Treatment and support for vascular dementia

Care and support for a person with dementia should always aim to be ‘person-centred’. This means it should be focused specifically on the individual person, not generally on their condition. It should take into account the person’s life history and background, relationships, needs and preferences. The person should always be included in any decisions about their care and support.

It is also important that the person with dementia regularly sees their GP. The GP can help them manage any health problems or refer them to the right support and expertise when they need it. They should also review a person’s care and support at least annually.

Page contents

• Managing long-term health conditions and recovery from stroke
• Managing symptoms of vascular dementia
  • Treatments for changes in mood and behaviour
  • Support for hallucinations and delusions
  • Support for movement and co-ordination problems
• Support services
• Support in the later stages of vascular dementia

Managing long-term health conditions and recovery from stroke

If a person has stroke-related vascular dementia, it is important to reduce their risk of having another stroke as much as possible. This means looking after their heart and blood circulation. For example, with support from doctors they can try to keep their blood pressure and blood sugar and cholesterol levels as normal as possible. They may also need to take drugs that thin their blood and prevent harmful clots.

Making lifestyle changes, such as cutting down on alcohol and being more physically active, should also help reduce the risk of further strokes. However, in practice this can be hard to do for many people. Drugs they have to take may cause side effects that make them feel worse or become more confused or unsteady.

All medication needs to be reviewed regularly by the person’s GP to make sure it is helping. In addition, making big changes to the person’s lifestyle or their longstanding habits can sometimes be challenging for them.

Stroke Association provides information, support and advice to help stroke survivors with recovery. 

Managing symptoms of vascular dementia

The person with dementia and those caring for them should be offered support soon after a diagnosis. This should give them the chance to talk to a professional about what’s important to them, ask questions about the diagnosis, and start to think about the future. It’s also important to get information on planning ahead, where to get help and how to stay well, both physically and mentally.

The drugs that are prescribed for Alzheimer’s disease and dementia with Lewy bodies do not have benefits for vascular dementia, and so are not recommended for it. However, these drugs may be prescribed to treat these types if they are present in mixed dementia along with vascular dementia.

There are a variety of activities and therapies that can help a person with dementia to maintain their abilities for as long as possible and to look after their physical and emotional wellbeing. Their availability will vary locally. These include:

• cognitive stimulation therapy (CST) – this is a popular way to help keep someone’s mind active. It involves doing themed activity sessions over several weeks
• cognitive rehabilitation – this is skills training that is tailored to a person’s needs and abilities. It can enable the person to keep their thinking skills, meet their goals and cope better with the symptoms of dementia. My life, my goals (opens in PDF) can help. This is an electronic resource to support people living with dementia with what they want to be able to do. It sets out meaningful goals based on what matters to them. 
• talking therapies, such as counselling – these can help someone come to terms with their diagnosis or discuss their feelings
• cognitive behavioural therapy (CBT) – this may be offered if the person develops depression or anxiety. It is most useful in the early stages of dementia
• life story work – many people with dementia enjoy this activity, where the person is encouraged to record their life experiences and memories. Knowing about a person’s life experiences may help others to provide person-centred care for them. Recording this information early on can also be helpful in the later stages of dementia, when a person may not be able to give this information
• occupational therapy (OT) – an occupational therapist will provide advice and support on ways to help someone with dementia stay independent and live well with vascular dementia at home. These will be specific to the person, depending on their symptoms, living environment and the everyday activities they want to do. The person’s GP can refer them to an occupational therapist
• reminiscence work – as a person’s dementia progresses, they may also enjoy talking about their past, with the help of things like photos, familiar objects or music
• music and creative arts therapies – these are therapeutic sessions where the person can be creative, such as making music, playing an instrument, and painting.

Find services for people with dementia near you

The details of the support that is available, and how people are generally referred, can vary around the country. Add your postcode below to see what is available near you.

Treatments for changes in mood and behaviour

Vascular dementia can sometimes cause a person to become agitated and distressed. These changes in behaviour may be because they are struggling to communicate a need or a feeling, or to understand what is going on around them. Positive interactions with other people, or activities matched to the person’s abilities and interests, can help.

Physical health problems such as pain, dehydration, infection or constipation can often cause a person with vascular dementia to become anxious, confused and disoriented. If these are serious, the person may develop delirium, which is an urgent medical problem.

Support for hallucinations and delusions

If someone is having hallucinations or delusions, carers should try to offer them reassurance. They can remind the person that they are there to support them and try gentle distraction. It rarely helps to try to convince the person that what they are seeing is not there, or that what they believe is untrue.

Hallucinations that are not distressing to the person may not need to be stopped. Some may even be comforting, such as the sight of a good friend or family member sitting by the bed.

It is important to get a person’s eyesight and hearing checked regularly and support them to keep their glasses or hearing aids clean and working properly. Any problems with these can make difficulties with recognising or understanding things worse.

A person who has had a stroke may have vision problems as a result, and this can increase their chance of having hallucinations. An orthoptist (eye health specialist) can assess whether this has happened and may be able to help correct it.

Support for movement and co-ordination problems

A person with movement problems, for example after a stroke, will often benefit from working with a physiotherapist or occupational therapist (or both). They can help the person to move and stay independent, as well as advise on aids and adaptations in the home. 

Support from a speech and language therapist (SLT) is often helpful if the person develops problems with swallowing or speaking, which are particularly common after having a stroke. The GP or community nurse can make a referral to an SLT who can help the person to keep eating well and communicate with others.

If the person has had falls or is worried about falling, the GP may refer them to a falls prevention service. Their risk of falls may be reduced by strength and balance exercises, an eyesight test, a medication review and making the home safer – for example, improving light levels, decluttering, and removing trip hazards.

Support services

There is also a range of support services that can help a person live well with dementia. These include:

• local dementia advisers and dementia support workers – who can offer support, practical advice and information over the phone, face to face or online
• homecare workers and personal assistants – who can help in and around the home
• respite care (temporary or short-term care) – to allow the person with dementia or their carer to take a break
• specialist dementia nurses – who can provide practical, clinical and emotional support to the person and their family, such as NHS clinical nurse specialists or Admiral nurses
• day centres – where the person can do activities and connect with others in a friendly and safe venue
• online discussion forums – online communities, for example Talking Point, where a person with dementia and carers can:
  • ask for advice from those in a similar situation
  • read other people’s stories
  • express concerns
  • share helpful information.

These services may vary by area and may have changed slightly since the coronavirus pandemic. To find local services, search Alzheimer’s Society’s dementia directory, or contact the GP, local memory service or local authority (council) social services department.

Support in the later stages of vascular dementia

Vascular dementia is a progressive condition, so over time symptoms will get worse. This is generally over a period of several years.

Stroke-related dementia often progresses in steps, with long periods when symptoms are stable followed by shorter periods when symptoms quickly get worse. This is because each stroke causes further damage to the brain and the effects tend to be sudden. Subcortical vascular dementia can occasionally follow this pattern, but more often symptoms get worse slowly as the disease damages the brain more gradually.

As vascular dementia progresses, a person is likely to become more confused or disoriented, and have more problems with memory, reasoning and communication. In the later stages of the condition, they may become much less aware of what is happening around them. They may have difficulties walking or eating without help and may become increasingly frail.

Eventually, someone with vascular dementia is likely to need a large amount of personal care. It is difficult to predict how quickly the condition will progress over time. The person will probably need personal care sooner due to having other health conditions that are linked to vascular dementia, such as diabetes or cardiovascular disease.

Planning for end of life is important for anyone who has a life-limiting condition, such as vascular dementia. It can be upsetting to think about, but planning ahead can help to meet the person’s needs at the end of their life.