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While Alzheimer’s is the most well-known form of dementia, especially given that life expectancy continues to rise, vascular dementia is the second most common cause of cognitive decline - and for women over 60, the risks can be particularly "hidden."
Neurologist Dr Silvia Gil, a spokesperson for the Spanish Society of Neurology (SEN), warns that poor cardiovascular health is often the silent trigger.
Why women over 60 are at higher risk
When neurologists discuss vascular dementia, they are referring to a form of cognitive decline resulting from brain damage caused by vascular lesions or a stroke. "These types of lesions can be caused by a reduction in blood flow to the brain or a haemorrhage. In either case, the damage is significant enough to adversely affect not only cognition, but also the ability to manage daily tasks independently. Consequently, the individual requires support and supervision from others," says the neurologist.
A common question is whether specific risk factors influence the development of the condition. "Various cardiovascular risk factors play a decisive role in an individual’s risk of developing vascular dementia," explains Dr Gil. "The primary factors include high blood pressure (hypertension), high blood sugar (diabetes), elevated cholesterol and triglycerides, smoking, a sedentary lifestyle, obesity and certain heart rhythm disorders."
She adds that age is also a significant factor in the risk of cognitive decline. "Furthermore, we know of several factors that increase the likelihood of vascular dementia following a stroke." These factors include:
- Being female
- Having a lower level of formal education
- Diabetes
- Atrial fibrillation (a common type of arrhythmia)
- Previous strokes or cerebrovascular lesions
The symptoms that signal more than just a 'senior moment'
If you suspect someone you know may be suffering from dementia, it is important to have a clear understanding of the symptoms to look out for. "The symptoms of vascular dementia vary widely and depend primarily on the extent and location of the brain damage, which may result from lesions in the large cerebral arteries or the small blood vessels," the doctor explains.
"Generally speaking, patients may develop problems with memory, language and processing speed, alongside difficulties with attention and reasoning. Changes in visual perception, manual dexterity, personality and behaviour can also occur."
Vascular dementia vs Alzheimer's: How to tell the difference
When signs of cognitive decline emerge, neurologists must pinpoint the specific cause to tailor treatment effectively. The goal is to improve the patient's quality of life and slow the disease's progression as much as possible. Along with Alzheimer's, other forms of dementia also include Lewy body dementia (which late CNN founder Ted Turner battled).
Vascular dementia is not primarily a neurodegenerative disease; rather, it is caused by damage to the blood vessels. In contrast, "Alzheimer’s and Lewy body dementia are both neurodegenerative conditions," explains Dr Gil. "Essentially, they involve a gradual breakdown of neurons and other cells in the nervous system, eventually causing them to die off. How these diseases present depends on which neural networks are hit and where the damage is located in the brain."
Confirming a diagnosis: What to expect when you visit a neurologist
Should these symptoms arise, it is time to consult a neurologist to confirm a diagnosis. "There are various diagnostic criteria for vascular dementia and its different clinical subtypes," explains Dr Gil.
"Generally, cognitive impairment must be identified through standard neuropsychological testing and be severe enough to interfere with a person’s day-to-day life, regardless of any physical or sensory after-effects from a previous stroke. Furthermore, vascular damage must be visible on a brain scan, and other possible causes for the decline must be ruled out."
Slowing the progression: Expert-approved lifestyle changes and treatments
Once a diagnosis is confirmed, what might the treatment plan look like? The neurologist explains that it is vital to ensure that the vascular risk factors mentioned earlier are effectively managed and treated. "Staying physically and mentally active also helps to slow the progression of cognitive decline, as does a balanced and varied diet, such as the Mediterranean diet. There are also certain medications we can offer patients and their families, particularly when Alzheimer's disease is also present," she notes.
Looking ahead: What is the long-term prognosis for patients?
Finally, we asked about the outlook for someone with vascular dementia. She notes that the prognosis varies significantly between individuals and depends on a combination of different factors.
"Some factors are difficult to manage, such as sex, specific genetic risk factors, age or an individual’s natural brain resilience. Others, however - such as lifestyle choices, mental stimulation and the medical management of vascular factors - are more easily influenced.
"We also have to consider the type and location of the vascular damage; certain lesions, however small, can cause severe impairment if they occur in critical areas of the brain," the neurologist concludes.
