Vascular cognitive impairment is a term used to describe the changes in thinking and memory that occur when there isn't enough blood flow to part of the brain, as can happen with a stroke. "Vascular" refers to blood flow and blood vessels. "Cognitive impairment" refers to changes in the way that you think. Vascular cognitive impairment can cause issues with language, decision-making, planning and judgment.

Previously, only the term "vascular dementia" was used to describe memory and thinking changes caused by problems with blood flow. But experts started using the term "vascular cognitive impairment" because it better represents the wide range of types and the severity of cognitive changes caused by vascular problems. Both terms still are used, but now they are used to describe different points on the spectrum of dementia:

• Vascular cognitive impairment (vascular mild cognitive impairment, mild VCI, VaMCI). This term indicates milder symptoms that don't affect daily living. These changes mostly affect thinking skills, memory, focus and language.
• Vascular dementia (vascular major cognitive impairment, major VCI, VaD). This term describes significant symptoms of dementia that affect daily living. Symptoms may be similar to vascular mild cognitive impairment but are more severe and may be more like symptoms of Alzheimer's disease. Vascular dementia sometimes is called major vascular cognitive impairment.

Vascular cognitive impairment and vascular dementia can happen after a stroke. A stroke may occur when a blood clot blocks an artery or a blood vessel bursts and causes bleeding inside the brain. Both of these events cut off the oxygen and nutrients brain cells need. Not every stroke leads to vascular cognitive impairment. Whether thinking and memory are affected depends on how severe the stroke is and where in the brain it happens.

Vascular cognitive impairment and vascular dementia also can result from other conditions that damage blood vessels and reduce circulation. Factors that increase your risk of heart disease and stroke also raise your risk of vascular cognitive impairment. Those factors include diabetes, high blood pressure, high cholesterol and smoking. Managing these factors may help lower your chances of developing vascular cognitive impairment.

Types of vascular cognitive impairment:

• Multi-infarct dementia. This type of vascular cognitive impairment is caused by several strokes, often affecting different parts of the brain. Over time, the damage from these strokes can affect memory and thinking.
• Post-stroke dementia. This type of major vascular cognitive impairment occurs in someone who has dementia symptoms within six months after having a stroke. The dementia does not go away. The person may or may not have had any dementia symptoms before the stroke.
• Mixed dementia. This term usually means that a person has both Alzheimer's disease and a type of vascular dementia. It sometimes is used to describe any combination of dementias. It's more common in older adults.
• Subcortical ischemic vascular dementia. This happens when there is damage to the small blood vessels and nerve fibers found in the white matter of the brain. This is most common in people with blood vessel disease or high blood pressure or those who have had an earlier stroke. Early symptoms often include trouble with attention, planning and movement rather than memory.

Vascular cognitive impairment symptoms vary depending on which area of the brain isn't getting enough blood flow. Symptoms often overlap with those of other types of dementia, especially Alzheimer's disease. In contrast to Alzheimer's, early symptoms of vascular cognitive impairment tend to affect the speed of thinking and problem-solving rather than memory loss.

There aren't specific stages of vascular cognitive impairment or vascular dementia, but the condition does tend to progress and get worse over time. Symptoms usually appear right afterward if vascular cognitive impairment is caused by a stroke. Symptoms may appear slowly over time if vascular cognitive impairment is caused by small blood vessel disease.

Vascular cognitive impairment symptoms include:

Thinking and communication changes

• Confusion.
• Trouble finding the right words.
• Difficulty paying attention.
• Trouble organizing thoughts or actions.
• Difficulty planning and following through with plans.
• Slowed thinking.
• Uncertainty about what to do next.
• Memory issues.

Behavior and mood changes

• Restlessness or agitation.
• Depression or lack of interest (apathy).

Physical changes

• Unsteady walk or poor balance.
• Sudden or frequent need to urinate or trouble controlling urine.

Vascular cognitive impairment symptoms may be most obvious when they occur suddenly following a stroke. When changes in thinking and reasoning seem clearly linked to a stroke, this condition sometimes is called post-stroke dementia.

Sometimes a pattern of vascular cognitive impairment symptoms follows a series of strokes or ministrokes, known as transient ischemic attacks. Changes in thought processes occur in noticeable steps downward from the earlier level of function. This is unlike the gradual, steady decline that typically occurs in Alzheimer's disease.

But vascular cognitive impairment can develop gradually as in Alzheimer's disease dementia. And vascular cognitive impairment and Alzheimer's disease often occur together.

Studies show that many people with dementia and evidence of brain vascular disease also have Alzheimer's disease.

Vascular cognitive impairment and vascular dementia result from conditions that damage the brain's blood vessels. When blood vessels in the brain are damaged, they're not able to supply the brain with enough nutrition and oxygen. This affects a person's thought processes.

Common conditions that may lead to vascular cognitive impairment include:

• Stroke that blocks a brain artery. Strokes that block a brain artery usually cause a range of symptoms that may include vascular cognitive impairment. But some strokes don't cause any noticeable symptoms. These silent strokes still increase dementia risk.

  The risk of vascular cognitive impairment increases with the number of strokes that occur over time. This is true for both silent and apparent strokes.

• Brain hemorrhage. A brain hemorrhage often is caused by high blood pressure weakening a blood vessel. This leads to bleeding into the brain. A brain hemorrhage also may happen when there's a buildup of protein in small blood vessels, which occurs with aging. The buildup weakens the blood vessels over time and causes bleeding, known as cerebral amyloid angiopathy. Bleeding into the brain causes damage that can lead to vascular cognitive impairment.
• Narrowed or damaged brain blood vessels. Any condition that narrows or damages brain blood vessels can lead to vascular cognitive impairment. These conditions include the wear and tear associated with aging, high blood pressure, diabetes, and the buildup of cholesterol and other substances in the arteries, known as atherosclerosis.

In general, the risk factors for vascular cognitive impairment are the same as those for heart disease and stroke. Risk factors for vascular cognitive impairment include:

Risk factors you can't change

• Increasing age. The risk of vascular cognitive impairment increases with age. The condition is rare before age 65.
• Family history. While vascular cognitive impairment isn't inherited, many of the risk factors for it are. This includes conditions such as high blood pressure and diabetes.

Medical conditions

• History of heart attacks, strokes or ministrokes. If you've had a heart attack, you may be at increased risk of blood vessel problems in your brain. The damage that occurs with a stroke or a ministroke also may increase your risk of developing vascular cognitive impairment.
• Atherosclerosis. This condition occurs when cholesterol and other substances known as plaques build up in your arteries and narrow your blood vessels. Atherosclerosis can increase your risk of vascular cognitive impairment by reducing the flow of blood that nourishes your brain.
• High cholesterol. Higher levels of low-density lipoprotein (LDL), the "bad" cholesterol, are associated with an increased risk of vascular cognitive impairment.
• High blood pressure. High blood pressure puts extra stress on blood vessels everywhere in your body, including in your brain. This increases the risk of vascular problems in the brain.
• Diabetes. High blood sugar levels damage blood vessels throughout your body. Damage in brain blood vessels can increase your risk of stroke and vascular cognitive impairment.
• Atrial fibrillation. In this condition, the upper chambers of the heart begin to beat rapidly and irregularly, out of coordination with the heart's lower chambers. Atrial fibrillation increases your risk of stroke. It causes blood clots to form in the heart. Blood clots can break off and travel to blood vessels in the brain causing stroke.

Risk factors you can change

• Smoking. Smoking damages your blood vessels. Smoking increases the risk of atherosclerosis and other circulatory diseases, including vascular cognitive impairment.
• Obesity. Being overweight is a well-known risk factor for vascular diseases. Obesity also is thought to increase the risk of vascular cognitive impairment.

The health of your brain's blood vessels is closely linked to your overall heart health. Taking these steps to keep your heart healthy also may help lower your risk of vascular cognitive impairment:

• Maintain a healthy blood pressure. Keeping your blood pressure in the healthy range may help prevent vascular cognitive impairment. High blood pressure strains the blood vessels in your brain and increases your risk of strokes and cognitive decline.
• Prevent or manage diabetes. Lowering your risk of type 2 diabetes with diet and exercise is another possible way to decrease your risk of dementia. If you already have diabetes, managing your blood sugar levels may help protect the small blood vessels in your brain from damage.
• Quit smoking. Smoking tobacco damages blood vessels everywhere in the body, including the brain.
• Get physical exercise. Regular physical activity should be a key part of everyone's wellness plan. Exercise improves heart health, blood flow and brain function. It also may help prevent vascular cognitive impairment later in life.
• Keep your cholesterol in check. Eating a healthy, low-fat diet and taking cholesterol-lowering medicines if you need them may reduce your risk of strokes and heart attacks. That could lower your risk of vascular cognitive impairment by reducing the amount of plaques building up inside your brain's arteries.

Experts nearly always can determine dementia in people with dementia symptoms. While certain test results can help with a diagnosis, there's no specific test that confirms vascular cognitive impairment. A diagnosis may be made based on the information provided, including any history of stroke or heart and blood vessel issues.

Lab tests

Laboratory tests provide key indicators of the health of your heart and blood vessels. Tests can measure your cholesterol levels and blood sugar levels. Other tests can check for potential causes of dementia symptoms and rule out others. These tests may check for:

• Thyroid-stimulating hormone. Tests can rule out a thyroid issue that could be causing symptoms.
• Compounds in the blood such as calcium, electrolytes and creatinine.
• Vitamin levels such as vitamin D or vitamin B12. Deficiencies in these vitamins could cause vascular cognitive impairment symptoms.
• Signs of syphilis, a bacterial infection that can cause dementia in its late stages.

Neurological exam

Your neurological health can be determined by testing your:

• Reflexes.
• Muscle tone and strength and how strength on one side of your body compares with the other side.
• Ability to get up from a chair and walk across the room.
• Sense of touch and sight.
• Coordination.
• Balance.

Brain imaging

Images of your brain can pinpoint changes caused by strokes, blood vessel diseases, tumors or trauma that may affect thinking and reasoning. A brain-imaging study can help pinpoint likely causes of your symptoms and rule out other causes.

Brain imaging that may help diagnose vascular cognitive impairment includes:

• Magnetic resonance imaging (MRI). MRI generally is the preferred imaging test to diagnose vascular cognitive impairment. MRI results can provide more detail than CT scans about strokes, ministrokes and blood vessel changes.

  An MRI machine uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into a tube-shaped MRI machine. The machine makes loud banging noises while it produces images. Having an MRI is painless, but some people don't like the tight space or the noise.

• Computerized tomography (CT) scan. A CT scan can provide information about your brain's structure. It can tell whether any regions of the brain show shrinkage. It also can detect evidence of a stroke, ministroke, blood vessel changes or a tumor.

  For a CT scan, you'll lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles. A computer uses this information to create detailed cross-sectional images of your brain.

Neuropsychological tests

This type of exam assesses your ability to:

• Speak, write and understand language.
• Work with numbers.
• Learn and remember information.
• Develop a plan and solve a problem.
• Respond effectively to various situations.

People with vascular cognitive impairment may have a hard time thinking through a problem and coming up with a solution.

People with vascular cognitive impairment may not have as much trouble learning and remembering new information as people with Alzheimer's disease. But learning and remembering may be affected if blood vessel problems occur in areas of the brain important for memory.

Overlap between vascular cognitive impairment and Alzheimer's dementia

While much focus is placed on telling the difference between Alzheimer's dementia and vascular cognitive impairment, the two often overlap. Most people diagnosed with Alzheimer's dementia have issues with blood vessels and blood flow that contribute to Alzheimer’s disease. And most people with vascular cognitive impairment have some brain changes associated with Alzheimer's disease.

There are no treatments to stop or cure vascular cognitive impairment, and vascular dementia and vascular cognitive impairment can't be reversed. But some causes of vascular dementia, such as an infection or a vitamin deficiency, can be reversed.

People with mixed dementia – vascular cognitive impairment and either Alzheimer's disease or Lewy body dementia – may benefit from medicines used to treat those other types of dementia.

Treatment often focuses on managing the health conditions and risk factors that contribute to vascular cognitive impairment.

Managing conditions that affect the health of your heart and blood vessels sometimes can slow the rate at which vascular cognitive impairment gets worse. You may take medicines to:

• Lower your blood pressure.
• Lower your cholesterol level.
• Prevent your blood from forming clots and keep your arteries clear.
• Help manage your blood sugar if you have diabetes.

Some studies have shown some benefit in using medicines called cholinesterase inhibitors for vascular cognitive impairment. These medicines often are prescribed to treat the symptoms of Alzheimer's disease. Cholinesterase inhibitors are not approved by the Food and Drug Administration (FDA) for vascular cognitive impairment. But since vascular cognitive impairment often occurs along with Alzheimer's, taking a cholinesterase inhibitor may be appropriate for some people.

Studies haven't shown that lifestyle changes such as exercise and a healthy diet can reverse or significantly improve existing vascular cognitive impairment or vascular dementia symptoms. However, these healthy habits still are widely recommended. Research suggests they may offer some benefit — particularly in slowing the progression of symptoms or delaying the onset of dementia. Some studies also show that regular physical activity may help prevent vascular dementia and symptoms may progress more slowly in people who are more physically active.

Lifestyle habits that may help lower your risk of vascular cognitive impairment and vascular dementia include:

• Getting regular physical activity.
• Eating healthy.
• Trying to keep a healthy weight.
• Taking part in social activities.
• Challenging your brain with games, puzzles and new activities, such as an art class or listening to new music.
• Limiting how much alcohol you drink.

People with any type of dementia — whether it's vascular cognitive impairment or Alzheimer's disease — experience a mixture of emotions. Caregivers may experience similar feelings. Emotions may include confusion, frustration, anger, fear, uncertainty, grief and depression.

Caring for someone with dementia

These strategies can help caregivers and care partners as they care for people with vascular cognitive impairment:

• Seek out support. Many people with dementia and their families benefit from counseling or local support services. Contact your local Alzheimer's Association affiliate to connect with support groups and resources. You also can find referrals, home care agencies, residential care facilities, a telephone help line and educational seminars.
• Prepare for what's ahead. Talk with a lawyer about the types of legal documents you'll need in the future while your loved one is in the earlier stages of the disease. This may include power of attorney, healthcare proxy and an advanced directive.
• Give encouragement. Care partners can help a loved one cope with vascular cognitive impairment by being there to listen. Provide encouragement and reassure the person that life can still be enjoyed. Do your best to help the person retain dignity and self-respect.
• Provide a calm environment. A calm and predictable environment can help reduce worry and agitation. Establish a daily routine that includes activities well within the comfort zone of the person with vascular cognitive impairment.
• Do activities together. Try to find activities you both like to do, such as a painting class or a long walk.
• Respect independence as often as is safe. It may be a long time before your loved one has to give up living alone or driving. The early stages of dementia can last years. Your loved one may still be capable of doing many things independently. If you and your loved one can't agree on when it's time to stop certain activities, such as driving, ask your loved one's healthcare team for advice.

Caring for the caregiver or care partner

Providing care and supporting a person with dementia is physically and emotionally demanding. It is common to feel anger, guilt, frustration, discouragement, worry, grief and social isolation. But paying attention to your own needs and well-being is one of the most important things you can do for yourself and for the person in your care.

If you're a caregiver or care partner:

• Learn as much about the disease as you can. Ask your loved one's healthcare team for good sources of information. Your local librarian also can help you find resources.
• Ask questions of specialists, social workers and others involved in the care of your loved one.
• Call on friends and family members for help when you need it.
• Take a break every day.
• Take care of your health by seeing your healthcare team on schedule, eating healthy meals and getting exercise.
• Make time for friends, and consider joining a support group.

If you've had a stroke, your first conversations about your symptoms and recovery likely will take place in the hospital. If your symptoms are milder, these conversations may take place during a healthcare appointment to talk about changes in your thought processes.

You may start by seeing a member of your healthcare team. You then may be referred to a doctor who specializes in issues of the brain and nervous system, known as a neurologist.

Appointments can be brief, and there's often a lot to talk about. It's a good idea to be prepared for your appointment. Here's some information to help you get ready and know what to expect.

What you can do

• Be aware of any restrictions before the appointment. When you make your appointment, ask if you need to fast for blood tests or if you need to do anything else to prepare for diagnostic tests.
• Write down all of your symptoms. Be ready to share details about why you're concerned about your memory or mental function. Include examples of forgetfulness, poor judgment or other lapses you want to mention. Try to remember when you first started to suspect that something might be wrong. If you think your symptoms are getting worse, be ready to describe them.
• Take a family member or friend along, if possible. A relative or trusted friend can play a key role in confirming the extent of your symptoms. Having someone with you also can help you recall all the information provided during your appointment.
• Make a list of your other medical conditions. This includes if you're currently being treated for diabetes, high blood pressure, heart disease, past strokes or any other conditions.
• Make a list of all your medicines, including prescription medicines and those you get without a prescription. Also include vitamins and supplements.

Writing down a list of questions ahead of time can help you remember your biggest concerns and allow you to make the most of your appointment. If you're seeing your healthcare team regarding concerns about vascular cognitive impairment or vascular dementia, some questions to ask include:

• Do you think I have memory problems?
• Do you think my symptoms are due to blood flow problems in my brain?
• What tests do I need?
• If I have vascular dementia, will you or another specialist manage my ongoing care? Can you help me get a plan in place to work with the rest of my healthcare team?
• What treatments are available?
• Is there anything I can do that might help slow the progression of dementia?
• Are there any clinical trials of experimental treatments I should consider?
• What should I expect to happen over the long term? What steps do I need to take to prepare?
• Will my symptoms affect how I manage my other health conditions?
• Do you have any brochures or other printed material I can take home with me? What websites and support resources do you recommend?

In addition to the questions you've prepared ahead of time, don't hesitate to ask questions to clarify anything you don't understand.

What to expect from your doctor

Being ready to respond to these questions may free up time to focus on any points you want to talk about in depth:

• What kinds of thinking problems and mental lapses are you having? When did you first notice them?
• Are they steadily getting worse, or are they sometimes better and sometimes worse? Have they suddenly gotten worse?
• Has anyone close to you expressed concern about your thinking and reasoning?
• Have you started having a hard time with any long-standing activities or hobbies?
• Do you feel sadder or more anxious than usual?
• Have you gotten lost lately on a driving route or in a situation that's usually familiar to you?
• Have you noticed any changes in the way you react to people or events?
• Do you notice any change in your energy level?
• Are you currently being treated for high blood pressure, high cholesterol, diabetes, heart disease or stroke? Have you been treated for any of these in the past?
• What medicines, vitamins or supplements are you taking?
• Do you drink alcohol or smoke? How much?
• Have you noticed any trembling or trouble walking?
• Are you having any trouble remembering your medical appointments or when to take your medicine?
• Have you had your hearing and vision tested recently?
• Did others in your family ever have trouble with thinking or remembering things as they got older? Was anyone ever diagnosed with Alzheimer's disease or dementia?