Blood vessels traveling from the heart branch into smaller vessels inside the brain, delivering oxygen and nutrients to the brain cells. These small vessels can become abnormal with age or with conditions like diabetes and high blood pressure. People with small vessel disease develop damage in areas of the brain rich in nerve cell axons -- cable-like structures responsible for communication between nerve cells -- and in certain clusters of nerve cells deep within the brain. The damage occurs because of blockage of blood flow or bleeding from small blood vessels in the brain. While some people with small vessel brain disease have no symptoms, others experience problems with thinking, mood and movement.
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Small vessel brain disease can lead to thinking problems. When severe, this is called vascular dementia. Although estimates vary, a June 2014 "BioMed Research International" article reported that blood vessel problems account for 20 percent of dementia worldwide -- second only to Alzheimer disease. Small vessel brain disease typically causes milder thinking problems than Alzheimer disease. It mainly affects the ability to remember information. It may also produce difficulties with staying focused, problem solving and planning tasks. Overall thinking and responding tend to be slower than usual.
Mood and Personality Changes
Mood and personality changes may signal small vessel brain disease. Depression can occur alone or along with thinking problems, and can worsen over time. In contrast to Alzheimer disease, people with vascular dementia may have mood swings or personality changes early in the course of the disease. They can be irritable or impatient or stop caring about themselves or their surroundings. People with small vessel disease may also develop uncontrollable and possibly inappropriate episodes of laughter or crying.
Movement Problems and Other Symptoms
Small vessel brain disease commonly causes strokes, in which an area of the brain is deprived of oxygen and dies. Some strokes cause no obvious symptoms despite the brain damage. Other strokes cause sudden weakness or numbness on one side of the body, problems with coordination, difficulty speaking or swallowing, or double vision. People with small vessel brain disease typically accumulate tiny strokes over time, leading to balance problems and slow walking. They have an increased risk of falling, which generally occurs at a earlier disease stage than with Alzheimer disease. Small vessel brain disease may also cause a sudden urge to urinate that may lead to urinary accidents.
When to Seek Medical Attention
Work with your doctor to control conditions that increase your risk for small vessel brain disease, such as diabetes and high blood pressure. Be sure to talk with your doctor if you notice changes in your memory, mood, balance or walking. Seek emergency medical attention if you experience sudden changes in your strength, sensation, speech, vision or coordination.
Reviewed by: Mary D. Daley, MD