You can’t turn back the clock, but as you enter your 70s, awareness of age-specific and lifestyle-related diseases can assist with making smarter choices to maintain an active and independent life.
A leading medical challenge in this decade is the increased risk for stroke—a major cause of death and serious neurological disability among U.S. seniors. In fact, a recent study reported that people who have had a stroke are at greater risk of developing dementia—one in four will go on to develop signs of the disorder.
People who have had a stroke are at greater risk of developing dementia—one in four will go on to develop signs of the disorder.
“Controlling one’s blood pressure is the single most important health parameter for aging Americans to prevent stroke,” said Renee Hickson, MD, a geriatric specialist and founder of Best Geriatric Healthcare, L3c, based in New Orleans. “Elevated blood pressure has the most direct effect on the heart, and we are now realizing its impact on brain structure and subsequent cognitive impairment.”
Elevated blood pressure has the most direct effect on the heart, and we are now realizing its impact on brain structure and subsequent cognitive impairment.
Renee Hickson, MD
Vascular dementia: Prevention is key
Cognitive decline related to stroke is called vascular dementia or vascular cognitive impairment, distinguishing it from other forms of dementia. Accounting for 10-20% of all dementias among older adults, it’s the second most common type after Alzheimer’s.
Vascular dementia is preventable, but only if underlying vascular disease (such as hypertension) is recognized and treated early. Those at highest risk are older adults ages 60 to 75, men and African Americans. Treatment can help prevent further damage to the brain in people with vascular dementia and may slow down its progression, but there’s currently no cure for the condition or a way to reverse the damage that’s occurred.
What is vascular dementia?
Compared to Alzheimer’s, which happens when the brain’s nerve cells break down, vascular dementia occurs when part of the brain doesn’t get enough blood, which carries oxygen and nutrients required for brain function.
Though the causes are different, it’s possible to have both vascular dementia and Alzheimer’s disease, making it even more important to control risk factors, as the condition can worsen Alzheimer’s symptoms.
A number of factors put people at greater risk for developing vascular dementia, including:
- High blood pressure
- High cholesterol
- Diabetes
- Heart disease
- Smoking
- Obesity
Are you more vulnerable to vascular dementia?
Research is ongoing to study why some people develop dementia after stroke and others don’t.
Loss of blood supply to brain cells can make symptoms of dementia such as memory loss worse. Previous research has revealed an area inside the front part of the brain containing bundles of cell fibers – known as ”white matter” – that are particularly vulnerable to damage.
People who develop dementia after a stroke are more likely to have leaking blood vessels in this region of the brain versus those who do not develop dementia after stroke.
In a healthy brain, specialized brain cells called astrocytes crowd around blood vessels, holding on tightly to prevent leaking. Scientists are interested in why these astrocytes aren’t performing this way in cases of dementia.
What are the symptoms of vascular dementia?
Symptoms of vascular dementia depend on the part of the brain affected. Like Alzheimer’s disease, the symptoms are often mild for a long time, so caregivers and loved ones should be on the alert for the following:
Symptoms of vascular dementia:
- Problems with short-term memory
- Wandering or getting lost in familiar surroundings
- Laughing or crying at inappropriate times
- Trouble concentrating, planning or following through on activities
- Trouble managing money
- Inability to follow instructions
- Loss of bladder or bowel control
- Hallucinations or delusions
- Impaired coordination or balance
Worsening symptoms often signal a stroke. Doctors look for more pronounced changes that help diagnose vascular dementia. Alzheimer’s, by comparison, progresses at a slower, steady pace.
Not all strokes are the same
A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke but lasts only a few minutes and doesn’t cause permanent damage.
Often called a ministroke, a TIA may be a warning: About a third of people who experience a TIA will eventually have a stroke, with about half occurring within a year after the TIA. Although similar, a ministroke aggravates the development of vascular dementia differently than a stroke would. The progression of this disease emerges a bit at a time. As more ministrokes occur, an individual will experience different stages and symptoms of vascular dementia, and the severity of each symptom can worsen after each.
About a third of people who experience a TIA will eventually have a stroke, with about half occurring within a year after the TIA.
Treatment for vascular dementia is limited, so prevention is important. The American Heart Association and American Stroke Association offer recommendations for preventing vascular dementia:
- Control blood pressure, cholesterol and blood sugar.
- Quit smoking.
- Adopt a heart-healthy eating plan like the Mediterranean diet that’s rich in vegetables and fruits, whole grains, oily fish and unsaturated fats.
- Exercise regularly.
- Limit or avoid alcohol.
- Spend time with family and friends.
- Keep your mind active with education, volunteering and hobbies.
- Identify and treat depression.
- Manage weight.
The American Stroke Association recommends consulting with your health care professional, who may prescribe medications to lower blood pressure and cholesterol, prevent blood from clotting, control blood sugar and mitigate Alzheimer’s symptoms.
What to do if stroke is suspected
Because there’s no cure for vascular dementia and treatment is limited, implementing lifestyle changes to prevent a stroke is key. Early intervention and diagnoses to manage symptoms for stroke can help with future stroke occurrence.
A thorough medical examination for vascular dementia can include a variety of different tests. A physician will conduct a full medical history and likely order blood tests to rule out reversible causes of cognitive decline, such as low vitamin B12 or hypothyroidism. Often, individuals are referred to a neurologist for more specialized examination of motor functioning, as well as reflexes, sensation and gait. A brain scan is often ordered in the examination stage to identify the presence of strokes or disease in the blood vessels.
Some individuals may also be referred for a carotid ultrasound if there’s concern about blockages in these specific arteries. Referral to a specialist for evaluation of thinking skills such as memory and processing speed is typical and an important component of the evaluation.
