Memory lapses or sudden confusion can feel scary. Could they point to vascular dementia or Alzheimer’s disease? These two conditions look alike but have different causes. Understanding the difference can help you get the best treatment and care plan.

See below for how these conditions are similar and how they differ.

Similarities Between Vascular Dementia and Alzheimer’s

Even though they have different causes, vascular dementia and Alzheimer’s share many features. Below are examples of similarities.

1. Both Are Caused by Damage to the Brain

Vascular dementia and Alzheimer’s are both caused by damage to the brain that disrupts how it works. In vascular dementia, reduced blood flow can cause brain damage that leads to memory issues. In Alzheimer’s, abnormal protein buildup damages the brain.

2. Both Get Worse Over Time

Both conditions are progressive, which means that your brain accumulates more damage over time. It’s also why many symptoms become noticeable as you age. For this reason, older age is the main risk factor for developing dementia, including Alzheimer’s and vascular dementia. However, it is important to understand that dementia is not a typical part of aging.

3. Both Cause Memory Loss and Other Symptoms of Dementia

People with vascular dementia or Alzheimer’s can experience similar symptoms, including:

• Memory loss — Difficulty recalling recent events, names, or tasks that were once familiar
• Hallucinations — Seeing, hearing, or sensing things that aren’t there, such as people or objects
• Delusions — Strongly held false beliefs, like thinking a caregiver is stealing from them or that someone is out to cause harm

Though both conditions lead to overall memory loss, early-stage Alzheimer’s typically features prominent memory loss, while early-stage vascular dementia more often affects executive functions like planning and processing speed.

People with vascular dementia or Alzheimer’s may show signs of dementia, including problems with:

• Remembering recent events
• Paying bills
• Keeping track of belongings
• Showing up for appointments

Symptoms of more advanced vascular dementia or Alzheimer’s include:

• Disorientation
• Personality changes and aggression
• Depression and mood swings
• Frequent falls and difficulty maintaining balance

Vascular dementia end-of-life symptoms are similar to those of Alzheimer’s. Late-stage symptoms include:

• Frequent infections
• Problems swallowing, eating, and drinking
• More hours spent sleeping
• Inability to get out of bed
• Decreased interest or ability to talk or make sense
• Incontinence (loss of bowel or bladder control)

4. Both Can Cause Hallucinations and Delusions

Some people with vascular dementia or Alzheimer’s may experience hallucinations, including visual hallucinations (seeing things that aren’t actually present). These hallucinations can be frightening or surprisingly ordinary. For example, you might see a familiar person who isn’t there or watch rain falling inside your home even though it’s dry.

While these symptoms can occur in people with advanced vascular dementia and Alzheimer’s, frequent or highly detailed visual hallucinations often prompt doctors to consider diagnoses like Lewy body dementia.

Someone with these disorders may also have delusions. Examples of delusions include:

• Believing a family member stole from you
• Thinking there’s an uninvited visitor in your house
• Believing that people you don’t know are posing as your friends

5. Both Require Diagnostic Tests

Diagnosis of vascular dementia or Alzheimer’s requires brain function and imaging tests.

A neurological exam measures your overall brain health. Your healthcare provider will check brain functions, including:

• Touch and vision
• Balance and coordination
• Walking
• Strength and muscle tone
• Reflexes

Brain imaging, including an MRI and a CT scan, can reveal if there are any physical changes in your brain. Brain shrinkage and blood vessel changes can indicate vascular dementia or Alzheimer’s. Positron emission tomography (PET) scans can also show changes in energy use, as well as neurofibrillary tangles and amyloid plaques (clumps of abnormal protein that build up in the brains of people with Alzheimer’s).

6. Both Often Require Daily Care

In the early stages of dementia, you may remain independent and go about your daily life, and you may need help only with complex tasks. As these disorders progress, you may need help with everyday tasks like bathing, cooking, and remembering to take your medicine.

It’s important that caregivers are supportive, finding balance between safety and independence, if possible. Family members often need to provide full-time care or hire a professional caregiver.

Differences Between Vascular Dementia and Alzheimer’s

Despite these similarities, important differences set vascular dementia and Alzheimer’s apart.

1. They Have Different Causes

Though vascular dementia and Alzheimer’s share symptoms, they have different causes and risk factors.

In vascular dementia, strokes or constricted blood vessels deprive the brain of oxygen. This can injure or kill cells. Risk factors for vascular dementia include health conditions like diabetes, history of heart attack or stroke, and atherosclerosis (plaque buildup in the arteries).

In Alzheimer’s, abnormal proteins called beta-amyloid and tau build up around and inside neurons (brain cells), blocking communication. This causes cells to die. Risk factors for Alzheimer’s include heart conditions, head injuries, a family history of the disease, and hearing loss, among others.

2. The Onset of Symptoms Is Different

Vascular dementia often begins with problems with executive function, like thinking and planning. Examples of these include poor judgment, difficulty following a series of steps, or sudden confusion. Someone in the early stages of vascular dementia may also struggle with remembering names or speaking properly.

Alzheimer’s usually starts with episodic memory loss — like forgetting things you recently learned. You might notice someone asks the same question over and over or needs reminder notes placed around the house so they don’t forget to do something.

3. They Progress Differently

Vascular dementia symptoms can come on suddenly, especially after a stroke. Symptoms usually get worse over time. However, there can be periods when symptoms temporarily get better. This is why people with vascular dementia often experience a stepwise pattern of progression — where sharp declines are followed by periods of stability.

Alzheimer’s usually comes on slowly and gradually gets worse over many years. Changes to the brain may occur before symptoms are noticeable.

4. People With Vascular Dementia Often Have a Shorter Life Expectancy

The life expectancy with vascular dementia is often shorter than that of Alzheimer’s. People with vascular dementia are also prone to strokes and heart attacks, which are more dangerous than the dementia itself. However, life expectancy can vary based on disease severity. Studies suggest that the average lifespan of someone who develops vascular dementia after having a stroke is three years.

People with Alzheimer’s typically live between three and 11 years after they’re first diagnosed. However, some people with slower disease progression can live for more than 20 years after diagnosis.

5. They Have Different Treatment Goals

There isn’t a cure for either condition, but different treatment strategies can slow disease progression.

Vascular dementia care aims to prevent future vascular events and increase blood flow to the brain. This can be done in multiple ways:

• Controlling high blood pressure
• Lowering cholesterol
• Managing diabetes
• Eating a healthy diet, engaging in physical activity, and quitting smoking
• Using blood thinners to prevent future strokes

Alzheimer’s care aims to improve symptoms and slow progression. Current treatments can’t stop brain cell death, but they may slow memory loss and help with thinking and reasoning. Medications are also available to help treat behavioral symptoms like agitation or hallucinations.

Join the Conversation

On myALZteam, people share their experiences with Alzheimer’s disease, get advice, and find support from others who understand.

If you or someone you’ve cared for has vascular dementia or Alzheimer’s, what early signs did you notice? Let others know in the comments below.