Vascular Dementia

One of the most common types of dementia in older adults, vascular dementia (VaD) refers to a subtle, progressive decline of memory and other cognitive function, such as thinking, learning, remembering, organization skills and complex visual processing. VaD is caused by a chronic, reduced blood flow in the brain. Normally, the brain cells receive an ample supply of blood, which is delivered through a network of blood vessels called the vascular system.

Males and African Americans are at an increased risk of developing the disease.

VaD may be caused by stroke, in which the blood supply to the brain becomes blocked, resulting in permanent brain damage. VaD caused by a single stroke is called single-infarct dementia. The condition can also be caused by a series of small, often unnoticeable strokes called multi-infarct dementia. Damage to tiny blood vessels that lie deep in the brain may also lead to a type of VaD known as sub-cortical vascular dementia. VaD may also occur with Alzheimer’s disease, which causes similar symptoms, such as memory loss.

Vascular dementia can occur suddenly or progress slowly over time. At times, people with VaD experience long periods without any noticeable changes, or even improvements. However, if another stroke occurs, their symptoms may progress rapidly.

VaD risk factors include:

  • High blood pressure
  • Heart disease
  • High cholesterol
  • Diabetes
  • Smoking
  • Alcoholism

It is important that these conditions are diagnosed and treated promptly as a way to prevent VaD.

The condition often occurs with Alzheimer’s disease, which further complicates its progression. VaD causes similar symptoms to those associated with Alzheimer’s disease (AD), such as memory loss. However, memory problems caused by VaD are usually easier to overcome with cues and reminders.

Common symptoms include:

  • Difficulty with organization and solving complex problems
  • Slowed thinking
  • Distraction or “absent mindedness”
  • Difficulty retrieving words from memory
  • Walking with rapid, shuffling steps
  • Speech difficulties
  • Difficulty following instructions

Other symptoms may include:

  • Mood and behavior changes, such as depression, irritability or apathy
  • Hallucinations or delusions, which may be very distressing to the patient and their caregiver
  • Balance and movement problems
  • Loss of bladder or bowel control
  • Symptoms of Parkinson’s disease, such as tremors

Currently, there is no cure for vascular dementia. Treatments are designed to prevent and control risk factors. Treating these conditions greatly reduces the risk of developing dementia.

Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is a rare brain disorder that causes problems with walking and balance as well as dementia.

About 20,000 North Americans — or one in every 100,000 people over age 60 — have PSP. Patients with PSP are usually middle-age or elderly, and men are affected more often than women. This disease is difficult to diagnose because it is so rare and is sometimes mistaken for Parkinson’s disease.

The signs and symptoms of progressive supranuclear palsy (PSP) vary from patient to patient but loss of balance while walking is the most common first symptom. Patients may have unexplained falls or a stiffness and awkwardness when walking. Sometimes the falls are described as attacks of dizziness, which can lead to an incorrect diagnosis of an inner ear problem. In addition, with PSP speech usually becomes slurred. In rare cases, some patients will experience shaky hands.

Other common early symptoms include a loss of interest in usual hobbies or recreational activities, increased irritability and forgetfulness. Patients may suddenly laugh or cry, be apathetic or have occasional angry outbursts for no apparent reason.

As the disease progresses, many patients develop blurring of vision and problems controlling eye movements. These symptoms are caused by a gradual deterioration of brain cells at the base of the brain in an area called the brainstem. PSP patients have trouble voluntarily shifting their gaze downward and can have trouble controlling their eyelids. This can lead to involuntary closing of the eyes, prolonged or infrequent blinking, or difficulty in opening the eyes.

Another common visual problem is an inability to maintain eye contact during a conversation. This can give the mistaken impression that the patient is hostile or uninterested.

As PSP gets progressively worse, patients are at greater risk for complications, such as pneumonia, head injury and fractures caused by falls. Swallowing solid foods or liquids can be difficult and choking becomes a hazard. The most common cause of death is pneumonia. However, with good medical attention and treatment, many PSP patients live well into their 70s and beyond.

There is currently no effective treatment or cure for PSP, although some of the symptoms can respond to nonspecific measures.

Multi-Infarct Dementia

Multi-infarct dementia (MID) is a common cause of memory loss in the elderly.

MID, which typically begins between the ages of 60 and 75, affects men more often than women.

MID is caused by multiple strokes (disruption of blood flow to the brain). Disruption of blood flow leads to damaged brain tissue. Some of these strokes may occur without noticeable clinical symptoms. Doctors refer to these as “silent strokes”. An individual having a silent stroke may not even know it is happening, but over time, as more areas of the brain are damaged and more small blood vessels are blocked, the symptoms of MID begin to appear.

Symptoms include:

  • Confusion or problems with short-term memory
  • Wandering, or getting lost in familiar places
  • Walking with rapid, shuffling steps
  • Losing bladder or bowel control
  • Laughing or crying inappropriately
  • Having difficulty following instructions
  • Having problems counting money and making monetary transactions

Because the symptoms of MID are so similar to Alzheimer’s disease, it can be difficult for a doctor to make a firm diagnosis. Since the diseases often occur together, making a single diagnosis of one or the other is even more problematic. MID can be diagnosed by an MRI or CT of the brain, along with a neurological examination.

The prognosis for individuals with MID is generally poor. The symptoms of the disorder may begin suddenly, often in a step-wise pattern after each small stroke. Some people with MID may even appear to improve for short periods of time, then decline after having more silent strokes. The disorder generally takes a downward course with intermittent periods of rapid deterioration. Death may occur from stroke, heart disease, pneumonia, or other infection.

There is no treatment available to reverse brain damage that has been caused by a stroke. Treatment focuses on preventing future strokes by controlling or avoiding the diseases and medical conditions that put people at high risk for stroke:

The best treatment for MID is prevention early in life – eating a healthy diet, exercising, not smoking, moderately using alcohol, and maintaining a healthy weight.

Mild Cognitive Impairment

Memory loss has long been recognized as an inevitable part of aging. Everyone experiences a “senior moment” — the inability to recall the name of an acquaintance or the items on a shopping list. With age, these memory lapses become more common.

But a sharp decline in short-term memory could be more than normal forgetfulness. It could be a symptom of a condition called mild cognitive impairment (MCI). People with MCI tend to retain critical thinking and reasoning skills but experience a significant short-term memory loss. They may experience trouble remembering the names of people they meet or the flow of a conversation. They also may have an increased tendency to misplace things. They may rely more on a calendar, notes and lists but still manage their daily activities. Long-term memories tend to remain in tact.

MCI is diagnosed when there is:

  1. Evidence of memory impairment
  2. Preservation of general cognitive and functional abilities
  3. Absence of diagnosed dementia

Doctors believe that mild cognitive impairment may be a signal of a more serious disease on the horizon. The condition has been associated with a higher-than-normal risk of developing dementia such as Alzheimer’s disease. But not all MCI patients develop dementia.

There is no proven treatment or therapy for mild cognitive impairment. As MCI may be a precursor to clinical Alzheimer’s disease, treatments proposed for Alzheimer’s disease, such as antioxidants and cholinesterase inhibitors, may be useful. However, potential treatments are still under investigation at this time.

Memory Disorders

Memory can be defined as an organism’s ability to encode, retain, and recall information. Disorders of memory are all a result of damage to neuroanatomical structures (either in part or in full) and can range from mild to severe. This damage hinders the storage, retention and recollection of memories.

Almost everyone has a lapse of memory from time to time. You can’t remember where you parked your car or can’t remember someone’s name. This is normal. But when memory loss interferes with work performance, social activities and other daily tasks, you may need medical care.

Memory disorders can severely disrupt your life. They can be progressive, including Alzheimer’s disease, or they can be immediate including disorders resulting from head injury. Hundreds of disorders can cause memory loss or dementia. Memory loss may be due to conditions such as:

  • Small strokes in the brain
  • Diabetes
  • High blood pressure
  • Nutritional deficiencies
  • Reactions to medications
  • Alcoholism
  • Depression

Memory disorders include:

Treatments vary by disease and their level of progression.

Huntingtons Disease

Huntington’s disease (HD) is a fatal condition typically characterized by involuntary movements and dementia. The disease is caused by genetically programmed degeneration of brain cells, called neurons, in certain areas of the brain. This causes uncontrolled movements, loss of intellectual faculties and emotional disturbance.

The disease is a hereditary disorder passed on by a parent to child through a mutation in a gene. In North America, Huntington’s disease occurs in about one of every 10,000 to 20,000 persons, affects males and females equally and crosses all ethnic and racial boundaries. Typically, symptoms begin between age 30 and 55. Symptoms appear in children in about 10 percent of families and children who develop the juvenile form of the disease rarely live to adulthood.

Each child of a parent with Huntington’s disease has a 50 percent chance of inheriting the HD gene. If a child does not inherit the HD gene, he or she will not develop the disease and cannot pass it on to subsequent generations. A person who inherits the HD gene will eventually develop the disease. Whether one child inherits the gene has no bearing on whether others will or will not inherit the gene. In 1 percent to 3 percent of individuals with HD, there is no family history of HD.

Early symptoms of Huntington’s disease include:

In addition, patients may notice problems in their daily activities such as driving, learning new things, remembering a fact or making a decision.

As the disease progresses, concentration and short-term memory decline and involuntary movements increase. The ability to walk, speak and swallow deteriorates. Eventually, patients become unable to care for themselves. Death may occur from complications such as choking, infection or heart failure.

At this time, there is no known cure or treatment to reverse the course of the disease. There are treatments available to reduce the severity of some of its symptoms. As the disease progresses and a person’s ability to tend to their own needs reduces, carefully managed multidisciplinary care giving becomes increasingly necessary.

Frontotemporal Dementia

Frontotemporal dementia (FTD) is a group of degenerative diseases that gradually damage or shrink the front of the brain — the frontal and anterior temporal lobes. These two areas are the center of many important brain functions, including language skills as well as the ability to focus attention, make plans and decisions and control impulses.

FTD affects an estimated 250,000 North Americans, with the average duration of the disease about eight years. Most cases are diagnosed during the 50s and 60s with men and women equally affected. Because FTD often occurs in younger people, it can severely affect families. Patients often still have children living in the home. Financially, it can be devastating as the disease strikes at the time of life that is often the top wage-earning years.

In the past, the disease was confused with Alzheimer’s disease or other forms of dementia. But unlike Alzheimer’s disease, frontotemporal dementia appears earlier in life. As researchers have learned more about the disease, they now believe it is the second leading cause of dementia in middle age.

Early symptoms of frontotemporal dementia typically involve personality or mood changes such as depression and withdrawal, sometimes obsessive behavior and language difficulties. Many patients lose their inhibitions and exhibit antisocial behavior. A small percentage of patients develop extraordinary visual or musical creativity, while experiencing language and social impairment.

Language problems are less common but do occur in the early stages of FTD before other thought processes, such as memory, are affected. Patients may experience difficulty speaking or finding the correct word when naming objects. Difficulties reading and writing then develop. As the disease progresses, less and less language is used, until the patient becomes virtually mute. Other patients may have a severe problem recalling words and understanding word meaning, but continue to have otherwise normal speech.

Early signs of frontotemporal dementia may involve the following symptoms:

  • Apathy or an unwillingness to talk
  • Change in personality and mood, such as depression
  • Lack of inhibition or lack of social tact
  • Obsessive or repetitive behavior, such as compulsively shaving or collecting items
  • Unusual verbal, physical or sexual behavior
  • Weight gain due to dramatic overeating

Patients may neglect hygiene and resist encouragement to attend to themselves. They also may lack awareness or concern that their behavior has changed.

As FTD progresses, it takes a toll on mental abilities, affecting memory and other functions that are more common in Alzheimer’s and other dementias. In Alzheimer’s disease, one of the first symptoms is memory loss. With FTD, unusual or antisocial behavior as well as loss of speech or language are usually the first symptoms.

In later stages, patients develop movement disorders such as unsteadiness, rigidity, slowness, twitches, muscle weakness or difficulty swallowing. Some patients develop Lou Gherig’s disease or amyotrophic lateral sclerosis (ALS). People in the final stages of FTD cannot care for themselves.

There is no known curative treatment for FTD. Supportive care is essential.


Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain.

Although it is common in very elderly individuals, dementia is not a normal part of the aging process.

People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems, such as agitation, delusions, and hallucinations.

While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions – such as memory and language skills — are significantly impaired without loss of consciousness.

Some of the diseases that can cause symptoms of dementia are:

Doctors have identified other conditions that can cause dementia or dementia-like symptoms including:

  • Reactions to medications
  • Metabolic problems and endocrine abnormalities
  • Nutritional deficiencies
  • Infections
  • Poisoning
  • Brain tumors
  • Anoxia or hypoxia – conditions in which the brain’s oxygen supply is either reduced or cut off entirely
  • Heart and lung problems

There are many disorders that can cause dementia. Some, such as Alzheimer’s disease or Huntington’s disease, lead to a progressive loss of mental functions. But other types of dementia can be halted or reversed with appropriate treatment. People with moderate or advanced dementia typically need round-the-clock care and supervision to prevent them from harming themselves or others. They also may need assistance with daily activities such as eating, bathing, and dressing.

Drugs to specifically treat Alzheimer’s disease and some other progressive dementias are now available. Although these drugs do not halt the disease or reverse existing brain damage, they can improve symptoms and slow the progression of the disease. This may improve an individual’s quality of life, ease the burden on caregivers, or delay admission to a nursing home. Many researchers are also examining whether these drugs may be useful for treating other types of dementia.

Many people with dementia, particularly those in the early stages, may benefit from practicing tasks designed to improve performance in specific aspects of cognitive functioning. For example, people can sometimes be taught to use memory aids, such as mnemonics, computerized recall devices, or note taking.

Corticobasal Degeneration

Corticobasal degeneration (CBD) is a rare neurological disease associated with progressive brain degeneration. The disease, also known as corticobasal ganglionic degeneration, leads to the loss of brain tissue in the cortex, or outer layer of the brain, especially the area in the upper, front section of the brain.

The gradual loss of brain tissue and symptoms typically begin between ages 45 and 70. Women are affected more often than men.

Currently, there are no known risk factors, such as toxins or infections.

Initial symptoms include stiffness as well as shaky, slow or clumsy movements as well as difficulty with speech or comprehension. Other early symptoms may include:

  • Balance — Difficulty walking and balancing
  • Memory — Short-term memory problems, such as repeating questions or misplacing objects
  • Muscle Control — Difficulty controlling the muscles of the face and mouth
  • Speech — Progressive difficulty speaking or articulating as well as difficulty comprehending language

Other symptoms are loss of movement control as well as loss of memory and intellectual ability. Symptoms may first appear on one side of the body, but eventually affect both sides as the disease progresses. There may be difficulties in completing specific tasks, such as opening a door or brushing one’s teeth or using tools such as a can opener. When a leg is affected, a patient may have problems with complex movements such as dancing. As the disease progresses, a patient may begin to trip and fall. A patient also may experience uncontrollable movement of an arm or leg.

Some patients experience memory or behavioral problems. Patients may have difficulty with expression of language, such as finding the right word or name. Reading, writing and simple mathematical calculations also may be impaired. In addition, personality changes, inappropriate behavior and repetitive and compulsive activities similar to those in frontotemporal dementia are common in CBD.

A person with the disease often becomes immobile five years after symptoms emerge. Within 10 years, pneumonia or other bacterial infections may lead to life-threatening complications.

In the past, patients have been diagnosed on the basis of movement problems that appear similar to Parkinson’s disease. CBD patients also experience many symptoms that are not characteristic of Parkinson’s and it is sometimes referred to as a “Parkinson’s-plus” syndrome.

Because the exact cause of CBD is unknown, no formal treatment for the disease exists. Instead, treatments focus on minimizing the appearance or effect of the symptoms resulting from CBD. The most easily treatable symptom of CBD is parkinsonism, and the most common form of treatment for this symptom is the application of dopaminergic drugs. However, only moderate improvement is seen and the relief from the symptom is generally not long-lasting.

Palliative therapies, including the implementation of wheelchairs, speech therapy, and feeding techniques, are often used to alleviate many of the symptoms that show no improvement with drug administration.

Binswangers Disease

Binswanger’s disease (BD), also called subcortical vascular dementia, is a type of dementia caused by widespread, microscopic areas of damage to the deep layers of white matter in the brain.

The damage is the result of the thickening and narrowing (atherosclerosis) of arteries that feed the subcortical areas of the brain. Atherosclerosis (commonly known as “hardening of the arteries”) is a systemic process that affects blood vessels throughout the body. It begins late in the fourth decade of life and increases in severity with age. As the arteries become more and more narrowed, the blood supplied by those arteries decreases and brain tissue dies.

The symptoms associated with BD are related to the disruption of subcortical neural circuits that control executive cognitive functioning:

  • Short-term memory
  • Organization
  • Mood
  • The regulation of attention
  • The ability to act or make decisions
  • Appropriate behavior

The most characteristic feature of BD is psychomotor slowness – an increase in the length of time it takes, for example, for the fingers to turn the thought of a letter into the shape of a letter on a piece of paper. Other symptoms include:

  • Forgetfulness (but not as severe as the forgetfulness of Alzheimer’s disease)
  • Changes in speech
  • An unsteady gait
  • Clumsiness or frequent falls
  • Changes in personality or mood (most likely in the form of apathy, irritability, and depression)
  • Urinary symptoms that aren’t caused by urological disease

Brain imaging with CT scans or magnetic resonance imaging (MRI) devices is essential for a positive diagnosis as it reveals the characteristic brain lesions of BD.

BD is a progressive disease; there is no cure. Changes may be sudden or gradual and then progress in a stepwise manner. BD can often coexist with Alzheimer’s disease. Because there is no cure, the best treatment is preventive, early in the adult years, by controlling risk factors such as hypertension, diabetes, and smoking. Behaviors that slow the progression of high blood pressure, diabetes, and atherosclerosis — such as eating a healthy diet and keeping healthy wake/sleep schedules, exercising, and not smoking or drinking too much alcohol — can also slow the progression of BD.

There is no specific course of treatment for BD. Treatment is symptomatic. People with depression or anxiety may require antidepressant medications such as the serotonin-specific reuptake inhibitors (SSRI) sertraline or citalopram. Atypical antipsychotic drugs, such as risperidone and olanzapine, can be useful in individuals with agitation and disruptive behavior. The successful management of hypertension and diabetes can slow the progression of atherosclerosis, and subsequently slow the progress of BD.