What is vascular dementia and how does it differ from Alzheimer’s

Dementia is not a single disease, but a group of symptoms caused by brain damage, of which memory loss and worsening of cognitive abilities are the most characteristic.

“It’s a term that describes a situation that I, provocatively, explain to patients that the family is the one who diagnoses it,” Juan Fortea Ormaechea, a neuroscientist at the Hospital’s Memory Unit, told BBC News Mundo, the BBC’s Spanish service. Santa Cruz and San Pablo in Barcelona, ​​Spain.

“Often it’s a family member who comes to the doctor because their relative has developed a memory loss and can no longer live alone. It’s the family who makes the description.”

“What the doctor has to do right away is to define which pathology it is about. In other words, which disease is producing it and leading to these symptoms of dementia”, he adds.

Because it is the most common, Alzheimer’s disease is the best-known form of dementia.

After Alzheimer’s comes vascular dementia, the second most common form of dementia that you may not have heard of or know less about.

vascular damage

According to the non-profit organization Dementia UK, around 17% of people diagnosed with dementia suffer from vascular dementia, a disease that has no cure but, when its risk factors are controlled, can progress more slowly.

Vascular dementia is a general term that describes a “cognitive decline that usually occurs when there is a blockage or a reduction in blood flow to the brain, and this causes the levels of oxygen and nutrients that reach the neurons to decrease”, he tells the BBC Mundo Inés Moreno-González, professor and researcher of neurodegenerative diseases at the University of Malaga – Institute for Biomedical Research of Malaga (Ibima) and Cyberned.

This reduction in blood flow can occur for causes that include cerebral ischemia, small intercerebral hemorrhages, and other disorders that affect the cerebral blood vessels.

The symptoms caused by the death or damage of these neurons will depend, mainly, on the location of the brain accident.

“If it occurs in one of the brain regions involved in memory and learning processes, the result could be —although not in all cases—a failure in the ability to remember and learn new information,” says Moreno-González.

On the other hand, if the damage occurs in regions that are more linked to movement, motor coordination and balance, there may be motor symptoms like those that usually affect people who suffer apoplexy, such as the paralysis of certain areas of the body or problems walking”, adds.

Differences between vascular dementia and Alzheimer’s

Although it is often difficult to differentiate one condition from the other — as the symptoms of vascular dementia vary enormously and some, such as memory, reasoning and thinking failures, are common to both conditions — Moreno-González explains that the causes of both are common. are distinct.

While the origin of vascular dementia is linked to vascular damage, “it is known that the main cause of Alzheimer’s is the accumulation of toxic proteins generated in the brain, which will directly or indirectly damage neurons, and ultimately cause death.” them”, says the researcher.

Furthermore, the two conditions tend to evolve differently.

“Alzheimer’s is usually a disease that progresses slowly, like a path that descends a hill in a more or less homogeneous way”, says Fortea Ormaechea.

“On the other hand, vascular events can happen today — if you have a heart attack, you have brain damage, you recover in a few months, but there are sequelae — and if you don’t have another heart attack and there’s no other cause, it’s stabilized. Or you can have another heart attack the following year and get worse again”, he explains.

That is, cognitive deterioration can occur in a staggered and more marked manner, as opposed to a more linear evolution.

mixed dementia

What is common between both diseases are their risk factors. This concerns genetic predisposition, smoking, high alcohol consumption, sedentary lifestyle, obesity, cholesterol, sugar or high blood pressure, and factors linked to aging.

On the other hand, it is also important to note that in most cases, patients suffer from a type of mixed dementia, when Alzheimer’s and vascular damage coexist.

“It’s because we only have one brain, and the damage is accumulating”, explains Fortea Ormachea. “The vast majority of people who die of dementia in their 80s don’t have just one cause of cognitive decline.”

“We call most Alzheimer’s, but that’s because we ‘alzheimer’ dementia, because it’s the most common, and because we have biomarkers for everything.”

“We often call Alzheimer’s what in an 80-year-old person can be other pathologies or comorbidities that contributed to this cognitive deterioration”, says the researcher.

Some signs and symptoms of vascular dementia

• disorientation;
• Difficulty paying attention and concentrating;
• Reduced ability to organize thoughts and actions;
• Slowness of reasoning;
• Mood swings (uneasiness, restlessness, apathy);
• Problems with memory and language (less common than in Alzheimer’s);
• Unsteady walking or lack of balance.

Source: Mayo Clinic, NHS



Treatment

As for treatment, the first point that must be clarified is that “once neurons die, they cannot be resuscitated”, says Fortea Ormaechea. Damage cannot be reversed, but the cause can be sought to prevent it from happening again and delay its advance.

“If there has been ischemia, for example, it is treated with drugs that dissolve the clot and anticoagulants, to restart blood flow and prevent a blockage in the blood vessel from happening again”, says Moreno-González.

“If there’s a little bleeding, there are different drugs that can facilitate blood reabsorption.”

“If a person has hypertension, high levels of cholesterol and high blood sugar, these conditions are treated.” That is, the underlying causes.

“There is currently no treatment for vascular dementia, so the most effective form of treatment is to control the triggers of the disease.”

In addition, leading a healthy lifestyle will obviously contribute to maintaining a healthier cardiovascular system.