Vascular dementia often progresses in a step-like manner, with each successive stage featuring worsening cognitive and physical symptoms requiring more care.

Vascular dementia occurs when impaired blood flow to parts of the brain causes changes in memory, thinking, reasoning, and behavior. It’s often due to a stroke or other conditions, like atherosclerosis, that damage blood vessels.

Vascular dementia is the second most common type of dementia, behind Alzheimer’s disease. But unlike Alzheimer’s, vascular dementia typically progresses through three main stages.

Understanding the stages of vascular dementia can help you recognize when additional care or intervention may be necessary.

Progression of vascular dementia vs. Alzheimer’s

Although both vascular dementia and Alzheimer’s disease cause cognitive decline, their progression differs. Vascular dementia typically progresses in a step-like manner, with sudden declines following strokes or other vascular events.

The symptoms of vascular dementia may stabilize for certain periods and worsen after another vascular incident. Alzheimer’s disease is characterized by a gradual, progressive decline in cognitive abilities such as memory, thinking, and reasoning.

The early stages of vascular dementia can be challenging to diagnose because the symptoms may overlap with other conditions, such as depression.

People in the early stages may still function independently, though they may find certain activities challenging. Common symptoms include:

  • Difficulty concentrating and paying attention: You may notice the person having difficulty focusing on tasks for long periods.
  • Problems with planning and organizing: They may find it harder to manage day-to-day activities, like following a schedule or organizing their belongings.
  • Difficulty making decisions: They may hesitate or make inadvisable choices, even for simple decisions.
  • Memory problems: They may experience short-term memory loss, like forgetting recent events or conversations.
  • Slowed thinking: Their thought processes may become slower, so they may take longer to respond or have difficulties understanding information.
  • Changes in mood: Sudden shifts in mood, such as irritability or frustration, may occur without a clear reason.

At this stage, cognitive decline is usually mild, and most people can continue living independently.

However, as the disease progresses, these symptoms may become more noticeable and interfere with daily activities, such as managing finances or making decisions.

The early stage typically lasts around 2 years, during which cognitive decline progresses gradually.

As vascular dementia progresses into the middle stages, the symptoms above become more noticeable and start to affect a person’s ability to function independently.

Tasks such as bathing, dressing, and cooking may become difficult, and people may require assistance. In some cases, they may need to move to an assisted living home.

Common symptoms during this stage include:

  • Increased confusion and disorientation: They may get lost in familiar places or have difficulty recognizing people they know well.
  • Language difficulties: Following conversations can become challenging, leading to disjointed or repetitive speech.
  • Worsening memory loss: They may forget important events, appointments, recent conversations, or where they put objects more frequently.
  • Personality changes: They may become more irritable, anxious, or display inappropriate behavior in social settings.
  • Difficulty concentrating: Tasks that require focus, like reading or watching TV, may become frustrating and hard to complete.

These symptoms may appear suddenly after experiencing another stroke or ministroke, leading to noticeable declines in cognitive and physical abilities. This stage is often the longest, lasting between 2 to 4 years.

The progression to late stages of vascular dementia is marked by increased difficulty with basic activities, such as eating or walking, or a severe decline in communication abilities.

This stage often follows a major vascular event, such as a larger stroke, and is typically the shortest, lasting around 1 to 2 years. During the late stage, symptoms become more severe, and people usually require full-time care.

Symptoms of the late stages of vascular dementia include:

  • Severe memory loss: The person may not recognize family members or familiar surroundings.
  • Loss of communication skills: They may become nonverbal or experience difficulty with any form of communication.
  • Loss of mobility: Many people lose the ability to walk without assistance, or they may become immobile, increasing the risk of bedsores or infections such as pneumonia.
  • Incontinence: Loss of bowel and bladder control becomes more common, requiring help with toileting.
  • Swallowing difficulties: Difficulty swallowing can increase the risk of choking or developing pneumonia.

During the late stage of dementia, care often shifts to palliative care, focusing on improving quality of life and managing symptoms, such as pain, agitation, or discomfort.

How long does someone live with vascular dementia?

Life expectancy varies, but on average, a person with vascular dementia may live around 3 to 5 years after diagnosis.

However, this can depend on the severity of their condition and whether they experience additional strokes.

How fast is cognitive decline with vascular dementia?

Cognitive decline in vascular dementia typically proceeds in a step-like manner. A noticeable decline often occurs after each stroke or vascular event, followed by a period of some stability.

However, the disease’s course can be unpredictable.

When should someone with dementia go into a care home?

Vascular dementia involves declining physical ability along with dementia. People with vascular dementia often have strokes affecting abilities other than cognition, including strength, coordination, and vision, which can affect independence and self-care.

You might consider a care home for a loved one with dementia when their care needs exceed what they or a caregiver can manage at home or when their safety is at risk. They may require specialized care to receive the necessary support.

Vascular dementia progresses in stages, each marked by worsening cognitive and physical symptoms that require more care.

Early recognition of signs like difficulty concentrating or decision making can lead to timely diagnosis and treatment, potentially slowing progression.

In the later stages, increased support from family members and caregivers becomes essential as the person’s independence significantly decreases.

If you or a loved one has received a vascular dementia diagnosis, working with a healthcare professional can help ensure personalized care at each stage of the condition.