Can you get vascular dementia from stroke?

These are great questions, let me try to tackle each one in turn:

First, "vascular dementia" is as much a clinical diagnosis as radiologic.  In the case of your grandfather, it sounds like he has had a slow, but steady, build-up of very tiny strokes over the years deep in his brain - the "significant small vessel disease" that is referred to in the image.  Over time, these tend to cause some mental slowing and memory loss, but there is not a perfect correlation between what is seen on the scan and the degree of symptoms.  In order to make a diagnosis of "dementia", your grandfather should be seen by either a Neurologist or a Neuropsychologist.  A Neuropsychologist would be particularly helpful here, because they can often put a great amount of detail into their analysis, even telling him whether his memory loss is from small strokes, or other diseases such as Alzheimers.  It sounds like he should be seen by a specialist.

That ties into your other question about when is memory loss considered "dementia".  This is somewhat hazy.  I typically use a tool called a mini-mental status examination to make this determination.  Most Neurologists use this as well.  A Neuropsychologist would use additional, more detailed tests.

In general, I start to use the phrase "dementia" when someone is losing several points on this mental status scale, and is having clear inabilities taking care of themself.  If you think he would be unfit or unsafe to take care of himself due to MENTAL reasons, he probably has dementia.  I would confirm this with a consultation from a Neurologist or Neuropsychologist.

Finally, it sounds like he is on a good medication regimen to prevent strokes.  He is taking a blood thinner, a blood pressure medicine, and a choleterol medicine.  He should carefully watch his blood pressure and cholesterol with his internist.  Smoking is absolutely horrible for the arteries and it is very much in his best interest to stop doing that immediately if he wants to avoid further strokes.

I hope that helps.  I think the bottom line here is that he needs to stop smoking and he should be seen by either a Neurologist or Neuropsychologist to determine the degree of his memory problems.  Good luck! 

I found this very helpful.

I do want to propose a very important question to everyone taking care of their loved ones.

Are you sure your family member is being taken care of by a licensed professional? I have recenly found that there are unlicensed or insured phlebotomist coming to draw patients routine Coumadin orders at Assisted Living facilites in my area. As a licensed professional I found this to be very disturbing. Please remember to become your own health care advocate. You want to make sure you are having all medical procedures being handled by licensed professionals.

My husband (82 years old) has been diagnosed with Alzheimer's Disease and Vascular Dementia (aka...hardening of the arteries in th brain). He has high blood pressure which is now under control with drugs. Both these problems cause memory loss, but he's also taking a memory drug called Galatamine which has much improved his awareness of where he is and what he's doing. This drug is not a cure, nor do we know how long it will be effective, but for now it's a great improvement over what he was like 8 months ago. Due to his AD, I believe he stopped taking his BH meds quite a while ago (unbeknown to me) and, therefore, it is thought that his high BP caused the Vascular Dementia. He can't be trusted to take his own meds which I now help him with.