Overview

It is known that many diseases which are more common with ageing, such as hypertension and diabetes, increase the risk of atherosclerotic damage to organs such as the brain, heart and kidneys.

Mild cognitive impairment may be the first sign of vascular disease affecting the brain. If risk factors remain unchecked, such as glucose control, eliminating obesity, increasing activity and stopping smoking, the risk of dementia and stroke increases.

With severe vascular disease patients may develop a dementia involving significant difficulties with memory, language and global function, as in Alzheimer’s, but the pathology is ischaemia (lack of blood supply to the brain) rather than plaque formation due to abnormal aggregation of tau (as in Alzheimer’s).

Most people have mixed pathologies, usually a mixture of Alzheimer’s and vascular disease.

Neuropsychiatrists are often involved in managing the psychiatric complications of dementia such as depression, anxiety, and challenging behaviours (which are described as ‘the behavioural and psychological symptoms of dementia’ – BPSD).