinal study on over 3,000 men, researchers determined that “supplementing with vitamin E and C supplements may protect against vascular dementia and may improve cognitive function in late life.”

B Vitamins, Vitamin C & E Martinez V, et  al.  The findings of this systematic review suggest that supplementation of B Complex vitamins, especially folic acid, may have a positive effect on delaying and preventing the risk of cognitive decline. Ascorbic acid and a high dose of vitamin E, when given separately, also showed positive effects on cognitive performance

Glucosamine & Calcium Zhou C, et al. In a study of over 200,000 people ages over 60 years, habitual intake of glucosamine supplementation was significantly associated with a reduction in vascular dementia risk. Furthermore, this impact was more pronounced if also taking calcium.

Curcumin Prathipati B et al. evaluated the bioavailability and efficacy of small particle-sized curcumin in rats to impact markers of oxidative stress and homocysteine in vascular dementia. Researchers concluded that this first-of-its-kind study provided evidence of improvement in learning and memory, making curcumin a promising therapeutic agent in the neuroprotection against homocysteine-induced oxidative stress in vascular dementia.

NUTRITIONAL DEFICIENCY-RELATED RISK FACTORS

Vitamin D Chen L, et al. Exploring Vitamin D status in over 260,000 people, using UK Biobank data, hazards analyses reveal that vitamin D deficiencies “were associated with a 25% increased risk of developing all-cause dementia.”

Calcium, Magnesium and Potassium Ozawa M, et al. In a study of over 1,000 Japanese men followed up after 17 years, those with higher dietary intakes of magnesium, calcium and potassium had a lower risk of all cause dementia.

Plasma Chain-Breaking Antioxidants: α carotene, β carotene, lycopene, Vitamin A, Vitamin C, Vitamin E Joy CJ, et al. in a small study, which included 37 people with vascular dementia, researchers found that all dementia groups had a lowered status of plasma chain-breaking antioxidants.”The reduction in plasma chain-breaking antioxidants in patients with dementia may reflect an increased free-radical activity, and a common role in cognitive impairment in these conditions.”

Folate Rotstein A, et al. In the largest prospective cohort to date, this study examined the association between serum folate deficiency and the risks of dementia and all-cause mortality among older adults. Researchers concluded that serum folate deficiency (less than 4.4 ng/mL) was associated with a 1.68-fold increased risk of dementia and a 2.98-fold increased risk of all-cause mortality. Authors note that serum concentrations of folate may function as a biomarker used to identify those at risk of dementia and mortality.

Taurine Rafiee Z, et al. Taurine is an important amino acid for the brain and nervous ssystem. Low levels of taurine have been reported in Alzheimer’s disease and associated with greater dementia risk and vascular dysfunction.

 

The biggest take home message when it comes to vacular dementia is that it is typically not a genetic or inherited condition that is largely out of our proactive control, like Alzheimer’s disease tends to be. 

There’s a lot more opportunity to intervene and be proactive about our wellbeing to prevent vascular dementia, as the biggest risk factors are diet and lifestyle related. 

By caring for brain health with antioxidant and fibre-rich diets or supplementation, participating in regular exercise, and avoiding detrimental habits that place us in metabolic risk, such as smoking, vaping, exessive alcohol, energy or soft drink intake, high junk food or sugar intakes or sedentary behaviours, we can ensure we are optimising our wellbeing to buffer against metabolic-related neurological damage.