Vascular dementia (VaD) is the second most common cause of dementia and its prevalence increases after the sixth decade of life [1] [2]. It is defined as a condition characterized by features of stroke or subclinical vascular brain injury which involves malfunction of at least two cognitive domains leading to a decrease in the ability to perform activities of daily living [3]. The cognitive features of VaD depend on the anatomical location of the vascular injury and this has led to the classification of VaD into different subtypes: small, large, or mixed vessel disease [4] [5]. Patients with small vessel disease present with a higher incidence of executive dysfunction whereas dysfunctional language and visuospatial perception are noticed more often in patients with large vessel VaD [6]. Clinical presentation of VaD in cortical injury includes speech abnormalities and neglect while a subcortical injury is associated with cognitive, emotional and behavioral difficulties, psychomotor retardation, pseudobulbar palsy, and gait dysfunction [1] [3]. Other features of VaD are restlessness, agitation, aggressive behavior, hallucinations, delusions, paranoia, circadian mood disturbances (sundowning), disorientation, and depression. As the brain injury is variable in VaD, memory disturbances may also be variable or may be completely absent [1]. The intellectual decline in VaD is classically described as "step-wise" (multi-infarct dementia) but can be continuous (lacunar infarcts) too.

Clinical presentation of VaD may resemble that of Alzheimer's disease (AD) although the following features help to differentiate between the two conditions:

• major depression is more commonly seen in patients with VaD
• apathy is seen in the early stages of VaD while it occurs in the late stages of AD
• VaD patients have diminished language fluency compared to AD patients
• Long-term memory deficits are more prevalent in AD patients

A physician should suspect VaD in a patient with cognitive dysfunction which follows a neurologic episode/deficit. The workup should commence with a detailed history eliciting onset and progression of cognitive and neuropsychiatric symptoms as well as a history of atherosclerotic conditions like angina pectoris. A detailed neurological and psychiatric assessment is essential. The Mini-Mental Status Exam (MMSE) is likely to reveal patchy cognitive deficits in VaD compared to global deficits in AD [7]. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria provide the guidelines to help in the diagnosis of VaD [8].

Laboratory tests are performed to exclude other etiologies of dementia. They include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), blood glucose levels, thyroid, liver, and kidney function tests, vitamin B12 levels, and Venereal Disease Research Laboratory (VDRL) test for syphilis. In addition, other tests like human immunodeficiency virus (HIV) testing, and tests to rule out autoimmune diseases should be ordered.

Neuroimaging with computed tomography (CT) and magnetic resonance imaging (MRI) help to confirm the diagnosis with MRI being considered the gold standard. A vascular cause of dementia mainly can be excluded if CT and MRI do not demonstrate any cerebrovascular pathology. MRI findings in VaD include multiple white matter infarcts or lesions in the periventricular white matter, lacunar infarcts, and atrophy of the hippocampal or entorhinal cortical areas. Positron emission tomography (PET) helps in the identification of VaD and differentiates it from AD [9]. Cerebral angiography is only indicated prior to carotid endarterectomy and is likely to show beading of the cortical blood vessels. Other tests which may be performed include an electrocardiogram, echocardiography, Holter monitoring, and carotid Doppler studies.

While there is no cure for vascular dementia, treatment focuses on managing symptoms and preventing further brain damage. This may include medications to control high blood pressure, cholesterol, and diabetes, as well as lifestyle changes like a healthy diet and regular exercise. Cognitive therapy and support groups can also be beneficial for patients and their families.

The progression of vascular dementia varies among individuals. Some may experience a gradual decline, while others may have a more sudden onset of symptoms following a stroke. Early diagnosis and management of risk factors can slow the progression of the disease and improve quality of life.

Vascular dementia is primarily caused by conditions that damage blood vessels in the brain, such as strokes, small vessel disease, or atherosclerosis (hardening of the arteries). These conditions lead to reduced blood flow and oxygen supply to brain tissues, resulting in cell death and cognitive decline.

Vascular dementia accounts for about 10-20% of all dementia cases. It is more common in older adults, particularly those with a history of stroke or cardiovascular disease. Risk factors include high blood pressure, diabetes, smoking, and high cholesterol.

The pathophysiology of vascular dementia involves the disruption of blood flow to the brain, leading to ischemia (lack of oxygen) and subsequent brain cell death. This can occur due to large vessel strokes, small vessel disease, or a combination of both. The resulting brain damage affects cognitive functions, depending on the areas of the brain involved.

Preventing vascular dementia involves managing risk factors for cardiovascular disease. This includes maintaining healthy blood pressure, cholesterol, and blood sugar levels, as well as adopting a healthy lifestyle with regular exercise, a balanced diet, and avoiding smoking and excessive alcohol consumption.

Vascular dementia is a common form of dementia caused by reduced blood flow to the brain. It presents with cognitive impairments and can be diagnosed through a combination of medical history, cognitive testing, and imaging studies. While there is no cure, managing risk factors and symptoms can improve patient outcomes and quality of life.

For patients and families, understanding vascular dementia can be challenging. It is important to recognize the symptoms and seek medical evaluation if cognitive changes are noticed. Support from healthcare providers, family, and community resources can help manage the condition and maintain a good quality of life.

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