Dr. Akil Patel, vascular neurosurgeon, first noticed the patient’s flat, dull tone. An older man, the patient was referred to Dr. Patel after imaging revealed a severe blockage in his carotid artery—critical for supplying blood to the brain. Left untreated, the patient could suffer from a stroke.

Though the blockage was Dr. Patel’s first concern, he remembers “the lack of emotion on the patient’s face.” Especially given the dire circumstances.

But after reviewing the patient’s health records and talking with the family, Dr. Patel learned how the patient had “completely changed as a person” just over the previous few months.

Memory issues. Lack of emotion. Emptied personality. The family thought it might be unrelated, undiagnosed Alzheimer’s. But looking at the carotid artery, among other patient details, Dr. Patel suspected something else: vascular dementia.

If it were, once he improved the patient’s blood flow, Dr. Patel could do more for the patient than stave off a stroke.

Less than two months after the procedure, the patient saw Dr. Patel for a follow-up. And “I tell you, he was a completely different person.”

The second most common type of dementia

Vascular dementia isn’t discussed as often as Alzheimer’s, but it’s fairly common. “Nearly 15 to 20% of dementia cases in the U.S. are due to vascular dementia,” Dr. Patel explains, making it the second most common type of dementia.

Unlike Alzheimer’s, which is associated with a build-up of plaque in the brain, “the crux of vascular dementia is that it forms from a lack of proper blood flow to the brain,” Dr. Patel says. “Its symptoms mimic Alzheimer’s. But it’s caused by an entirely different process.”

This can make diagnosing vascular dementia more involved than with Alzheimer’s. Dr. Patel says vascular dementia is a “diagnosis of exclusion,” meaning that while looking at heart health and blood flow is critical to a diagnosis, other causes for dementia-like symptoms—Alzheimer’s, depression, thyroid conditions—need to be ruled out. 

But vascular dementia still has clear signs and risk factors.

Risk factors and diagnosis

As we age, our hearts weaken. And since our hearts need to pump against the force of gravity, this can make getting blood to the brain especially difficult.

While aging is a risk factor, Dr. Patel says he looks for others, along with aging, before suspecting vascular dementia in someone with dementia symptoms, including

• Cardiovascular disease, or a family history of it
• High cholesterol, or a family history of it
• Narrowing blood vessels, especially in the neck
• Strokes, even small ones

Strokes especially can increase the likelihood of vascular dementia.

If someone has these risk factors and dementia symptoms (what Dr. Patel calls “neurocognitive” indicators like balance, speech, and memory issues), brain imaging, like a PET scan, is the next step. 

If a PET scan doesn’t show plaque in the brain, pointing to Alzheimer’s, Dr. Patel says imaging of the heart and blood flow, called an angiogram, would follow. The goal, Dr. Patel clarifies, is to get as full a picture as possible and “assess if a patient fits the criteria for vascular dementia based on all available information.” 

The importance of early diagnosis

Neither vascular dementia nor Alzheimer’s have a cure. However, unlike Alzheimer’s, vascular dementia’s progress can be slowed, sometimes significantly, with treatment.

But early diagnosis is key.

If an older loved one has memory, balance, or speech issues, Dr. Patel emphasizes not to quickly label it with the blanket term “dementia” and consider it explained. Instead, if you notice symptoms, especially after a stroke, schedule an appointment with a primary care provider to start addressing the cause.

If imaging shows reduced blood flow from a stroke, heart disease, or blockages, improving blood flow can help quite a bit.

“This form of dementia is so connected to blood flow to the brain that after treatment, patients often report feeling like themselves again, with better energy, personality, and judgment. It’s remarkable.”

But if the disease progresses too much without treatment, treatment is less likely to help. “The brain is resilient,” Dr. Patel says. “But if it takes too much of a beating, it has difficulty bouncing back.” 

Left untreated, the life expectancy for someone with advanced vascular dementia is around five years.

What you can do now

If you’re concerned about your risk for vascular dementia, Dr. Patel advises knowing your family’s health history, emphasizing heart disease and high cholesterol. Even if you have a family history of these things, it doesn’t mean you’ll have vascular dementia. But it does mean you, your family, and your doctor can stay more attentive to your cognitive health and treatment options.

Even with certain family histories, lifestyle changes can help reduce your risk, including

• Improving your diet to reduce cholesterol
• Staying physically active
• Taking medication prescribed by your doctor

These, Dr. Patels says, “reduce your stroke risk, which, in turn, reduce your risk of vascular dementia.”

While vascular dementia isn’t as common as Alzheimer’s, Dr. Patel believes it may be more prevalent than we realize. It’s often a matter of not hastily labeling a loved one’s symptoms as “dementia” or assuming Alzheimer’s but getting help to explore the underlying causes.

If those causes start at the heart, early treatment can practically give someone their life—and personality—back.