Vascular dementia

Vascular dementia is a decline in memory and thinking caused by problems with blood flow in the brain. When blood cannot reach part of the brain, the cells there do not get the oxygen and food they need. Over time, they can be damaged or die.^1,2

It can follow a large stroke. More often, it builds up from many small strokes or from slow damage to the brain's tiny blood vessels. The good news is that the same steps that protect the heart, like controlling blood pressure, can help protect the brain. This page explains how it happens, what it looks like, and what you can do.

What causes vascular dementia?

Any problem that blocks, narrows or breaks blood vessels in the brain can lead to vascular dementia. How much it affects thinking depends on the size, number and location of the damage.¹ Doctors sometimes use a wider term, vascular cognitive impairment, because the changes can range from mild to severe.²

The main causes are:¹

• A large stroke. A stroke happens when a blood vessel in the brain is blocked by a clot or bursts and bleeds. A big stroke raises the risk of dementia, but not everyone who has one develops it.
• Many small strokes. Some small strokes cause no clear symptoms at the time. People call them "silent" strokes. When enough of them add up, thinking can suffer. This is sometimes called multi-infarct dementia.
• Small vessel disease. The tiny blood vessels deep in the brain become thick and narrow. This slowly damages the white matter (the wiring that connects different brain areas). One older name for this is Binswanger's disease.
• Rarer causes. Cerebral amyloid angiopathy is a buildup of protein in the walls of brain blood vessels. It raises the risk of bleeding and dementia.¹ CADASIL is a rare inherited disease of the small blood vessels. It often starts with migraine and leads to repeated strokes, usually beginning in a person's 20s to 40s.³

Step-wise or gradual: how it changes over time

Vascular dementia does not always follow one path. Families often notice one of two patterns:^1,2

Some people show both patterns. The brain can also recover some ground. During rehab, healthy areas near the damage may take over some jobs.² But even when thinking improves after a stroke, the person's risk of dementia later on stays higher.⁴

Signs and symptoms

The signs depend on which part of the brain was hurt. Memory loss may be mild at first, or it may be strong if memory areas were affected.²

After a major stroke, signs may include sudden confusion, trouble speaking or understanding, trouble walking, poor balance, and weakness or numbness on one side of the body.²

With small strokes or small vessel disease, common signs include:^1,2

• Slower thinking, and trouble paying attention
• Trouble planning, organizing or following steps, such as paying bills or cooking a meal
• Poor judgment
• Trouble finding words
• Getting lost on familiar routes
• Loss of interest in people or activities (apathy)
• Mood changes, including depression, irritability or anger
• Laughing or crying that comes on suddenly and is hard to control
• Changes in sleep, and sometimes seeing or believing things that are not real

Depression is common with vascular disease. It can make thinking problems worse, so it is worth checking and treating.² See depression with heart disease and stroke and apathy and depression in dementia.

Who is at risk?

Age is the biggest risk factor. The other risk factors are the same ones that harm the heart and blood vessels:^1,2

• High blood pressure
• Past strokes or mini-strokes (TIAs)
• Diabetes
• High cholesterol
• Atrial fibrillation (an irregular heartbeat that can cause clots) and other heart disease
• Smoking
• Little physical activity and carrying extra weight

Stroke and thinking problems are closely linked. In the first year after a stroke, up to 6 in 10 survivors have some trouble with thinking. Up to 1 in 3 people who have a stroke develop dementia within five years.⁴

Vascular dementia mixed with other types

In older adults, blood vessel damage often shows up together with Alzheimer's disease or Lewy body disease. This is called mixed dementia.² The different kinds of damage seem to add up, making dementia more likely.² This is one reason why caring for blood vessels matters for people with any kind of dementia. See also Alzheimer's disease.

How doctors diagnose it

There is no single test. A doctor usually looks for three things:²

1. Memory and thinking tests that show mild cognitive impairment or dementia. See memory and thinking tests.
2. A brain scan, usually an MRI, that shows strokes or blood vessel damage that fits the test results. A CT scan is used if MRI is not possible.⁹ See brain scans.
3. No other cause that better explains the problems.

A scan that shows some small vessel changes is not enough on its own. Many older adults have these changes without dementia.⁹ The doctor should also check for treatable conditions that look like dementia, and screen for depression.²

After a stroke, experts advise checking thinking whenever the person, family or care team has concerns. A short test called the MoCA is often used. Weakness, speech problems or a language barrier can make test results less reliable, so a fuller exam may be needed.⁴ If English is not the person's first language, ask for a trained medical interpreter.

Treatment: protecting the brain from more damage

There is no cure, and the FDA has not approved any medicine just for vascular dementia.² Treatment aims to stop new damage and help the person live as well as possible.

What about the newer Alzheimer's drugs? Medicines like lecanemab are only for early Alzheimer's disease with amyloid confirmed by a test. They do not treat vascular damage. They can cause brain swelling or small bleeds (called ARIA), so an MRI and a review of blood thinners and aspirin are needed before starting.¹⁴ See are anti-amyloid treatments right for us?

For more on lowering risk, read blood pressure, cholesterol and the brain and diabetes, weight and dementia risk.

What the research shows about blood pressure

The best-known study is SPRINT MIND. It included more than 9,300 adults age 50 and older with high blood pressure. About 1 in 4 were 75 or older. Half aimed for a top number (systolic pressure) under 120. Half aimed for under 140.⁵

After about five years, the lower target group had 19% less mild cognitive impairment. In plain numbers, each year about 15 in 1,000 people in the lower group developed it, compared with about 18 in 1,000 in the usual group. The drop in dementia itself was smaller and not clear enough to be sure. The study stopped early because of heart benefits, so it may have been too short to tell.⁵

This trial did not include people who had already had a stroke or who had diabetes.⁵ Your own target depends on your health, falls risk and other medicines. Ask your doctor what goal is right for you.

Rehab after a stroke

Rehabilitation (rehab) helps people relearn skills and find new ways to do things. It usually begins in the hospital, often within the first two days after a stroke.¹¹ All stroke survivors need some kind of rehab.¹¹

The rehab team may include:^11,12

• Physical therapists for walking, balance and strength
• Occupational therapists for daily tasks like dressing, bathing and cooking
• Speech-language pathologists for speech, swallowing, and thinking skills like memory and problem solving
• Psychologists and social workers for mood, adjustment and planning

Where rehab happens. Options include an inpatient rehab facility, a skilled nursing facility, outpatient clinics, and therapy at home.¹² The American Stroke Association recommends an inpatient rehab facility when possible. To go there, a person must be medically stable and able to handle about three hours of therapy a day, five days a week.¹² Medicare Part A can cover inpatient rehab when a doctor certifies that it is needed. In 2026, the deductible is $1,736 per benefit period.¹³

What to expect for thinking. Attention and planning often improve the most in the first three to six months. Language problems tend to improve less.⁴ Thinking rehab gives small gains, mostly in memory, when people learn strategies like lists, routines and reminders.⁴ Full recovery is less common than partial recovery.⁴ A memory notebook and a steady daily routine can help at home.

Ask the team before discharge about driving, home safety, swallowing, and who to call with problems. See driving and dementia, preventing falls and hospital stays.

Living with vascular dementia

How fast vascular dementia changes is hard to predict. Preventing more strokes can help keep things steady.² Like other dementias, it can shorten life.²

Some tips for families:

• Keep a list of all medicines and blood pressure readings to bring to each visit.
• Break tasks into small steps and give extra time to answer. Slowed thinking is not the same as not understanding. See talking with someone who has dementia.
• Plan ahead while the person can still share their wishes. See advance directives.
• Look after yourself too. See caregiver stress and burnout and adult day care.

When to get help

Call the doctor soon if:

• Thinking or memory has changed, especially after a stroke or mini-stroke
• Blood pressure readings at home are often high
• The person seems depressed, withdrawn or very anxious
• Falls or walking problems are new or getting worse

For more on the first steps, see getting a dementia diagnosis and which specialist to see. The Alzheimer's Association Helpline at 800-272-3900 answers questions about all types of dementia, day and night.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.