Taking brain health to heart: about vascular dementia

The links between heart disease and vascular dementia
February is Heart Month -- time to take your brain health to heart! Vascular dementia is the second most common form of dementia after Alzheimer's disease. Caused by problems in the supply of blood from the heart to the brain, it accounts for 20% of all dementia cases in Canada today.

How does vascular dementia happen?
Healthy functioning brain cells need a good supply of blood. The blood is delivered through a network of blood vessels called the vascular system. If the vascular system within the brain becomes damaged and blood cannot reach the brain cells, the cells will eventually die. This can lead to the onset of vascular dementia.

Sometimes one stroke is enough to cause damage to the brain. This is called single-infarct dementia. More commonly, however, the cumulative effect of many strokes is far more damaging and can destroy much of the brain's tissue impairing memory, language and other cognitive functions. This is known as multi-infarct dementia.

Are you at risk?
People who are most prone to developing vascular dementia have

• a medical history of stroke, high blood pressure, high cholesterol, diabetes (particularly type II), heart problems, or sleep apnea (where breathing stops during sleep)
• a lack of physical activity, drinking more than recommended levels of alcohol, smoking, eating a fatty diet, or leaving conditions such as high blood pressure or diabetes untreated
• a family history of stroke or vascular dementia
• an Indian, Bangladeshi, Pakistani, Sri Lankan or African-Caribbean ethnic background.

Symptoms of vascular dementia
Some symptoms, such as difficulty remembering, solving problems or concentrating, may be similar to those of other types of dementia. People with vascular dementia may particularly experience:

• depression accompanying the dementia
• symptoms of stroke, such as physical weakness or paralysis
• memory problems (although this may not be the first symptom)
• a 'stepped' progression, with symptoms remaining at a constant level and then suddenly deteriorating
• epileptic seizures
• periods of acute confusion.

Other symptoms may include:

• hallucinations (seeing things that do not exist)
• delusions (believing things that are not true)
• walking about and getting lost
• physical or verbal aggression
• restlessness
• incontinence.

What should you do if you have symptoms of vascular dementia?
See your doctor immediately. The earlier a diagnosis is made, the better the chance of treatment to slow the progression of the disease. The doctor will ask about your symptoms, medical history, current health and lifestyle.

Unless another cause can be found for the symptoms, the doctor should refer you to a specialist for cognitive tests to assess your attention, planning and thinking speed. The specialist may order brain scans to check for blockages or narrowing of blood vessels in the brain.

If possible, ask a close friend or family member to come to the first medical appointment. They may be able to describe subtle changes that you have not noticed. Be sure to mention if you have any family history of vascular dementia, or related conditions (such as heart problems).

What you can do to help prevent vascular dementia
There's good news! Vascular dementia is not only preventable but in many cases, treatable, if caught early.

Here are some healthy habits to live by:

• Learn about the early warning signs of stroke such as slurred speech, weakness on one side of the body, or blurred vision, even if they are only temporary. Talk to your doctor immediately. If left untreated, they can cause permanent damage.
• Get regular checkups to make sure your blood pressure and cholesterol levels are within the recommended range.
• Get at least 30 minutes of exercise every day, five days a week. Pumping your heart promotes healthy circulation and also keeps you in shape.
• Control weight gain. This will reduce the risk of diabetes. Seek advice from a dietician or nutritionist if required.
• Don't smoke or quit if you're already a smoker.
• Load up your plate with lots of fresh fruit and vegetables. Opt for a Mediterranean diet for optimum heart-health benefits.
• Take a pass on the salt shaker; avoid saturated fats, fast-foods or processed foods.
• Limit alcohol to one or two glasses a day.
• Manage or reduce your stress. Make time for yourself and indulge in a favourite activity.
• Keep your mind challenged and stay socially connected.

For more information about vascular dementia or if you're looking for support, call your local Alzheimer Society. There are 39 Ontario Chapters waiting to help you.

With files from Alzheimer's Society (UK), www.alzheimers.org.uk