Vascular dementia (VaD) is caused by reduced blood flow to the brain and is the second most common dementia after Alzheimer’s disease. They may have memory issues (vascular cognitive impairment or VCI), an unsteady gait, mood swings, or can’t plan ahead. Our guide covers each vascular dementia stage and how you can get paid to care for a family member with VaD.
Vascular dementia is when poor blood flow harms brain cells. Like a stroke, it causes cognitive problems because of minor strokes or blood vessel problems. Your doctor may talk about "vascular cognitive impairment" (VCI). VCI refers to the range of mental challenges, from mild to severe. Vascular changes happen with other dementia types like Alzheimer's disease.
Vascular dementia moves through the stages in clear steps. Unlike Alzheimer’s disease, which progresses steadily, with VaD a person may have sudden decline, like after a stroke. Moving through the stages can be quick. The rate of decline depends on the type of vascular dementia, age, lifestyle, diabetes or cardiovascular disease, and other factors.
The doctor can prepare a better treatment plan if they know which type of vascular dementia your family member has. There are several types. And each type needs its own support for them and you.
Vascular Cognitive Impairment (VCI) is a milder form of mental decline. Caregivers might notice small memory problems that don’t affect daily tasks. VCI comes before more severe forms of vascular dementia. Early detection and management of risk factors slow disease progression.
Multi-infarct dementia is caused by multiple small strokes, or infarcts. Infarcts increase longterm damage to different areas of the brain. Each stroke may have a small impact, but combined, they lead to severe cognitive decline. Because different parts of the brain are affected, there’s a mix of mental and physical symptoms. You may notice confusion, imbalance, or lack of coordination.
A large stroke can cause post-stroke vascular dementia. The stroke damages brain areas for memory and thinking. Symptoms don’t always appear right away. They can show up immediately or over a long time.
Families might not connect memory changes to the stroke. Time has passed. You might not understand why your loved one is suddenly forgetful or extremely agitated. This is hard for both the family caregiver and their loved one.
How much post-stroke vascular dementia affects your family member depends on the location and amount of the brain damage. Common symptoms include:
Subcortical vascular dementia affects deeper parts of the brain, like the white matter and basal ganglia. This type of dementia causes problems with body movement, mental functions, and mood.
Your loved one may have slower thinking, difficulties with walking and balance. You might notice emotional changes like apathy or depression. Subcortical vascular dementia is also linked to small vessel disease, which affects the smaller blood vessels in the brain.
Vascular dementia is caused when reduced blood flow damages brain cells. Several risk factors increase the likelihood of developing vascular dementia. Some are beyond your loved one's control.
Heart disease and vascular dementia share common risk factors like high blood pressure and diabetes. These conditions damage blood vessels, including those in the brain, reducing oxygen and nutrient supply to cells. This damage can lead to memory problems, slow thinking, and mood swings.
Family caregivers may notice these changes in their loved ones. If you have concerns about vascular dementia, talk to a doctor. Early diagnosis and managing risk factors significantly improves the overall prognosis and quality of life for loved ones with vascular dementia.
Vascular dementia can be challenging to diagnose because its symptoms vary a lot and overlap with other types of dementia. Common symptoms include difficulties with planning and organizing, memory problems, trouble swallowing and changes in behavior and mood.
If your loved one has vascular dementia, they may have trouble with planning, decision-making, and following multi-step instructions. Memory problems are common, like forgetting recent events or important appointments.
You might see changes in mood and behavior, including increased irritability, depression, or sudden anger. They may have nighttime confusion and disorientation, similar to Alzheimer’s sundowners syndrome.
They may seem delirious. There is a difference between delirium vs. dementia. Delirium has a sudden onset, not a gradual decline.
After a stroke, your loved one might show cognitive issues or mood swings. Over time, these symptoms may lessen or disappear entirely. However, the symptoms can come back.
Sometimes symptoms don’t show up right away, even weeks or months after a stroke. Call their doctor for any noticeable behavior changes or memory problems, especially if they have had a stroke in the past.
Shuffling, unsteady walking, and imbalance are early symptoms of vascular dementia. Physical disability may help your loved one qualify for Medicaid self-directed programs that pay family caregivers. Watch for falls and difficulty climbing stairs safely.
Communication issues are very common in vascular dementia. Your family member may have difficulty finding the right words, speaking in complete sentences, or understanding written text. Repeating the same questions or statements and forgetting familiar names can also be vascular dementia symptoms.
Diagnosing vascular dementia needs medical history evaluations, physical exams, and cognitive tests. Doctors may use brain imaging techniques like MRI or CT scans to identify blood flow changes or brain tissue damage. Cognitive tests evaluate memory, problem-solving abilities, and other mental processes. Early and accurate diagnosis can improve the quality of life for those affected.
Family caregivers often can’t tell the difference between vascular dementia vs. Alzheimer's. These conditions share many of the same symptoms like memory loss. You may need a specialist neurologist or geriatrician to get an early, accurate diagnosis of vascular dementia.
Unfortunately, you may be dismissed if you mention cognitive problems after a loved one’s stroke. The doctor may misdiagnose your family member with Alzheimer’s disease. It can be frustrating to deal with a wrong diagnosis or have to go to countless medical appointments without answers. Write down your observations and share with the doctor.
It’s so important to catch vascular dementia early. Early diagnosis allows treatment to manage symptoms and improve your loved one's quality of life. When family caregivers notice dementia symptoms, they should call the primary care doctor for a proper evaluation. Don’t wait.
Vascular dementia may not have a cure, but treatments can manage symptoms for a much better quality of life.t have a cure, but treatments will manage symptoms and better overall quality of life.
The medications listed below are commonly used to manage symptoms and underlying conditions of vascular dementia. Medication decisions should always be made with a doctor. Do not start, stop, or change any medication without medical guidance.
While there are no medications specifically approved to target VaD memory loss, several drugs help manage symptoms. They may improve your loved one's quality of life.
Heart disease, high cholesterol and diabetes are risk factors for vascular dementia. You want your loved one to control their blood pressure, blood sugar, and cholesterol to prevent more brain damage.
Antiplatelet medications and anticoagulants can reduce the risk of further strokes. The doctor will prescribe medicine based on your loved one’s medical history. Always speak with a physician before giving any medicine to your family member.
A healthy diet low in saturated fats and salt, regular exercise, and quitting smoking can all make a difference. Staying active goes beyond physical health - it can also improve mood, thinking, and daily activities.
As vascular dementia progresses, your loved one may need more support with personal care, managing finances, or medication reminders.
Speech therapy helps with communication difficulties, while occupational therapy teaches new ways to manage daily tasks.
Vascular dementia has several stages. Every person’s journey is a little different. What you experience as a family caregiver may be different than another caregiver.
Your loved one might have a change in gait or memory problems, or maybe they have trouble swallowing (dysphagia). You might only need to help a little, or your family member may need round-the-clock care. Caregivers should plan for each stage, especially the later stages of vascular dementia.
Caregivers may run across the FAST scale (Functional Assessment Staging Tool), which was created to measure Alzheimer’s decline. However, vascular dementia often jumps from one stage to another, unlike Alzheimer’s, which has a steady decline.
Family caregivers usually are the first to notice a difference in a loved one’s memory, mood, or physical ability. Maybe you have to help them with planning doctor appointments or handle multi-step tasks like cooking. They might misplace their keys or not know why they walked into a room. You might see minor mood swings and increased forgetfulness.
At this stage, your loved one is independent. Their vascular dementia hasn’t affected most daily tasks. They safely care for themselves. This stage can last for several years before diagnosis.
If you notice differences in memory or mood, speak with their doctor. Unfortunately, not all doctors will listen to the family caregiver. Write down changes in behavior, forgetfulness, and other symptoms. Then bring those notes to the appointment to help the doctor make a diagnosis and decide on treatment.
Now you care for your loved one nearly full-time. As vascular dementia progresses, forgetfulness and anxiety increase. They might forget what they had for lunch or someone’s name.
Your role shifts from an occasional helper to a family caregiver responsible for handling finances, driving to medical appointments, managing treatment, and more.
Mobility problems increase. You have to worry about falls and make their home safe and hazard-free. Your loved one might accidentally start a kitchen fire while cooking dinner because they forgot to check on the chicken they put in five hours ago. They may need constant supervision.
This heavy caregiver responsibility brings financial stress. You may have to cut your work hours, hire a home health aide, or quit your job entirely. The pressure on caregivers isn’t talked about enough. Many times, you are expected to step in because they are family. Yet, economic stress can lead to burnout and money troubles.
At this stage, living independently is not possible. Your loved one has serious physical challenges. Memory decreases significantly. They might not even respond to you.
Incontinence and poor motor skills severely limit your loved one. They may become anxious or aggressive. They have swallowing difficulties and can’t walk. Mood swings tax caregivers. Aggression is very common in vascular dementia. Another stroke can accelerate dementia decline.
Eventually, your loved one won’t be able to respond at all. They might not remember family members. They are bedbound. Caregivers have to bathe, feed and dress them. Most people with vascular dementia pass away before this point. You might look at assisted living and memory care options.
Family caregivers should prepare for later-stage vascular dementia well before their loved one’s health worsens. You will need to plan long-term care, hospice care, and make end-of-life decisions. You need support.
It’s heartbreaking to see your loved one struggle with eating breakfast, sitting up, or just speaking. Vascular dementia end-of-life symptoms might look like your loved one sleeping all day, unresponsive. They may not recognize anyone. Care is around-the-clock.
As a family caregiver, you find yourself managing all their medical care. You try to keep them comfortable. They need someone to help them eat, bathe, and dress. It’s not unusual for family caregivers to burn out by this point.
Most families consider hospice care when end-of-life symptoms become too severe for the family to handle.
You may not feel comfortable discussing hospice care before your loved one has later-stage vascular dementia. Prepare ahead with their medical team and family to coordinate the best long-term care. It’s possible to pay for hospice care through Medicaid.
You need to be ready for the high financial costs of hospice care. Partnering with a care team can help you through this time. You don’t need to do this alone.
When your loved one’s end-of-life symptoms become severe, you have to decide on the best care for them. You might move your loved one to an assisted living community or a memory care facility. Hospice care provides a safe, comfortable environment. You might hire an in-home health aide or take care of them full-time.
All of these choices cost money. Most families haven’t budgeted for later stage vascular dementia. Monthly memory care facility costs differ from patient to patient. Expenses depend on location, patient needs, and other factors. Below are the median costs for monthly memory care at a facility.
Monthly median costs by state (2026):
Rates differ from state to state. Connecticut, for example, is almost twice as expensive as Georgia. It’s the highest cost in this select group.
Are you feeling overwhelmed? Finances are upside-down. You are tired, and your daily life has become nothing but caregiving.
As you research how to pay for long-term care, you might run across several financial programs. The Medicaid program can pay family caregivers for work they are already doing.
Getting paid for caregiving eases your financial burden. And since money problems are one of the top sources of stress for caregivers, you can take care of your mental and physical well-being when you get paid to care for a family member.
Unlike Alzheimer’s disease, vascular dementia jumps stages. It escalates quickly. Family caregivers may not be ready for vascular dementia end-of-life symptoms. You might go from working full-time to caregiving full-time overnight. You might have to cut work hours or quit your job.
How can you handle the financial costs of full-time caregiving? Medicaid can offset the costs of your reduced income due to caregiving.
Vascular dementia's physical symptoms, like mobility loss and incontinence, may qualify your loved one for Medicaid self-directed care programs in some states.
Medicaid self-directed programs allow eligible family members to get paid to care for a family member. Family members can include adult children or spouses. Review specific state rules to see if your loved one meets requirements; a vascular dementia diagnosis alone is not enough to qualify.
In self-directed Medicaid programs, the beneficiary chooses who they hire to care for them. They also set the caregiver pay rate.
What steps do you need to get paid for caregiving? While most services require a phone call and a 24-48-hour wait, Givers lets you find out immediately online, at no cost, if you qualify for caregiver pay. You can start the application process right away.
