Subcortical Vascular Dementia: What To Expect If You Have A Neuro-Disease

Subcortical vascular dementia usually involves damaged blood supply to the brain that can lead to damage, as well as changes in cognitive ability, behavior, and mobility. Although this disease currently has no cure, certain lifestyle changes and health management strategies can slow its progression. It can be challenging to cope with a dementia diagnosis, whether you are someone living with dementia or a caregiver for a loved one with this disease. It can be beneficial to care for your mental health during this time by talking with a licensed therapist who can help you work through your emotions.

What is subcortical vascular dementia?

Vascular dementia is the second most common type of dementia after Alzheimer’s disease. There are three types of vascular dementia: multi-infarct dementia, subcortical vascular dementia, and stroke-related dementia. All of them usually develop when the brain is damaged due to reduced blood flow. Like most forms of dementia, older adults have a greater risk of being affected by vascular cognitive impairment. Vascular dementia may present in different ways, including decline in functional abilities, difficulty using thinking skills, cognitive decline, and other symptoms.

Subcortical vascular dementia, also called subcortical ischemic vascular dementia, is the most common type of vascular dementia. Subcortical vascular dementia begins in the region of the brain called the subcortex and is caused by small vessel disease—which is technically a group of diseases in the very small blood vessels deep inside the brain. 

Other neuro small vessel diseases

Common small vessel diseases that can cause vascular cognitive impairment include cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), cerebral amyloid angiopathy, and hypertension-induced cerebral small vessel disease. A cerebral small vessel disease can limit blood flow to the brain. For example, cerebral amyloid angiopathy involves deposits of amyloid proteins, which can slow blood flow.

Infarction and cognitive impairment

When blood flow to the brain decreases, brain cells die from lack of oxygen. This response is called an infarction. Subcortical infarcts, also called small vessel stroke, are a potential cause of cognitive impairment. Decreased blood flow and subcortical infarcts have been connected to white matter hyperintensities, which are white matter lesions that have been found in people with various forms of small vessel disease, including cerebral amyloid angiopathy.

Subcortical vascular dementia vs. Alzheimer's disease

While both dementia and Alzheimer’s disease can affect the brain, they typically do so in different ways. In subcortical vascular dementia, there is normally more damage to the white matter of the brain, less atrophy in the hippocampus, and no cerebrovascular amyloid deposits or plaques.

Two types of subcortical vascular dementia

There tend to be two main types of subcortical vascular dementia, although it may have many different causes. The two primary types include Binswanger's Disease, which usually involves more damage to the nerve fibers in the brain, called white matter, due to the hardening of the arteries, and multiple lacunar infarctions, which can be related to mini strokes. These deep white matter abnormalities and lacunar infarctions can disturb basal ganglia-thalamocortical circuits that facilitate social behaviors, task switching, and other important functions. Magnetic resonance imaging scans have found that alterations in deep white matter are also connected to Alzheimer’s disease. Additionally, the most common manifestation of mixed dementia is co-occurring Alzheimer’s and vascular dementia. 

As for symptoms, forgetfulness is typically more severe for Alzheimer's patients. Also, people with subcortical vascular dementia tend to have more disruption in their sleep cycles than those with Alzheimer's disease.

Symptoms of subcortical vascular dementia

If you're experiencing symptoms that cause you concern, impede daily function, or accompany other health problems, it may be important to keep track of them. Write them down, or if this is difficult for you, you might ask a loved one to take notes. The following can be some of the subcortical vascular dementia symptoms.

• Psychomotor slowness - Taking longer to turn thought into action

• Forgetfulness

• Changes in speech

• Unsteady gait

• Clumsiness

• Frequent falls

• Personality changes

• Mood changes

• Urinary symptoms

• Weakness or loss of sensation in part of your body

• Having good and bad days – symptoms may be more severe on some days 

• Evening confusion

• Depression

• Hallucinations or delusions

• Being able to recognize that you're having memory problems

Subcortical vascular dementia diagnosis

Diagnosis usually has two phases. First, the person experiencing symptoms or someone who knows them well may talk to a doctor to explain their experiences. Second, the doctor can make an evaluation based on objective facts, like test results.

There are normally three main criteria for reaching a diagnosis of subcortical vascular dementia:

• It comes on suddenly and quickly causes a loss of independence.

• Brain imaging tests, typically magnetic resonance imaging (MRI) scans, show white matter lesions in specific parts of the brain.

• There's evidence that a stroke happens at about the same time and may be responsible for the loss of function.

It can be important to identify the issue at hand as quickly as possible for several reasons. First, there may be lifestyle changes you can make to slow the progression of the disease. Second, loved ones may better understand how to support you. Finally, knowing your diagnosis can relieve some of the confusion about what is happening to you.

Treatment for subcortical vascular dementia

Currently, no medical treatment can cure subcortical vascular dementia. Treatments are generally designed to prevent further decline, defend nerve cells, slow the progression of the disease, or help you manage its symptoms. Your doctor may prescribe blood thinners to prevent a major stroke and improve your circulation and recommend taking low dose aspirin to reduce risk of blood clots.

Additional treatments a physician may prescribe include acetylcholinesterase inhibitors, memantine, and cholinesterase inhibitors. Clinical trials have shown that these medications may help manage symptoms and slow cognitive decline.

Perhaps the best thing you can do if you don't have the disease already, but may be at risk of developing it, is to do what you can to prevent it.

Dementia prevention: Risk factors of this degenerative disease of the brain

For people who don't have dementia right now, prevention may be possible. It can start with knowing what puts you at risk. The risk factors for all types of vascular dementia typically include the following:

• Getting older

• Having a history of heart attacks, strokes, or mini strokes

• Atherosclerosis, also known as the hardening of the arteries

• High cholesterol

• High blood pressure

• Diabetes

• Obesity

• Smoking

• Arterial fibrillation (A-fib)

While the evidence isn't overwhelming at this point, there may be two more things you can do to decrease your risk of vascular dementia. Alcohol use is one of several lifestyle-related risk factors for dementia. Modest alcohol consumption - the equivalent of one or two glasses of wine per day - might help. Taking vitamins, like folic acid and B12, may also reduce your risk. Because these remedies are not well-proven yet, it can be important for you to talk to your doctor before you try them.

By avoiding health risks when you can, managing illnesses like diabetes and high blood pressure, acting quickly to seek care if additional strokes occur, and making lifestyle changes, like quitting smoking and exercising regularly, you may reduce your chances of developing subcortical vascular dementia.

What to expect after diagnosis: Problems with memory and cognitive impairment

Knowing what to expect can help you plan for future needs. The course of this disease can be different from person to person. 

Early on, you may notice some problems with memory, problem-solving, and planning. There may be times when the disease is stable and unchanging for long periods. Then, symptoms may begin to worsen again. 

What to do when you suspect subcortical vascular dementia or neuro impairment

If you're experiencing any of the symptoms discussed above, it can be best to talk to your doctor immediately. This disease can be difficult to diagnose, so it’s often important that you don't assume you know what's wrong. The symptoms may be due to another unrelated disorder that can be treated more successfully. Neuropsychological testing can help you determine whether you have subcortical vascular dementia.

Even if your doctor gives you a diagnosis of subcortical vascular dementia, it can be helpful to know what the problem is. Then, you can make lifestyle changes that might help and plan for the care you may need in the future.

How to manage the challenges of dementia

It can be normal to experience strong emotions after receiving a diagnosis or learning that a loved one is living with subcortical vascular dementia. You might feel anger, numbness, denial, fear, sadness, or isolation, among other emotions. Recognizing and accepting these feelings can help. 

It can also be beneficial to talk to your loved ones about how you feel. Try to build a good support system of people who care about you. You might also go to dementia support groups to interact with people who understand what it's like to have dementia. If you’d like to learn more about dementia, there are several free resources available; for example, you can find the full text of articles in the journal Alzheimer’s & Dementia, courtesy of the Alzheimer’s Association. 

Finally, it may help to stay involved with your usual activities as much as you can. If you like to fish or play cards, continue doing so if you are able. Know that there will likely be good and bad days and try to take advantage of times when you feel your best.

How to receive professional support

The challenges of subcortical vascular dementia can significantly affect an individual’s mental health, contributing to concerns like anxiety and depression. Additionally, research suggests that vascular disease complications that can cause cognitive impairment may also be connected to mental health disorders. In a study published in the Journal of Neurology, Neurosurgery and Psychiatry (J Neurol Neurosurg Psychiatry), magnetic resonance imaging (MRI) scans showed more pronounced and frequent changes in white matter in people who lived with depression. Findings from another study—published in the journal Archives of Neurology (Arch Neurol)—suggest that obsessive-compulsive disorder, mania, and other mental health challenges are associated with the basal ganglia-thalamocortical circuits, which are, as previously stated, linked to vascular cognitive impairment. 

 Navigating the emotions surrounding dementia can be hard for both those who have it and those close to them. If the emotional stress becomes too great, though, there are things you can do to cope, including talking to a mental health professional like a therapist. 

Benefits of online therapy

Working with a therapist may help you learn to work through difficult feelings, come to terms with a diagnosis, and learn how to prepare for the changes that dementia might cause. When you speak to a licensed therapist online, you can do so from the comfort of your own home. This may be a more comfortable and available option for those living with dementia.

Effectiveness of online therapy

A recent review of over a dozen studies analyzing the benefits of online cognitive behavioral therapy (CBT) found that digital treatment was typically more cost-effective for clients than in-person therapy. The same review also noted that online therapy can be just as effective as traditional in-person options for treating symptoms of depression, which may accompany a dementia diagnosis.