Vascular dementia: causes, symptoms and ways to slow it down

The NHS explains that vascular dementia results from reduced blood supply to the brain, which damages and eventually kills brain cells. This can follow narrowing and blockage of the small blood vessels inside the brain, a single stroke that suddenly cuts off blood to part of the brain, or lots of "mini strokes" (transient ischaemic attacks) that each cause tiny but widespread damage.

In many cases the NHS links these problems with high blood pressure and diabetes, and with smoking and being overweight. Alzheimer's Society says age is the biggest risk factor, with risk increasing from 65, and lists several types: multi-infarct dementia, subcortical vascular dementia and stroke-related dementia, all arising from problems with blood supply to parts of the brain.

Alzheimer's Society says the most common early symptoms are problems with planning, organising, decision-making or problem-solving, difficulty following a series of steps such as when cooking a meal, slower thinking, and concentration problems including short periods of sudden confusion. Memory and language difficulties can occur in the early stages too but are not always the leading problem.

The NHS adds changes to mood, personality or behaviour, feeling disoriented, and difficulty walking and keeping balance. This last point matters for older people because unsteadiness raises falls risk. Symptoms can come on quickly after a stroke or build slowly, and as the condition progresses they cause increasing problems with everyday living.

• Slowness of thought and trouble concentrating.

• Trouble planning, organising or understanding.

• Mood, personality or behaviour changes.

• Disorientation and confusion.

• Difficulty walking and keeping balance.

• Memory and language problems, especially when Alzheimer's disease is also present.

The NHS says to see a GP if you think you have early symptoms of dementia, especially over 65, and for someone else to go along if possible. The GP can do simple checks and refer to a memory clinic or another specialist. There is no single test. The NHS lists an assessment of symptoms, a full medical history including strokes and high blood pressure, an assessment of mental abilities using several tasks and questions, and a brain scan (MRI or CT) to look for changes.

Alzheimer's Society says dementia is usually diagnosed by a combination of tests with a specialist health professional and that early diagnosis has many benefits, such as time to adjust and access to support. Anyone who has had a stroke or TIA and then notices lasting changes in thinking should mention it, as the medical history is part of the diagnosis.

The NHS says there is no cure and no way to reverse brain-cell loss that happened before diagnosis, but treatment aims to tackle the underlying cause, which may reduce the speed at which brain cells are lost. This often involves a healthy balanced diet, losing weight if overweight, stopping smoking, getting fit, cutting down on alcohol, and medicines used to treat high blood pressure, lower cholesterol or prevent blood clots. For older people already on several tablets, a medicines review alongside the memory assessment is a sensible way to keep that list safe and manageable, and any blood pressure treatment should be balanced against dizziness and falls.

Other treatments such as physiotherapy, occupational therapy, memory cafes and psychological therapies help reduce the impact of existing problems.

The NHS says vascular dementia will usually get worse over time, which can happen in sudden steps with periods between where symptoms change little, though it is difficult to predict when. Home-based help will usually be needed and some people eventually need nursing home care. It can significantly shorten life expectancy, but this is highly variable and many people live for several years or die from another cause.

The NHS points to guidance on living well, staying independent, communicating, coping with behaviour changes, managing money and legal affairs, end-of-life planning, and the Dementia UK nurse helpline. Alzheimer's Society runs a support line and online forum.