Another way to think about dementia

While Alzheimer’s disease continues to be the most recognized type of dementia, older men should also be mindful about the second most common: vascular dementia.

In vascular dementia, memory problems result from damage to large and small blood vessels in the brain. It develops when cholesterol-clogged blood vessels can’t deliver enough oxygen to the brain. Small blockages deprive some brain cells of oxygen, which causes a series of small strokes that kill brain cells. This can lead to episodes of confusion, slurred speech, and problems thinking or remembering.

“About 15% to 20% of dementia cases in older adults are vascular dementia,” says Dr. Anand Viswanathan, associate professor of neurology at Harvard-affiliated Massachusetts General Hospital. “However, the brain damage is often so small and subtle that most people don’t notice it.”

Vascular dementia gets confused with normal aging since symptoms can mirror “senior moments,” like forgetting a name or just-learned information. Adding to the confusion, trademark signs of dementia like memory loss are not always present, as they are with Alzheimer’s. And some symptoms of vascular dementia may be more prominent than others depending on the area and extent of brain damage. For instance, you may have difficulty calculating numbers, while your critical thinking and planning skills remain fine.

Risk factors and treatment

If you or anyone in your family notices these symptoms, see your doctor for a complete evaluation. Brain imaging can often detect blood vessel problems characteristic of vascular dementia.

Several factors put people at a greater risk. These include high blood pressure, high cholesterol, diabetes, and heart disease. Your risk also rises if you are overweight or smoke.

Symptoms of vascular dementia can stay the same or worsen over time, but once the damage is done, treatment options are limited. Drugs available for Alzheimer’s are sometimes helpful, but at best they offer temporary and modest protection of thinking skills and memory.

Good for heart and brain

The best treatment for vascular dementia continues to be prevention. “What is good for the heart tends to also be good for the brain,” says Dr. Viswanathan. “Since the risk factors for vascular dementia are heart-related, adopting many heart-healthy habits like losing weight and not smoking may offer the best protection.” Here are some other suggestions:

Reduce high blood pressure. A study published online May 10, 2016, by Stroke reviewed the medical records of more than four million people and found that high blood pressure was associated with a 26% higher risk of vascular dementia from ages 51 to 70. Your doctor can suggest dietary changes to help lower blood pressure, or prescribe medication, if needed.

Lower cholesterol with statins.

High levels of “bad” low-density lipoprotein cholesterol can increase your risk of stroke. A study in the Nov. 19, 2016 issue of The Lancet predicted that cholesterol-lowering statin therapy could lower the absolute risk of a stroke among an average man in his 60s from 8% to 6.5% over a 10-year period. The drugs also are effective at reducing the risk of a recurring stroke. (Consult your doctor about whether statins may be an option.)

Exercise more. Researchers writing in the 2016 Journals of Gerontology Series A: Biological Sciences and Medical Sciences tracked 2,000 people, ages 60 or older, for 10 years and found an association between higher physical activity and a lower risk for dementia. Specifically, they found that physical activity affected the size of the hippocampus, the part of the brain involved with short-term memory.

Dr. Viswanathan recommends adding moderate-intensity exercise to your routine, either daily or several times a week. “It could vary from walking a mile a day to playing tennis to cycling,” he says. “Tailor it to your interests, which can help you stay motivated.”

Watch the alcohol. Alcohol intake has a mixed message for vascular dementia. On one hand, a glass of red wine can relax blood vessels and thus improve circulation. However, excessive amounts of alcohol can trigger atrial fibrillation, a type of irregular heartbeat that can increase your risk of stroke by five times, according to the American Stroke Association. “For most older men, just a single serving of alcohol per day can offer the cardiovascular benefits they need,” says Dr. Viswanathan.

Stay mentally engaged. Your brain is like a muscle. “Working the mind can improve brain blood flow similar to how exercise stimulates blood flow in muscles,” says Dr. Viswanathan. Try to stimulate your mind on a regular basis: solve word puzzles, play card games, or learn a new skill.