Vascular Dementia MRI: Info, Appearance and When to Get a Scan

If you, or someone you love, is showing signs of vascular dementia, such as forgetfulness, confusion or behaviour problems, it can be incredibly difficult. However, you’re doing the right thing by reading this guide. That’s because the progress of vascular dementia can be slowed down if caught early on, giving you, or your loved one, better mental functioning and independence for longer.

In our comprehensive guide, you can learn why MRI is a critical tool in diagnosing VaD, learn more about the symptoms and discover the main differences between vascular dementia and Alzheimer’s disease.

What is Vascular Dementia?

Vascular dementia (also known as vascular cognitive impairment) is the second most common form of dementia following Alzheimer's disease. It accounts for approximately one in five of all dementia cases. Unlike Alzheimer's, which typically causes memory problems, people with vascular dementia are more likely to have problems with reasoning and planning, and they may also have mood fluctuations. However, symptoms can vary quite significantly from one person to the next. 

There are a variety of causes for vascular dementia, but they often combine to result in impaired blood flow to the brain, causing the cognitive decline we see in people with the condition. Because of what can sometimes be a complex chain of events leading to vascular dementia, it needs a comprehensive approach to diagnosis and management.

Vascular dementia can be divided into three main subtypes:

• Subcortical vascular dementia: This happens when small blood vessels in the brain get blocked repeatedly. It’s thought to be the most common type of VaD.

• Stroke-related dementia: This happens when the blood supply to part of the brain is cut off by a stroke, causing cognitive decline.

• Multi-infarct dementia: This is caused by a series of smaller strokes or transient ischemic attacks (TIA). TIAs are like strokes, but the symptoms are short-lived and usually get better without treatment. 

• Mixed dementia: More than one in 10 people with dementia is diagnosed with this type of dementia. It means their symptoms are caused by more than one type of dementia, such as a mix of Alzheimer’s and VaD.

What Are the Symptoms of Vascular Dementia?

The symptoms of vascular dementia can vary from person to person and can depend on certain factors. However, the main symptoms are:

• Slowing down of thought processes.

• Difficulties with reasoning, planning and performing complex tasks.

• Problems with perception or recognising once-familiar objects or faces.

• Difficulties with language in terms of reading, writing and speaking.

• Problems with memory.

• Mood swings

• An increase in negative emotions, such as anxiety, depression, and irritability.

• Feeling tired more often.

• Difficulty managing emotions, for example, crying or laughing in inappropriate situations.

If a person with vascular dementia has a stroke, they may also have physical symptoms, including:

• Weakness or paralysis in the arms, legs or one side of the face.

• A reduction in the speed and coordination of physical movements, such as walking, writing, or performing everyday tasks. 

• Partial or total loss of the ability to understand language and/or to speak.

• Loss of vision in one or both eyes.

• Loss of bladder control (urinary incontinence).

• Problems swallowing.

People who have hereditary vascular dementia (caused by a genetic mutation) may also have:

• Migraines

• Hair loss

• Weakening of the spine

• Further strokes

The symptoms of vascular dementia can start suddenly or come on gradually, but they usually tend to get worse over time. However, certain treatments can help to slow this down.

Can an MRI Scan Detect Vascular Dementia?

Magnetic resonance imaging (MRI) is a critical tool in diagnosing vascular dementia because it can provide detailed images of the brain. These images can reveal changes to the brain that are associated with VaD. 

Here are some of the brain changes that MRI scans can detect:

• White matter hyperintensities (WMH) which are linked to small blood vessel disease. They show areas of the brain that are affected by poor blood flow. 

• Tiny, deep brain lesions (lacunar infarcts) which are areas of tissue damage caused by blockages in small blood vessels.

• Brain shrinkage (atrophy), especially in areas linked to memory, such as the hippocampus. The pattern of shrinkage helps doctors tell VaD apart from other types of dementia, including Alzheimer’s disease.

• Cerebral microbleeds, which are tiny bleeds in the small blood vessels that can help to predict the rate of cognitive decline and the risk of dementia. 

What Does Vascular Dementia Look Like on an MRI?

White matter hyperintensities will appear as bright white spots or patches on T2-weighted and FLAIR (Fluid-Attenuated Inversion Recovery) MRI images. They’ll appear in areas of white matter, usually near the brain’s ventricles or in deeper regions of the brain.

Brain lesions will show up as small, dark areas or holes on T1-weighted images and may appear as bright spots on T2-weighted images. They will typically appear in the deeper brain regions.

Brain shrinkage is characterised by widening of spaces on the surface of the brain and enlarged cavities and ventricles inside the brain. These may be spotted in multiple areas but can also affect the hippocampus.

Cerebral microbleeds will appear as tiny black dots on MRI sequences sensitive to blood, such as susceptibility-weighted imaging (SWI) or gradient-echo (GRE) sequences.

How Does an MRI Scan Detect Vascular Dementia?

MRI uses strong magnetic fields to align hydrogen atoms in the body’s water molecules. It then uses short bursts of radio waves to disrupt the alignment. When the radio waves stop, the atoms return to their original state, releasing energy as they do. 

This energy is detected by the MRI scanner and processed to generate detailed images, allowing doctors to check for any structural and functional abnormalities in the brain.

Different tissues release energy at different rates, so an MRI scan can show grey matter, white matter, fluid and any abnormalities in the brain.

T1-weighted images are helpful for assessing brain atrophy, while T2-weighted and FLAIR images are better suited for visualising WMH and other vascular changes.

How is Vascular Dementia Diagnosed?

Your clinician will diagnose VaD by taking a comprehensive approach to your medical history and symptoms. They’ll use more tests and checks to rule out other potential types of dementia, too, such as Alzheimer’s disease or mixed dementia, in which VaD is just one part. Here’s how they do it.

Medical History

Your doctor will identify what kinds of symptoms are happening by asking you, and your relatives, a series of questions about those symptoms. They’ll also ask about your medical history, including any history of stroke, diabetes, cardiovascular disease or dementia.

Physical Examination

They’ll conduct a physical examination which will include exercises and tests to assess motor skills, coordination and balance.

Cognitive Testing

Standardised cognitive tests, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA), are often used to check memory, attention, language and reasoning.

Blood Tests

Blood tests can rule out other conditions, such as vitamin deficiency or thyroid issues, that could be contributing to cognitive decline. 

Neurological Evaluation

A detailed neurological evaluation assesses reflexes, motor function, and sensory perception. Your neurologist may also check your gait and balance, as they can be affected by vascular issues in the brain.

MRI

MRI is key to detecting structural changes in the brain and critical to confirming a diagnosis of vascular dementia, as well as differentiating it from other types of dementia. 

CT Scan

While not as detailed as MRI scans, CT scans may be easier to access sooner or in emergencies. They can reveal evidence of strokes, brain atrophy and other abnormalities in the absence of an available MRI.

Doppler Ultrasound

Doppler ultrasound is a noninvasive imaging technique that checks blood flow in the carotid arteries and identifies blockages that may impact blood flow to the brain.

Neuropsychological Testing

These tests assess specific thinking skills to differentiate vascular dementia from other types of dementia. They may check memory, attention, reasoning and other cognitive skills, helping to build a profile of symptoms. 

Specialised Heart and Blood Vessel Tests

Your doctor may recommend these to gain an in-depth understanding of your cardiovascular health. They may include echocardiograms or stress tests to check your heart function and identify any underlying cardiovascular issues that could contribute to cognitive decline. 

What Are the Causes of Vascular Dementia?

Vascular dementia usually develops after a stroke or series of strokes, which damage brain tissue over time. This deterioration can lead to memory and thinking problems. 

The biggest risk factor for vascular dementia is getting older. As soon as you reach the age of 65, your risk of developing VaD doubles every five years. Another risk factor is being male - men tend to develop VaD more than women. 

As well as ageing and being male, several other risk factors can increase the likelihood of VaD by damaging blood vessels in the brain or increasing the risk of brain atrophy:

• Cardiovascular conditions: High blood pressure, stroke, diabetes, and heart disease can increase thehance of having a clot or bleed in the brain’s blood vessels.

• Atrial fibrillation: An irregular, fast heartbeat that affects blood flow.

• Atherosclerosis: Fatty deposits in artery walls, reducing blood flow.

• High cholesterol (dyslipidemia): Elevated fats in the blood.

• Diabetes: High blood sugar levels, damaging blood vessels.

• Sleep apnoea: Problems breathing during sleep, which can cause small blood clots in the brain. 

• Unhealthy lifestyle: Smoking, too much alcohol, obesity, poor diet, and lack of exercise.

What Are the Differences between Vascular Dementia and Alzheimer's disease?

Alzheimer’s disease and VaD are different in several ways. Alzheimer’s is caused by the breakdown of specific brain neurons, particularly in the hippocampus, an area of the brain associated with memory. In contrast, vascular dementia is caused by damage to the brain’s blood vessels.

Alzheimer’s typically begins slowly and affects a person’s memory first, while VaD usually starts suddenly (after a stroke, for example) and affects arange of functions, with memory problems often appearing later. People with VaD frequently struggle with reasoning, planning and attention at first. Symptoms of Alzheimer’s generally follow a set pattern of development, while symptoms of vascular dementia can be unpredictable. 

People with VaD usually have other health problems, such as cardiovascular issues, which damage their blood vessels. People with Alzheimer’s may not have these other underlying conditions. 

Prognosis and Treatment

Sadly, there is no cure for vascular dementia. However, certain treatments can help to manage symptoms and improve quality of life for many. 

Your medical team will create a care plan for you that includes support for you or your carer at home, or in a nursing home. The hpe is that you can remina as independent for as long as possible.You may need some changes to your home so that it’s easier and safer for you, and you may need financial assistance. 

Your medical team will also help you identify and make any lifestyle changes that can help stop the condition from getting worse. This may include a healthy diet, losing weight, quitting smoking, cuting down on alcohol or increasing your fitness levels. 

Medicines to treat VaD include:

• If you have a combination of Alzheimer's with vascular dementia, your doctor may prescribe acetylcholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine. They can help with memory and cognitive functions by blocking the breakdown of acetylcholine, a substance important for communication between nerve cells. 

• Memantine is also a medication used for Alzheimer's combined with vascular dementia. It works by blocking excess glutamate, a chemical in the brain that can cause damage. 

• Your doctor may prescribe antipsychotics like Risperidone or Haloperidol in the later stages of dementia, when you may experience behavioural and psychological symptoms, such as agitation, anxiety, aggression, and hallucinations. These medications are used with caution and only for short periods, to manage extreme distress or risk of harm.

• Medication to treat underlying conditions, such as high blood pressure, diabetes or high cholesterol, for example. 

Non-medicinal treatments include:

• Occupational therapy to help you with everyday tasks.

• Speech and language therapy.

• Physiotherapy for people who have difficulty moving.

• Cognitive stimulation therapy to improve memory, language, and problem-solving skills.

• Relaxation techniques, including dance, massage or music therapy.

• Social interaction with other people who have memory problems, including drop-in sessions and other group activities.

Why an MRI Scan is a Good Option

An MRI scan is an essential tool in diagnosing vascular dementia (VaD) because it can detect critical changes in the brain associated with VaD. The scan also helps rule out other conditions, such as Alzheimer's disease or brain tumours, that may cause similar symptoms. By providing detailed images of the brain's structure and blood vessels, an MRI offers crucial information that helps doctors make an accurate diagnosis and plan treatment effectively.

Find an MRI Scan for Vascular Dementia

If you’re worried that you or a loved one have symptoms of trigeminal neuralgia, you can book a private MRI scan today. If you’re unsure whether an MRI is suitable for you, one of our expert clinicians is available for a personalised consultation. They can discuss your symptoms and concerns and help you decide what to do next.

Sources

Bourin, M. (2023). Vascular Dementia: Definitions, Origins, Symptoms, Diagnosis and Treatments. https://sarpublication.com/media/articles/SARJPN_41_1-4.pdf

Esawy, E.I., et al. (2023). Role of Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy in  Evaluation of Different Types of Dementia. https://www.journaljammr.com/index.php/JAMMR/article/view/4975/9963

Treatment. Vascular dementia. (2023). https://www.nhs.uk/conditions/vascular-dementia/treatment/

Vascular dementia. (2021). https://radiopaedia.org/articles/vascular-dementia?lang=gb

What are the treatments for dementia? (2023). https://www.nhs.uk/conditions/dementia/about-dementia/treatment/

Who gets vascular dementia? (2022). https://www.alzheimers.org.uk/about-dementia/types-dementia/risk-factors-vascular-dementia