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Dementias
Vascular dementia
This can be caused by a single stroke that is either large or affects very important areas of the brain; by repeated very small strokes that accumulate over time; or by extensive changes around the very small blood vessels in the white matter of the deep part of the brain (which in an extreme form is sometimes called Binswanger's disease). Large strokes are obvious but, because of the physical problems that can develop, the related difficulties with memory or other higher cognitive functions are often not recognised. As many as twenty-five per cent of older people can develop VaD after a stroke. Smaller strokes in the brain and changes around the very small blood vessels are less obvious and may just result in gradual progression of symptoms or may be experienced as 'dizzy spells' , but they do lead to cumulative damage to important areas of the brain. VaD is the most common cause of dementia after Alzheimer's disease.
Symptoms can sometimes be distinguished from Alzheimer's - the decline in higher brain function is more likely to have a clear start date, and symptoms often progress in a series of steps following small strokes. Symptoms may include:
Some areas of the brain may be more affected than others and, as a result, some cognitive abilities may be relatively unaffected. The person is more likely to be aware of their impairments than in Alzheimer's disease. This can increase depression.
Anyone who has had a stroke is at greater risk of another, and someone with VaD is usually at high risk of further damage.
There is no specific treatment for VaD, but the underlying risk factors and stroke disease can be treated. Proper control of blood pressure and other risk factors such as high cholesterol, diabetes and irregular heart rhythm will reduce the rate of progression and improve outcome. Treatment with an antiplatelet drug like aspirin will also reduce the risk of further stroke. Half of the people with VaD will also have some changes similar to Alzheimer's disease in the brain. There is some evidence that these people benefit from treatment with cholinesterase inhibitor drugs.
Inheritance patterns
Unclear, but a number of genes have been identified as risk factors for vascular disease.
Prenatal diagnosis
None.
Inheritance patterns and prenatel diagnosis
| Dementia with lewy bodies 
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