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[Conditions](https://durgical.com/en/conditions/) · [Neurology](https://durgical.com/en/conditions/)

# Vascular dementia

Vascular dementia is a loss of thinking abilities caused by strokes or damage to the small vessels of the brain. It is the second most common dementia.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [White matter](https://durgical.com/en/anatomy/white-matter-of-telencephalon/)
- [Thalamus](https://durgical.com/en/anatomy/thalamus/)
- [Middle cerebral artery](https://durgical.com/en/anatomy/middle-cerebral-artery/)
- [Frontal lobe](https://durgical.com/en/anatomy/superior-frontal-gyrus/)
- [Caudate nucleus](https://durgical.com/en/anatomy/caudate-nucleus/)
- [Hippocampus](https://durgical.com/en/anatomy/hippocampus/)
- [Anterior cerebral artery](https://durgical.com/en/anatomy/anterior-cerebral-artery/)
- [Posterior cerebral artery](https://durgical.com/en/anatomy/posterior-cerebral-artery/)
- [Internal carotid artery](https://durgical.com/en/anatomy/internal-carotid-artery/)
- [Lateral ventricles](https://durgical.com/en/anatomy/lateral-ventricle/)

## Why it happens

- [Infarction: red vs white, and what decides the damage](https://durgical.com/en/general-pathology/infarction-red-vs-white-and-what-decides-the-damage/)
- [Watershed areas and the organs most sensitive to ischemia](https://durgical.com/en/general-pathology/watershed-areas-and-the-organs-most-sensitive-to-ischemia/)
- [Atrophy](https://durgical.com/en/general-pathology/atrophy/)
- [Cerebral blood flow, brain metabolism and intracranial pressure](https://durgical.com/en/physiology/cerebral-blood-flow-brain-metabolism-and-intracranial-pressure/)
- [Blood vessels: artery, vein and capillary layers](https://durgical.com/en/histology/blood-vessels-artery-vein-and-capillary-layers/)

## What it is

A major neurocognitive disorder caused by cerebrovascular disease, from large strokes, multiple small (lacunar) infarcts or diffuse small-vessel damage to the white matter. It is the second most common cause of dementia after Alzheimer disease and often coexists with it (mixed dementia).

## Who gets it

Accounts for roughly 15–20% of dementia cases, more in populations with a high burden of hypertension and stroke, as in much of Latin America. In Colombia, hypertension, diabetes and Chagas cardiomyopathy (a source of cardioembolic stroke) add to vascular risk, and familial small-vessel disease (CADASIL) has been described in Colombian families.

## Causes

- Cerebral small-vessel disease: lacunar infarcts and white matter damage (leukoaraiosis) from arteriolosclerosis
- Multiple cortical infarcts (multi-infarct dementia) from atherosclerotic or cardioembolic strokes
- Single strategic infarcts (e.g. [thalamus](https://durgical.com/en/anatomy/thalamus/), caudate, angular gyrus)
- Less common: cerebral amyloid angiopathy, vasculitis, hereditary small-vessel disease (CADASIL)

## Risk factors

- Hypertension, the most important modifiable factor
- Diabetes, dyslipidaemia and smoking
- Atrial fibrillation and other sources of cardiac emboli
- Previous stroke or transient ischaemic attack
- Older age, physical inactivity and obesity

## Pathophysiology

Narrowed, stiff small arteries reduce blood flow to the deep white matter and subcortical nuclei, breaking the frontal-subcortical circuits that support attention, planning and processing speed. Large or repeated infarcts destroy cortex directly. Damage accumulates in steps with each new event or progresses gradually in diffuse small-vessel disease.

## Classification

- Subcortical ischaemic vascular dementia (small-vessel disease), the most common type
- Multi-infarct (cortical) dementia
- Strategic infarct dementia
- Mixed dementia (vascular plus Alzheimer pathology)
- Vascular mild cognitive impairment when daily function is preserved

## Symptoms and signs

- Slowed thinking, poor attention and trouble planning and organising (executive dysfunction), more than early memory loss
- Stepwise decline after strokes, or gradual decline in small-vessel disease
- Focal neurological signs: weakness, brisk reflexes, speech problems
- Short-stepped, shuffling gait, falls and urinary urgency or incontinence
- Apathy, depression and emotional lability

## Red flags

- Sudden new weakness, facial droop or speech disturbance (acute stroke)
- Sudden worsening of confusion with fluctuating attention (delirium from infection, drugs or metabolic causes)
- Repeated falls or unsafe swallowing
- Rapid cognitive decline over weeks (look for another cause)

## Diagnosis

**Clinical**
Cognitive decline that affects daily function, with evidence of cerebrovascular disease and a plausible link in time or pattern. Cognitive screening (e.g. MoCA, which tests executive function better than MMSE), neurological examination and assessment of vascular risk.

**Tests**
Bloods to exclude reversible causes: blood count, glucose, lipids, thyroid function, vitamin B12, electrolytes, calcium, [kidney](https://durgical.com/en/anatomy/kidney/) and [liver](https://durgical.com/en/anatomy/liver/) function; syphilis and HIV serology when indicated. ECG or Holter for atrial fibrillation.

**Imaging**
Brain MRI is the key test: [white matter](https://durgical.com/en/anatomy/white-matter-of-telencephalon/) hyperintensities, lacunes, cortical infarcts or microbleeds. CT can show infarcts and white matter hypodensity. Carotid ultrasound and echocardiography look for stroke sources.

## Differential diagnosis

- Alzheimer disease or mixed dementia
- Dementia with Lewy bodies
- Normal pressure hydrocephalus (gait, incontinence, cognitive decline)
- Depression with cognitive complaints (pseudodementia)
- Reversible causes: hypothyroidism, vitamin B12 deficiency, neurosyphilis, subdural haematoma, delirium

## Goal of treatment

Prevent further vascular damage by controlling risk factors, manage cognitive and behavioural symptoms, and maintain function, safety and quality of life for the person and caregivers.

## Treatment

**Medical**
Secondary stroke prevention: blood-pressure control, statins, antiplatelet agents after ischaemic stroke, anticoagulation in atrial fibrillation, and diabetes control.

**Medical**
Cholinesterase inhibitors and memantine give modest benefit, mainly in mixed dementia; antidepressants for depression. Antipsychotics are avoided where possible because of stroke and death risk.

**Rehabilitation**
Cognitive stimulation, physiotherapy for gait and balance, occupational therapy and speech therapy after stroke.

**Conservative**
Caregiver education and support, structured routines, home safety, advance care planning; stopping smoking, physical activity and a heart-healthy diet.

**Follow-up**
Regular review of cognition, blood pressure, mood, falls and swallowing; nursing priorities are orientation, fall prevention, nutrition, continence and medication safety.

## Complications

- New strokes and further stepwise decline
- Falls and fractures
- Aspiration pneumonia and malnutrition
- Delirium during illness or hospital stays
- Loss of independence and caregiver burden

## Prognosis

Usually progressive, with survival often shorter than in Alzheimer disease because of the associated cardiovascular disease. Strict control of vascular risk factors can slow or stabilise the decline. Death is often due to stroke, heart disease or infection.

## Test yourself

Think of the answer, then tap the question to see it.

## What type of cognitive impairment is most typical of subcortical vascular dementia?

Executive dysfunction and slowed processing speed, with relatively less early memory loss than Alzheimer disease.

## What is the classic time course of multi-infarct vascular dementia?

Stepwise decline, with sudden worsening after each new stroke followed by periods of stability.

## Which is the most important modifiable risk factor for vascular dementia?

Hypertension.

## Which imaging finding supports vascular dementia?

On MRI, white matter hyperintensities, lacunar infarcts or cortical infarcts consistent with cerebrovascular disease.

## Which reversible causes should be checked in every new dementia?

Hypothyroidism, vitamin B12 deficiency, depression, drugs, neurosyphilis, subdural haematoma and normal pressure hydrocephalus.

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## Related conditions

- [Alzheimer disease](https://durgical.com/en/conditions/alzheimer-disease/)
- [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/)
- [Transient ischaemic attack](https://durgical.com/en/conditions/transient-ischaemic-attack/)
- [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/)
- [Atherosclerosis and dyslipidaemia](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/)
- [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/)
- [Dementia with Lewy bodies](https://durgical.com/en/conditions/dementia-with-lewy-bodies/)
- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)
- [Delirium](https://durgical.com/en/conditions/delirium/)
- [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/)
- [Huntington disease](https://durgical.com/en/conditions/huntington-disease/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Vascular dementia](https://medlineplus.gov/ency/article/000746.htm) (MedlinePlus (U.S. National Library of Medicine), 2024).

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Source: https://durgical.com/en/conditions/vascular-dementia/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/vascular-dementia/