Memory Digest

Vascular Dementia

The second most common type of dementia, caused by reduced blood flow to the brain. Learn the signs, causes and how to lower risk.

Last reviewed: October 2026

Vascular dementia is a decline in thinking skills caused by conditions that block or reduce blood flow to the brain, depriving brain cells of oxygen and nutrients. It is generally considered the second most common cause of dementia after Alzheimer's Disease, and the two often occur together (called mixed dementia).

What causes it?

The brain uses about a fifth of the body's oxygen and depends on a constant blood supply. Vascular dementia can result from:

• A major stroke that blocks a large blood vessel (sometimes called post-stroke dementia).
• Multiple small strokes ("silent strokes" or "mini-strokes") that may go unnoticed individually but add up.
• Small vessel disease – gradual narrowing and damage to tiny blood vessels deep in the brain, often visible on MRI as "white matter changes." This is the most common form.
• Bleeding in the brain, sometimes related to high blood pressure or amyloid in blood vessel walls.

Risk factors

The risk factors are largely the same as for heart disease and stroke:

• High blood pressure (the most important)
• Diabetes
• High cholesterol
• Smoking
• Atrial fibrillation (irregular heartbeat)
• Obesity and physical inactivity
• Previous stroke or heart attack
• Older age

Symptoms

Symptoms depend on where and how much the brain is damaged. Compared with Alzheimer's, memory may be less affected at first, while these are more prominent:

• Slowed thinking and difficulty concentrating
• Trouble planning, organizing and making decisions (executive function)
• Difficulty following steps or solving problems
• Confusion and agitation
• Walking problems, unsteadiness, and falls
• Urinary urgency or incontinence
• Depression, apathy and mood swings

After a stroke, symptoms may appear suddenly. With small vessel disease they develop gradually. Vascular dementia is classically described as progressing in a "stepwise" pattern—stable periods followed by sudden drops after new strokes—but gradual decline is also common.

Sudden confusion, weakness or numbness on one side, trouble speaking, vision loss, or a severe headache may be a stroke. Call 911 immediately—every minute counts.

Diagnosis

Doctors look for evidence of thinking problems plus evidence of blood vessel disease. Evaluation includes a medical history, cognitive testing, a neurological exam, blood pressure and blood tests, and brain imaging—usually MRI, which can show strokes and small vessel changes. Because Alzheimer's often coexists, doctors may also consider Alzheimer's biomarker tests. See Getting a Diagnosis.

Treatment

Damage that has already occurred can't be reversed, but treatment focuses on preventing further damage and managing symptoms:

• Controlling blood pressure – the SPRINT MIND trial found that intensive blood pressure control (systolic target under 120) reduced the risk of mild cognitive impairment, though its effect on dementia itself was not statistically certain.
• Managing diabetes and cholesterol
• Stopping smoking
• Blood thinners or anticoagulants when appropriate (for example, for atrial fibrillation)—only as prescribed
• Physical activity, a healthy diet, and rehabilitation (physical, occupational and speech therapy) after stroke
• Treating depression, which is common
• Cholinesterase Inhibitors and Memantine are sometimes used, especially when Alzheimer's is also suspected, though benefits are modest

Anti-amyloid drugs are not approved for vascular dementia.

Outlook

The course varies widely. Some people remain stable for long periods, especially when vascular risk factors are well controlled; others decline after further strokes. Planning ahead, home safety, and caregiver support are as important as in any dementia. See Caregiving Guide: Where to Start.

Can it be prevented?

Vascular dementia is among the most preventable forms of dementia. What's good for your heart is good for your brain: control blood pressure, stay active, don't smoke, eat well, limit alcohol, and manage diabetes. See Reducing Dementia Risk: The 14 Risk Factors.

Sources

1. National Institute on Aging: Vascular Dementia
2. Alzheimer's Association: Vascular Dementia
3. Mayo Clinic: Vascular dementia
4. SPRINT MIND Investigators. Effect of intensive vs standard blood pressure control on probable dementia. JAMA, 2019

Not medical advice. This article is general information, not a diagnosis or treatment plan for any individual. Talk with a doctor about your situation.

Related articles

• What Is Dementia?
• Alzheimer's Disease
• Reducing Dementia Risk: The 14 Risk Factors
• Delirium vs. Dementia
• Frontotemporal Dementia