They get through the hospitalization, and you're relieved. Of course you are.
But then they come home, and you realize that getting through it didn't mean everything went back to how it was before.
Maybe they're more forgetful. Maybe they're less steady on their feet. Maybe they suddenly need help with things they've managed on their own for years.
And just as you're figuring out what life looks like now, something else changes.
If you've experienced this with someone you love, you know how difficult it can be to make sense of what's happening. You may find yourself wondering whether these changes are temporary, whether things will improve, or whether this is simply what life looks like now.
Sometimes, changes like these are connected to vascular dementia.
But vascular dementia doesn't always begin with a dramatic medical event. Sometimes the changes happen so gradually that families struggle to recognize them.
Understanding what vascular dementia is, how it can progress, and what it looks like in everyday life can help families recognize changes, ask better questions, and find practical ways to support the person they care for.
What Is Vascular Dementia?
Vascular dementia is a type of dementia caused by damage to the brain associated with problems in its blood vessels.
Our brains depend on a steady supply of blood to deliver oxygen and nutrients. When that blood supply is interrupted or blood vessels become damaged, brain cells may be injured.
Depending on where that damage occurs, a person may experience changes in memory, attention, reasoning, problem-solving, movement, or their ability to complete everyday activities.
Vascular dementia can develop following a stroke, but it can also result from damage to the smaller blood vessels deep within the brain.
Conditions that increase the risk of vascular damage include:
- High blood pressure
- Diabetes
- High cholesterol
- Heart disease, including atrial fibrillation, an irregular heart rhythm that increases stroke risk
- Smoking
- Previous strokes
Having one or more of these conditions does not mean someone will develop vascular dementia. But understanding their medical history can help healthcare professionals evaluate changes in thinking and everyday function.
Vascular Cognitive Impairment vs. Vascular Dementia
You may also hear the term vascular cognitive impairment.
Vascular cognitive impairment describes a range of changes in thinking associated with vascular disease in the brain. These changes can be mild or severe.
When cognitive changes significantly interfere with a person's ability to function independently, they may meet the criteria for vascular dementia.
The distinction matters because not everyone with vascular-related cognitive changes has dementia.
And because the location and extent of vascular damage vary, no two people will experience vascular dementia in exactly the same way.
My Grandmother's Story: When Every Hospitalization Changed Something
My grandmother experienced several hospitalizations over the course of a few years.
There were episodes of chest pain, small heart attacks, events we knew as mini-strokes, and problems with stenosis, or narrowing of blood vessels.
Each time something happened, we were relieved when she made it through.
But afterward, she never quite returned to where she'd been before.
She became more forgetful. Her facial expressions became less animated. Her walking grew increasingly unsteady.
The changes kept adding up.
At the time, we were simply trying to understand what was happening and adjust to what she needed.
My grandmother never received a formal dementia diagnosis. None of my grandparents did.
But after 25 years as a physical therapist, including 15 years specializing in dementia care, I look back on those years with a different understanding.
I suspect vascular changes may have contributed to what we were seeing.
I can't tell you exactly what was happening in her brain or whether more than one condition was involved.
But I remember the pattern.
Something happened medically. She got through it. And afterward, things were different.
That experience helps explain one of the ways vascular dementia can progress.
How Does Vascular Dementia Progress?
One of the most common questions families ask is, "How quickly does vascular dementia progress?"
The answer is that it depends.
Unlike the gradual decline many people associate with Alzheimer's disease, vascular dementia may follow a stepwise pattern, particularly when someone experiences repeated strokes.
But that isn't the only way it progresses.
Stepwise Progression: When Abilities Change After a Stroke
Imagine someone who has been managing their daily routines relatively independently.
Then they experience a stroke or another significant vascular event.
Afterward, they need more help.
Maybe they have difficulty walking. Maybe they can't organize their morning routine. Maybe their thinking seems slower.
Over the following weeks or months, they may regain some abilities through recovery and rehabilitation.
But they may not return completely to their previous level of function.
Things settle for a while.
Then another event occurs, followed by another noticeable change.
This is often called stepwise progression because abilities seem to decline in noticeable steps rather than along one continuous slope.
For families, it can feel like repeatedly adjusting to a new normal.
You learn how to help with the changes from the first event, only to find yourself facing another set of challenges.
Can Vascular Dementia Progress Gradually?
Yes.
Vascular dementia doesn't always involve obvious strokes or sudden changes.
Disease affecting the brain's small blood vessels can lead to changes that develop gradually over months or years.
A family may notice that someone is taking longer to complete familiar tasks, struggling to make decisions, or becoming less organized.
There may be no hospitalization or single event they can identify.
This is one reason it's so important to share changes in everyday abilities with the healthcare team, even when memory loss isn't the primary concern.
Does Everyone With Vascular Dementia Continue to Decline?
Vascular dementia often progresses over time, but the rate and pattern vary considerably.
Some people experience periods of relative stability. Others may have noticeable changes following additional vascular events.
Recovery following a stroke can also complicate the picture because some abilities may improve while other difficulties remain.
Treatment of underlying vascular conditions may help reduce the risk of additional brain injury.
And a new decline doesn't automatically mean the dementia has progressed. Other medical conditions, medications, depression, or delirium may contribute to changes in function.
That's why new or worsening symptoms deserve medical evaluation rather than being dismissed as an expected part of dementia.
What Are the Early Signs and Symptoms of Vascular Dementia?
When most people hear the word dementia, they immediately think about memory loss.
But memory may not be the most noticeable early change in vascular dementia.
Depending on the location and extent of vascular injury, difficulties with attention, planning, organization, processing speed, and movement may become apparent first.
1. Slower Thinking and Difficulty Processing Information
A person may understand what you're saying but need more time to process it and respond.
They may struggle when given several instructions at once or become overwhelmed when too much is happening around them.
This can be especially noticeable during busy morning routines or unfamiliar situations.
2. Trouble Planning, Organizing, or Starting Tasks
These abilities are part of what we call executive function.
Executive function helps us plan, organize, make decisions, begin activities, and move through the steps needed to complete a task.
When these abilities are affected, a person may know what needs to happen but struggle to make it happen.
For example, imagine you're getting ready for a doctor's appointment.
You say, "We need to leave soon. Get dressed, brush your teeth, and grab your shoes."
They say, "Okay."
A few minutes later, you return to find they haven't started.
It's easy to become frustrated.
After all, they heard you. They understood what you said. They even agreed.
But understanding instructions and carrying them out are two different things.
The person needs to remember the instructions, decide where to begin, organize the steps, and move through them.
If one part of that process is difficult, the whole activity can come to a stop.
Instead of repeating the entire instruction, try bringing them their shirt and saying, "Here's your shirt. Let's get this on."
Then give them time.
Maybe that's enough to get things moving. Maybe another cue is needed.
The goal isn't to do everything for them. It's to find the amount of support that allows them to participate.
And yes, I know this sounds much easier when we're talking about it than when you're already running late.
Understanding what's happening doesn't give us endless patience.
But it can help us recognize that the person may need support rather than another reminder.
3. Changes in Walking, Balance, and Movement
Vascular damage can affect physical abilities as well as thinking.
Some people experience changes in walking speed, balance, coordination, or mobility.
They may become less steady when standing, have difficulty navigating unfamiliar environments, or need more assistance moving around safely.
These changes can also make everyday activities more challenging.
Getting dressed, preparing meals, or using the bathroom may require both physical and cognitive effort.
As a physical therapist, I think this connection is particularly important.
We can't always separate what's happening with someone's thinking from what's happening with their body.
Both influence their ability to function.
4. Changes in Mood, Motivation, and Facial Expression
One of the changes I remember most clearly with my grandmother was how much less expression we saw in her face.
Clinically, we might describe that as flat affect, meaning reduced outward emotional expression.
But when it's someone you love, you're not thinking about clinical terminology.
You're noticing that the familiar smile or reaction you expect isn't quite the same.
Some people with vascular cognitive changes also experience apathy, which can involve reduced motivation or initiative.
Depression and other mood changes can occur as well.
But here's something I want families to remember:
A reduced emotional response doesn't necessarily mean the person isn't feeling anything.
A quieter face doesn't tell us everything about someone's experience.
They may still enjoy familiar music, appreciate your company, or find comfort in sitting beside you.
Instead of focusing only on the response you expected, pay attention to smaller signs of connection.
Do they turn toward you? Relax when you sit nearby? Respond to a familiar song?
Those moments matter.
Changes in mood, motivation, and expression should also be discussed with the healthcare team, especially because some contributing conditions may be treatable.
How Is Vascular Dementia Different From Alzheimer's Disease?
Although vascular dementia and Alzheimer's disease can share many symptoms, they involve different underlying disease processes.
Alzheimer's disease is associated with changes in the brain involving abnormal accumulations of proteins, including amyloid and tau.
Vascular dementia is associated with damage caused by problems affecting blood vessels and circulation within the brain.
Memory difficulties are a common early feature of Alzheimer's disease, but they aren't always the first symptom.
With vascular dementia, changes in attention, processing speed, planning, and organization may be more noticeable early on.
However, both conditions can affect many of the same abilities, and symptoms alone cannot reliably distinguish them.
The pattern of progression may also differ.
Alzheimer's disease commonly develops gradually, while vascular dementia may develop suddenly, progress in steps, or change more slowly over time.
But these are general patterns, not rules.
A person can also have both Alzheimer's-related changes and vascular brain damage. This is one example of mixed dementia.
And here's something I think is especially important for families to understand.
Why Someone Can Remember a Conversation but Struggle With Everyday Tasks
Maybe your family member remembers a story from years ago.
They recognize visitors and carry on a pleasant conversation.
But they can't organize their medications, prepare lunch, or get dressed without help.
Then someone visits and says, "They seemed fine to me."
If you've heard that before, you know how frustrating it can feel.
A conversation on the couch asks different things of the brain than managing a complicated daily activity.
Someone may have relatively preserved conversational abilities while experiencing significant difficulty with planning, sequencing, judgment, or physical function.
That doesn't mean the challenges you're seeing at home aren't real.
It means different activities place different demands on the brain.
When talking with family members or healthcare professionals, it may help to say:
"They can still enjoy a conversation, but they're needing more help carrying out everyday tasks."
That paints a clearer picture than simply saying someone seems more forgetful.
How Can You Support Someone Living With Vascular Dementia?
Understanding the diagnosis matters, but families also need to know what to do when everyday life becomes harder.
This is where I turn to my Wheel of Function Framework™.
The framework encourages us to look beyond the behavior or task that's becoming difficult and consider the different factors influencing the person's ability to participate.
The five areas are:
- Cognitive: Attention, memory, language, sequencing, and problem-solving
- Physical: Strength, balance, pain, fatigue, and mobility
- Emotional: Feelings, motivation, comfort, and sense of security
- Sensory: Vision, hearing, and other sensory experiences
- Environmental: Noise, lighting, distractions, setup, and the people around them
These areas don't operate independently.
They're all part of the person's experience.
A Practical Example: Getting Dressed
Imagine someone who has difficulty following the steps of getting dressed and also feels unsteady when standing.
If we continue giving instructions from across the room while they're trying to balance, we may be asking more than they can manage.
Instead, consider what could make the activity easier.
Could they sit in a sturdy chair?
Could you bring their clothes within reach?
Would it help to offer one instruction at a time?
Is the television creating unnecessary distraction?
Are you rushing because you're worried about being late?
Each of these questions looks at a different part of the Wheel of Function Framework™. Sometimes a small adjustment to the task or environment makes participation easier. And sometimes it helps us recognize that additional support or a professional assessment is needed.
Support Independence Without Expecting Someone to Do Everything Alone
When abilities change, families sometimes feel caught between two choices.
Do we let the person continue trying, even when things are difficult?
Or do we step in and take over?
There is often a middle ground.
Maybe the person can no longer prepare an entire meal independently, but they can help wash vegetables or stir ingredients.
Maybe getting dressed works better when clothes are laid out in order.
Maybe they need someone nearby for safety but can still complete much of the activity themselves.
The goal is to understand what remains possible and provide the support needed to help the person participate.
Independence doesn't have to mean doing everything without assistance.
Can Rehabilitation Help Someone With Vascular Dementia?
Depending on the person's needs, rehabilitation services may help support mobility, communication, daily activities, and participation.
Following a stroke or noticeable change in function, it may be appropriate to ask the healthcare team about:
Physical therapy: To address walking, balance, strength, transfers, and safe mobility.
Occupational therapy: To support everyday activities such as dressing, bathing, meal preparation, and adapting the home environment.
Speech-language pathology: To address communication, swallowing, and cognitive-communication challenges.
Not everyone will need the same services, and recovery will look different for each person.
Rehabilitation cannot guarantee that lost abilities will return. However, individualized therapy may help someone improve certain skills, learn compensatory strategies, and participate more safely in everyday activities.
A new need for assistance doesn't automatically mean we should stop offering opportunities to participate.
It means we need to understand what has changed and what support may help.
What Should Families Tell the Doctor About Changes in Thinking or Function?
You don't need to know whether someone has vascular dementia before bringing your concerns to a healthcare professional.
In fact, you shouldn't have to figure that out on your own.
What you can do is describe the changes you've noticed.
Instead of saying only, "She's getting worse," try giving specific examples.
For instance:
- "Since the hospitalization, she needs help with things she used to manage."
- "He remembers what we're doing but seems unsure how to get started."
- "Her walking and thinking have both changed."
- "He can have a conversation, but he can't organize his medications anymore."
- "She seems less interested in activities she used to enjoy."
It also helps to document when changes began.
Did they happen suddenly?
Were they noticeable after a hospitalization?
Have they developed gradually over several months?
Has the person regained any abilities?
These details can help the healthcare team understand the bigger picture.
And remember, a decline following a hospitalization doesn't automatically mean permanent dementia progression.
Other medical conditions or complications may be contributing, and some may be treatable.
Free Resource: Navigating the Doctor's Office
If you're having trouble organizing what you've noticed, my free Doctor Visit Guide can help. It's designed to help you document changes, organize your concerns, and prepare questions before the appointment.
You don't need a diagnosis to use it.
Can Vascular Dementia Be Treated or Its Progression Slowed?
There is currently no cure for vascular dementia, and treatment cannot reverse brain damage that has already occurred.
However, managing conditions such as high blood pressure, diabetes, high cholesterol, and atrial fibrillation may reduce the risk of additional vascular injury.
Treatment may help slow further decline, but it cannot guarantee that dementia will stop progressing.
Rehabilitation and individualized support can also help people make the most of their remaining abilities.
Depending on the person's medical history, the healthcare team may focus on managing:
- Blood pressure
- Diabetes
- Cholesterol
- Heart disease and certain heart rhythm problems
- Other factors that increase stroke risk
Treatment decisions need to be individualized. And the plan needs to be realistic for the person and the family supporting them.
If medication schedules are confusing, appointments are difficult to manage, or you're struggling to carry out recommendations at home, tell the healthcare team.
That information matters.
I also want to be clear about something. Learning that certain medical conditions increase the risk of vascular dementia isn't an invitation to blame yourself or your family. Knowing the risk factors doesn't mean you could have controlled everything that happened. Use that information to ask what may help moving forward.
When Is a Sudden Change a Medical Emergency?
This is one of the most important things I want families to understand.
Even when someone has vascular dementia and has experienced stepwise changes in the past, a sudden decline should never automatically be dismissed as dementia progression.
Sudden changes can signal a stroke or another serious medical problem.
Remember the stroke warning signs using B.E. F.A.S.T.:
- B, Balance: Sudden loss of balance or coordination
- E, Eyes: Sudden vision changes
- F, Face: Facial drooping
- A, Arms: Weakness or numbness, especially on one side
- S, Speech: Sudden difficulty speaking or understanding
- T, Time: Call 911 immediately
Other warning signs include sudden confusion or a severe headache without an obvious cause. If you suspect a stroke, call 911 rather than driving the person to the hospital yourself. Even if symptoms improve or disappear, emergency evaluation is necessary.
What Is a TIA or Mini-Stroke?
A transient ischemic attack (TIA), sometimes called a mini-stroke, occurs when blood flow to part of the brain is temporarily interrupted, causing stroke-like symptoms that resolve without evidence of an acute brain infarction.
A TIA is not harmless simply because the symptoms disappear.
It can be a warning sign of a future stroke and requires emergency medical evaluation.
Not every sudden change is caused by a stroke. Other acute medical problems can affect thinking and function.
The important thing is not to assume that a sudden change is simply part of dementia.
Caring for Someone With Vascular Dementia: Your Needs Matter, Too
When I think back on my grandmother's experience, I wish we'd had more help connecting what was happening medically with what we were seeing at home.
We knew she was changing.
We were living that part.
What we needed was help understanding those changes, figuring out how to support her, and recognizing what our family needed along the way.
Maybe you're in that place right now.
Maybe things have settled after a difficult hospitalization, but everyday life looks different.
You're grateful the person is home.
And you're also realizing how much more help they need.
Both of those feelings can exist together.
You can be relieved, grateful, tired, and grieving changes, all in the same day.
And while you're trying to understand what the person needs, I want you to pay attention to what those changes are asking of you.
If getting ready now takes an extra hour, that matters.
If you can't safely leave the person alone while you finish something else, that matters.
If you're struggling to manage appointments, medications, or new care responsibilities, that matters, too.
Your need for support belongs in the care conversation.
One Thing to Try This Week
Choose one everyday activity that's become more difficult for the person you care for.
Instead of focusing only on whether they can complete it, pay attention to where the difficulty begins.
Do they struggle to get started?
Do they lose track of the steps?
Do they need more time?
Would fewer instructions help?
Could a change in the environment make the activity easier or safer?
Try one small adjustment and see what happens.
You don't have to solve everything at once.
And remember to notice what that activity requires of you, too.
Sometimes the most useful information comes from paying attention to the ordinary moments that make up your day.
Listen to Navigating Dementia: Episode 14
In this episode of Navigating Dementia, I share more about my grandmother's experience, the different ways vascular dementia can affect everyday abilities, and how families can recognize when someone needs a different kind of support.
Listen to Episode 14: Vascular Dementiaor Watch on YouTube
Next week, we'll explore mixed dementia, including what happens when more than one disease process contributes to changes in thinking and function.
Because sometimes the diagnosis isn't straightforward.
But even when the medical picture is complicated, we can keep learning about the person, recognizing what they need, and finding ways to support them.
Frequently Asked Questions About Vascular Dementia
What are the first signs of vascular dementia?
Early signs may include slower thinking, difficulty concentrating, trouble planning or organizing tasks, reduced motivation, memory changes, or changes in walking and balance. Symptoms depend on which areas of the brain are affected.
How quickly does vascular dementia progress?
There is no single timeline. Some people experience sudden declines following strokes, with periods of stability or partial recovery. Others experience gradual changes associated with small vessel disease. Progression depends on several factors, including the location and extent of brain injury and the person's overall health.
Can someone have vascular dementia without having a stroke?
Yes. Vascular dementia can develop from disease affecting the brain's small blood vessels, even without a recognized stroke.
Is vascular dementia the same as Alzheimer's disease?
No. They have different underlying causes, although symptoms can overlap. Vascular dementia is associated with damage to the brain's blood vessels, while Alzheimer's disease involves neurodegenerative changes. A person can also have both conditions.
Can vascular dementia affect walking and balance?
Yes. Depending on the areas of the brain affected, vascular dementia may involve changes in walking, balance, coordination, and mobility.
Can vascular dementia be reversed?
There is currently no cure for vascular dementia, and established brain injury generally cannot be reversed. However, some abilities may improve after a stroke through recovery and rehabilitation. Managing vascular risk factors may help reduce further injury. New declines should always be evaluated because other treatable conditions may also be involved.
Notes
- American Stroke Association. (n.d.). Vascular dementia. American Heart Association. https://www.stroke.org/en/about-stroke/effects-of-stroke/cognitive-effects/vascular-dementia
- Centers for Disease Control and Prevention. (2026, May 19). Signs and symptoms of stroke. https://www.cdc.gov/stroke/signs-symptoms/
- National Heart, Lung, and Blood Institute. (n.d.). Vascular dementia. National Institutes of Health. https://www.nhlbi.nih.gov/health/vascular-dementia
- National Institute on Aging. (n.d.). Vascular dementia: Causes, symptoms, and treatments. National Institutes of Health. https://www.nia.nih.gov/health/vascular-dementia/vascular-dementia-causes-symptoms-and-treatments
- National Health Service. (n.d.). Vascular dementia. https://www.nhs.uk/conditions/vascular-dementia/
- Sorond, F. A., Gorelick, P. B., Bae, H.-J., Carmichael, S. T., Greenberg, S. M., Hinman, J. D., Iadecola, C., Iruela-Arispe, M. L., Leonard, A., Valdes, E., & Waddy, S. P. (2026). Vascular contributions to cognitive impairment and brain health: Clinical update and mechanistic considerations: A scientific statement from the American Heart Association. Stroke, 57(7), e254–e270. https://doi.org/10.1161/STR.000000000000052
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ABOUT THE AUTHOR
Carlyn Lenfestey, PT, MPT, CDP, CADDCT, is a licensed physical therapist with 25 years of clinical experience and 15 years specializing in dementia care. She is the founder of A Better Way: Dementia Care Solutions, LLC, the creator of the Wheel of Function Framework™, and the host of the podcast, Navigating Dementia.
DISCLAIMER
The information provided in this blog is for educational purposes only and should not be considered medical advice. Always consult with a doctor or a licensed physical therapist before starting any new exercise routine, using assistive devices, or following the recommendations mentioned. Every individual's needs are different, and professional guidance is essential to ensure safety and appropriateness of care.
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