Vascular dementia causes problems with mental abilities and several other difficulties.

The symptoms can start suddenly or gradually. They tend to get worse over time, although treatment can help slow this down.

Early symptoms

Early signs of vascular dementia can include mild:

• slowness of thought
• difficulty with planning
• trouble with understanding
• problems with concentration
• changes to your mood or behaviour
• problems with memory and language (but these are not as common as they are in people with Alzheimer's disease)

At the beginning, these problems may be barely noticeable or mistaken for something else, such as depression. But they indicate some brain damage has happened and that treatment is needed.

Later symptoms

The symptoms often continue to get worse over time. This may happen slowly, or in sudden steps every few months or years.

The symptoms depend on the part of the brain that's affected, but can include:

• significant slowness of thought
• feeling disorientated and confused
• memory loss and difficulty concentrating
• difficulty finding the right words
• severe personality changes, such as becoming aggressive
• depression, mood swings and lack of interest or enthusiasm
• finding it difficult to walk and keep balance, with frequent falls
• loss of bladder control (incontinence)
• increasing difficulty with daily activities

Some people also have some symptoms of Alzheimer's disease.

Getting medical advice

See a GP if you think you have early symptoms of dementia, especially if you're over 65 years of age.

If it's found at an early stage, treatment may be able to stop vascular dementia getting worse, or at least slow it down.

If you're worried about someone else, encourage them to make an appointment with a GP and perhaps suggest that you go with them.

Symptoms of dementia can have several causes. A GP can do some simple checks to try to find out the cause and may refer you to a specialist for further tests.

Read more about:

Getting a dementia diagnosis

Tests used to diagnose dementia

Advice if you're worried someone else could have dementia

Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells.

This is usually due to:

• narrowing of the small blood vessels deep inside the brain, known as subcortical vascular dementia or small vessel disease
• a stroke (where the blood supply to part of the brain is suddenly cut off, usually because of a blood clot), called post-stroke dementia or single-infarct dementia
• lots of "mini strokes" (also called transient ischaemic attacks or TIAs) that cause tiny but widespread damage to the brain, known as multi-infarct dementia

Some people with vascular dementia also have brain damage caused by Alzheimer's disease. This is known as mixed dementia.

Who's most at risk?

Things that can increase your chances of getting vascular dementia in later life include:

• high blood pressure (hypertension)
• smoking
• an unhealthy diet
• high blood cholesterol
• lack of exercise
• being overweight or obese
• diabetes
• drinking too much alcohol
• atrial fibrillation – a type of irregular heartbeat (arrhythmia) – and other types of heart disease

These problems increase the risk of damage to the blood vessels in and around your brain, or cause blood clots to develop inside them.

Can I reduce my risk?

By making healthy lifestyle changes, such as stopping smoking and exercising regularly, and treating any health conditions you have, you may be able to reduce your chances of getting vascular dementia.

This may also to help slow down or stop the progression of vascular dementia if you're diagnosed in the early stages. Find out more about treating vascular dementia.

But there are some things you cannot change that can increase your risk of vascular dementia, such as:

• your age – the risk of vascular dementia increases as you get older, with people over 65 most at risk
• your family history – your risk of problems such as strokes is higher if a close family member has had them
• your ethnicity – if you have a south Asian, African or Caribbean background, your risk of vascular dementia is higher, as related problems such as diabetes and high blood pressure are more common in these groups

In rare cases, unavoidable genetic conditions can also increase your risk of vascular dementia.

Treatment can help prevent further damage to the brain in people with vascular dementia and may slow down its progression.

But there's currently no cure for the condition or a way to reverse the damage that's already happened.

Care plans

Before treatment starts, your current and future health and social care needs will be assessed and a care plan will be created. This is to make sure you receive the right treatment for your needs.

A care plan identifies areas where you may need help, such as:

• support for you or your carer so you can remain as independent as possible, including whether you might need care at home or in a nursing home
• changes that might need to be made to your home so it's easier to live in
• financial assistance

Read more about care plans.

Lifestyle changes

The main aim of treatment for vascular dementia is to treat the underlying cause to help stop the condition getting worse.

This will usually involve making healthy lifestyle changes, such as:

• eating a healthy, balanced diet. For example, you may be advised to follow a low-salt diet to manage high blood pressure
• losing weight if you're overweight
• stopping smoking
• getting fit
• cutting down on alcohol

Medicines

Medicines may also be offered to treat the underlying cause of vascular dementia and help stop it getting worse.

These include:

• medicines to treat high blood pressure
• medicines to treat high cholesterol, such as statins
• medicines such as aspirin or clopidogrel to reduce the risk of blood clots and further strokes
• anticoagulant medicines, such as warfarin, which can also reduce the risk of blood clots and further strokes
• medicines to treat diabetes

An antipsychotic medicine, such as haloperidol, may sometimes be given to people showing persistent aggression or extreme distress where there's a risk of harm to themselves or others. A consultant psychiatrist should be involved in deciding whether to prescribe this medicine.

Alzheimer's disease medicines, such as donepezil (Aricept), galantamine (Reminyl), rivastigmine (Exelon) or memantine are not used to treat vascular dementia, but may be used in people who have a combination of vascular dementia and Alzheimer's disease.

Support and other therapies

There are also several therapies and practical measures that can help make everyday living easier for someone with dementia.

These include:

• occupational therapy to identify problems in everyday life, such as getting dressed, and find practical solutions
• speech and language therapy to help improve communication problems
• physiotherapy to help with movement difficulties
• psychological therapies, such as cognitive stimulation (activities and exercises to improve memory, problem-solving and language)
• relaxation techniques, such as massage, music or dance therapy
• social interaction, leisure activities and other dementia activities, such as memory cafes (drop-in sessions for people with memory problems and their carers to get support and advice)
• making changes to your home, such as removing loose carpet and potential trip hazards, making sure the home is well lit, and adding grab bars and handrails

It can also be helpful to get in touch with a support group, such as the Alzheimer's Society or Dementia UK.

Read more about other treatments for dementia.

Read more about living well with dementia.

End of life and legal issues

If you have been diagnosed with dementia, you might want to make arrangements for your care that take into account the decline in your mental abilities.

This may include making sure that your wishes are upheld if you're not able to make decisions for yourself.

You may want to consider:

• creating an advance decision, which makes your treatment preferences known in case you're unable to do this in the future
• having a "preferred place of care" plan, which outlines where you would like to receive treatment
• giving a relative lasting power of attorney, enabling them to make decisions about you if you're unable to

Read more about managing legal affairs for someone with dementia and end of life planning.

Help and advice for carers

If you care for someone with dementia, you may find it helpful to read more about:

Looking after someone with dementia

Carer's breaks and respite care – this can allow you to take breaks from caring

Benefits for carers – such as allowances and tax credits that may be available