Vascular dementia: causes, symptoms and stages

Vascular dementia is the second most common type of dementia in the UK after Alzheimer’s disease. It’s caused by reduced blood flow to the brain, which damages brain cells and affects memory, thinking and behaviour.

The condition affects people in different ways. Symptoms and progression depend on the cause, the extent of blood vessel damage, and which parts of the brain are involved.

What is vascular dementia?

Vascular dementia is a type of dementia caused by problems with blood supply to the brain.

When blood vessels are blocked or damaged, often due to stroke or small vessel disease, the brain can be starved of the oxygen and nutrients it needs. Over time, this leads to cognitive decline.

Unlike Alzheimer’s disease, which is caused by abnormal protein build-up in the brain, vascular dementia is linked to vascular (blood vessel) damage.

What causes vascular dementia?

Vascular dementia is caused by reduced blood flow to the brain, which damages brain cells over time. This most commonly happens as a result of:

• A stroke
• Multiple mini strokes
• Small vessel disease
• Long-term conditions that damage blood vessels.

Risk factors for vascular dementia

Several health conditions increase the risk of vascular dementia, including:

• High blood pressure
• Heart disease
• Diabetes
• High cholesterol
• Atrial fibrillation
• Smoking
• Obesity.

Because the condition is linked to problems with blood vessels and circulation, it is sometimes referred to as post-stroke dementia or multi-infarct dementia.

Vascular dementia symptoms

Early signs of vascular dementia

The signs of vascular dementia can vary depending on which part of the brain is affected. Symptoms may appear suddenly after a stroke or develop gradually.

Common vascular dementia symptoms include:

• Slower thinking and processing
• Difficulty concentrating
• Problems with planning or decision-making
• Memory problems (though often less severe than in early Alzheimer’s)
• Mood changes, including depression
• Balance and walking difficulties.

Vascular dementia sundowning

Some people experience vascular dementia sundowning, where confusion and agitation become worse in the late afternoon or evening.

Sundowning can include:

• Increased restlessness
• Irritability
• Anxiety
• Difficulty sleeping.

Establishing a calm evening routine and reducing stimulation can help manage symptoms.

Vascular dementia stages

Unlike Alzheimer’s disease, vascular dementia doesn’t always follow a clear seven-stage pattern. Progression can be step-like, meaning symptoms worsen suddenly after a stroke, then stabilise for a period.

However, it’s generally described in three broad stages:

1. Early-stage vascular dementia

• Mild problems with organisation and concentration
• Subtle changes in personality or mood
• Increasing difficulty with complex tasks

2. Mid-stage vascular dementia

• More noticeable memory loss
• Increased confusion
• Communication difficulties
• Needing help with daily activities

3. Late-stage vascular dementia

• Severe cognitive impairment
• Limited communication
• Full-time care needs
• Physical frailty and mobility problems

How is vascular dementia diagnosed?

Diagnosis usually involves:

• A GP assessment
• Referral to a memory clinic
• Cognitive tests
• Brain scans (CT or MRI)
• Review of medical history, including stroke or heart disease

Early diagnosis helps families plan care and manage risk factors.

What is the difference between Alzheimer’s and vascular dementia?

It can be difficult to tell Alzheimer’s and vascular dementia apart, as both affect memory and thinking in different ways.

Some people have mixed dementia, which is a combination of Alzheimer’s disease and vascular dementia.

If you’re unsure what is the difference between vascular dementia and Alzheimer’s, a specialist assessment can help confirm the diagnosis and guide the right support.

Treatment and management

There’s currently no cure for vascular dementia, but treatment focuses on:

• Controlling blood pressure
• Managing diabetes and cholesterol
• Preventing further strokes
• Encouraging healthy lifestyle changes
• Providing cognitive and emotional support

Medication may be prescribed to reduce stroke risk.

Living with vascular dementia: getting the right support

Caring for someone with vascular dementia can become increasingly demanding as symptoms progress. Changes in memory, mobility, behaviour and communication often mean extra support is needed at home.

Professional care at home can help with:

• Personal care and daily routines
• Medication management
• Preparing meals and supporting nutrition
• Mobility and fall prevention
• Companionship and emotional reassurance
• Monitoring changes in health

For many families, staying at home provides familiarity and stability, which can help reduce confusion and anxiety.

How Elder can help

At Elder, we connect families with experienced self-employed carers who provide personalised care at home.

Live-in care offers:

• Dedicated one-to-one support
• Continuity with the same carer
• Flexible routines built around your loved one
• Support with complex health conditions, including stroke-related needs.

If you’re concerned about vascular dementia symptoms or planning ahead for care, speaking with an Elder care advisor can help you understand your options and find the right level of support.