Understanding Vascular Neurocognitive Disorder

Doctor and patient

Vascular neurocognitive disorder is a condition characterized by disruptions in the brain’s blood supply that lead to impairment of one or more aspects of a person’s conscious brain functions. The American Psychiatric Association includes this condition in the new fifth edition of its Diagnostic and Statistical Manual of Mental Disorders as a replacement for a condition previously identified as vascular dementia. The degree of impairment associated with vascular neurocognitive disorder can vary considerably. Some affected individuals retain enough mental function to maintain their everyday lives, while others lose much of their mental function and become dependent on some form of assistance for their daily well-being.

Background Information

Dementia is the medical term for a group of symptoms that point toward a disruption of certain brain activities that fall largely under conscious control and help define each one of us as unique human beings. Most people probably equate dementia-related symptoms with the loss of memory function, but these symptoms can also include disruptions in such things as the normal ability to talk or understand language, the normal ability to reason and exercise judgment, the normal ability to track and adjust to changes in the immediate environment, the normal ability to control impulsive behaviors, and the normal ability to establish long-term goals and make plans to meet those goals. While many people specifically associate dementia with the presence of an illness called Alzheimer’s disease, a number of other conditions can also produce dementia symptoms.

Until May 2013, the American Psychiatric Association (APA) used the term “dementia” to identify declines in conscious brain function that are significant enough to cause considerable mental impairment and degrade a person’s quality of life. However, while the term still has currency in a general medical context, it no longer appears in the APA’s Diagnostic and Statistical Manual (DSM), which is specifically intended to supply practicing mental health professionals with the tools they need to diagnose the full range of officially recognized mental disorders.

Instead of making reference to dementia, the DSM now makes reference to an equivalent condition called major neurocognitive disorder. The manual also allows doctors to specify the underlying cause of any given case of this newly named disorder. In line with these changes, vascular dementia is now known as major vascular neurocognitive disorder. The new DSM guidelines also allow doctors to identify and diagnose the early symptoms of brain dysfunction before that dysfunction grows extreme enough to produce serious life impairment. These symptoms are now known collectively as mild neurocognitive disorder. In line with this change, doctors can now diagnose a condition called mild vascular neurocognitive disorder.

Vascular Neurocognitive Disorder

The “vascular” in vascular neurocognitive disorder refers to the body’s system of blood vessels, known medically as the vascular system. The condition gets this name because the impairments it produces stem from some sort of reduction or blockage in the supply of blood that normally passes through the blood vessels called arteries and into the brain’s tissues. The Mayo Clinic lists potential causes of vascular neurocognitive disorder (vascular dementia) that include stroke – a condition that occurs when a brain artery either gets blocked or springs a leak—and any ongoing health problems that either degrade a blood vessel’s general health or produce abnormal narrowing in a blood vessel’s interior diameter. Conditions that can trigger these damaging blood vessel changes include atherosclerosis (hardened arteries), hypertension (high blood pressure) and diabetes, as well as the effects of the normal aging process.

Doctors use standard brain function tests to evaluate people who may have vascular neurocognitive disorder and determine the extent of the mental dysfunction present. As a rule, people with mild vascular neurocognitive disorder have impairments in their conscious brain functions that are prominent enough to produce testing results lower than those found in people unaffected by a vascular disorder, but not prominent enough to produce serious life disruption. In contrast, individuals with major vascular neurocognitive disorder produce test results that are considerably lower than those produced by individuals with the mild form of the disorder, and have impairments that at least partially eliminate their ability to live successfully without some form of outside care.

Treatment Considerations

Vascular dementia is incurable and inevitably shortens the lives of affected individuals. However, doctors can potentially slow the disorder’s progression—or even stop its effects from growing substantially worse over time – with the help of certain medications originally developed to treat Alzheimer’s disease. Examples of these medications include a group of drugs known collectively as cholinesterase inhibitors and a single drug called memantine.

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