Early symptoms of vascular dementia

The early symptoms of vascular dementia tend to be more evident right after a major stroke but may actually develop and worsen progressively following a series of small or silent strokes – which is why this condition is also known as multi-infarction dementia (MID) or post-stroke dementia (stroke is synonymous with infarct). Not only can the symptoms of vascular dementia resemble those of Alzheimer’s disease, but Alzheimer MID may occur at the same time, what with them being the most common and second most common forms of dementia, respectively. Additionally, the symptoms may vary based on the severity and location of the damage. For example, loss of memory may or may not be a symptom depending on the area of the brain affected.

Vascular dementia symptoms include:

·         Confusion.

·         Disorientation.

·         Difficulty talking to or understanding others.

·         Loss of vision.

·         Difficulty to pay attention and concentrate.

·         Decreased ability to organize thoughts or actions.

·         Decreased ability to analyze a situation, develop a plan, and tell the plan to others.

·         Trouble making decisions.

·         Memory problems.

·         Restlessness.

·         Agitation.

·         Unsteady gait.

·         Frequent or sudden urination.

·         Incontinence.

·         Depression.

·         Trouble performing tasks that used to be easy; e.g., balancing a checkbook, playing games, or learning new information.    

·         Difficulty finding the correct word.

·         Becoming uninterested in formerly enjoyable things.

·         Misplacing things.

·         Changes in personality.

·         Loss of social skills.

In order to understand how vascular dementia can cause these symptoms, first we have to understand the relationship between strokes and dementia. During a stroke, circulation to the brain is interrupted. Multiple infarcts mean that more areas of the brain are receiving less blood on several different occasions. No blood means no oxygen; without oxygen brain cells die and cannot be regenerated. At first there may be no symptoms; this phenomenon is called silent stroke. However, the effect of repeated silent strokes is accumulative, and in time the symptoms of vascular dementia begin to appear.

Risk factors for vascular dementia

·         Age

Rare before 65 years of age, the risk increases considerably in the 80s and 90s

·         A history of heart attack, strokes, or mini-strokes

The brain damage resulting from these events may increase the risk.

·         Atherosclerosis

Cholesterol and plaque deposits accumulate in the arteries and constrict the blood vessels, diminishing the brain’s blood supply.

·         Hypertension

High blood pressure exerts additional pressure on blood vessels in the entire body – including the brain.

·         Diabetes

High blood sugar can damage brain blood vessels.

·         Smoking

Increases the risk of atherosclerosis and other circulatory conditions.

·         Atrial fibrillation

Increases the risk of stroke by causing inadequate circulation to the brain and the rest of the body.

·         High cholesterol

High levels of LDL cholesterol have been linked to an increased risk.

·         Obesity

A risk factor for vascular disease in general and presumably for vascular dementia in particular.


Risk factors plus early symptoms of vascular dementia can help a doctor make an approximate diagnosis, though there are no specific tests to diagnose MDI. However, there are several tests that a doctor can use to not only confirm MDI but also rule out other conditions that may causing the symptoms, like anemia, brain tumor, chronic infection, medications, severe depression, thyroid disease, or vitamin deficiency.

Tests, exams, and diagnosis of vascular dementia

Lab tests

·         Blood pressure.

·         Cholesterol.

·         Blood sugar.

Neurological exam

·         Reflexes.

·         Muscle stone and strength on one side of the body compared to the other.

·         Ability to get up from a chair and walk across the room.

·         Touch and sight.

·         Coordination.

·         Balance.

Brain imaging

·         CT scan.

·         MRI.

·         Carotid ultrasound.

Neuropsychological tests

·         Speaking, writing and understanding language.

·         Working with numbers.

·         Learning and remembering information.

·         Developing a plan and solving a problem.

·         Responding effectively to hypothetical situations.


The damage caused by small strokes is irreversible. This may sound like a cliché, but seldom is it truer than with vascular dementia: prevention is the best medicine. And the best way to prevent MID is to avoid the risk factors:

·         Avoid foods that are high in fat.

·         Do not drink more than 1-2 drinks per day.

·         Keep blood pressure under 130/80 mm/Hg.

·         Keep LDL cholesterol under 70mg/dL.

·         Do not smoke.

·         Exercise regularly.

In addition to the early symptoms of vascular dementia, MID can also lead to future strokes, heart disease, inability to care for oneself, pneumonia, urinary tract infections, skin infections, and pressure ulcers.