{"id":12304,"date":"2026-03-04T11:00:01","date_gmt":"2026-03-04T11:00:01","guid":{"rendered":"https:\/\/magazines.uthscsa.edu\/mission\/?p=12304"},"modified":"2026-03-11T11:25:14","modified_gmt":"2026-03-11T11:25:14","slug":"dementia-isnt-destiny","status":"publish","type":"post","link":"https:\/\/magazines.uthscsa.edu\/mission\/dementia-isnt-destiny\/","title":{"rendered":"Dementia isn\u2019t destiny: A healthy heart is also good for the brain"},"content":{"rendered":"

Why vascular health may hold the key to cognitive function<\/span><\/em><\/h4>\n

 <\/p>\n

When most people think about vascular health, the heart typically comes to mind. Controlling blood pressure, managing cholesterol and staying active are often seen as ways to stave off heart disease. But maintaining a healthy vascular system is also critical for another essential organ: the brain.<\/p>\n

\u201cVascular contributions to cognitive impairment and dementia are very common,\u201d said Sudha Seshadri, MD, DM<\/a>, founding director of the Glenn Biggs Institute for Alzheimer\u2019s and Neurodegenerative Diseases<\/a> at UT Health San Antonio. \u201cOver a lifetime, nine out of 10 people in the U.S. will develop hypertension, so the risk of developing damage to the brain because of injury to the blood supply is extremely high.\u201d<\/p>\n

Vascular cognitive impairment and dementia, or VCID, is the second-most-common cause of dementia after Alzheimer\u2019s disease, often overlapping with it. According to the Centers for Disease Control and Prevention, it accounts for 5% to 10% of dementia cases on its own, but experts say that in mixed cases, vascular injury plays a role far more often.<\/p>\n

\u201cThe most common form of dementia isn\u2019t just one type \u2014 it\u2019s a mixture. It\u2019s what we call multiple etiology dementia, and vascular injury is the most frequent contributor to that mix,\u201d Seshadri said.<\/p>\n

\u201cEven when someone has Alzheimer\u2019s disease, we still need to ask: Are there vascular contributions that we can manage? Because treating those may slow progression more than any single drug we have right now.\u201d<\/p>\n

Signs of vascular injury to the brain <\/strong><\/span><\/h4>\n
\"\"
\u201cEven when someone has Alzheimer\u2019s disease, we still need to ask: Are there vascular contributions that we can manage? Because treating those may slow progression more than any single drug we have right now.\u201d \u2014 SUDHA SESHADRI, MD, DM<\/figcaption><\/figure>\n

Symptoms of VCID differ from those of other dementias, like Alzheimer\u2019s disease, and they present in a number of ways depending on what part of the brain is affected by the vascular injury.<\/p>\n

\u201cSomeone who suffers a big stroke could have critical regions like the thalamus knocked out. That area controls motivation and planning,\u201d Seshadri explained. \u201cOr, someone could have a series of smaller strokes that collectively impair function. You might see signs like slowed thinking, trouble with language and executive function and physical symptoms like difficulty walking \u2014 features that differ from the typical early symptoms of memory impairment seen in Alzheimer\u2019s disease.\u201d<\/p>\n

Other signs include emotional changes, such as inappropriate laughing or crying, known as pseudobulbar affect, and a higher prevalence of depression.<\/p>\n

\u201cThese clinical features can give doctors clues that vascular issues are involved,\u201d Seshadri said.<\/p>\n

Advancing care through AI <\/strong><\/span><\/h4>\n

In addition to how clinical symptoms present, advanced imaging can help clinicians diagnose and detect brain changes earlier and more precisely.<\/p>\n

An artificial intelligence tool developed at UT Health San Antonio can accurately count brain lesions on MRI scans within seconds, helping neuroradiologists evaluate patients\u2019 brain diseases at earlier stages. With this technology, doctors are able to not only see the signs of vascular injury like microbleeds or enlarged perivascular spaces with the imaging, but also quantify the imaging.<\/p>\n

\u201cWe can quantify changes to the brain, the number, the intensity and the location of the changes in the brain,\u201d Seshadri said. \u201cAll this information is crucial to helping our understanding of what\u2019s causing them, which can lead to developing better treatments.\u201d<\/p>\n

Small vessels, large damage <\/strong><\/span><\/h4>\n

While a large stroke can cause devastating damage, the more common contributor to vascular injury is not from the large arteries, but from cerebral small vessel disease, which affects the tiny vessels deep in the brain, Seshadri explained.<\/p>\n

When these small vessels become obstructed, they can impair oxygen flow, causing numerous small, silent strokes. Obstructed small vessels can also burst, causing small hemorrhages, or microbleeds.<\/p>\n

Common causes for cerebral small vessel disease are hardened arteries, or arteriosclerosis, and cerebral amyloid angiopathy, which is when amyloid protein \u2014 the same found in Alzheimer\u2019s disease \u2014 deposits in blood vessel walls, causing them to leak or rupture.<\/p>\n

While injury to small vessels doesn\u2019t present as dramatically as having a large stroke, over time it can lead to widespread structural damage.<\/p>\n

\u201cSome people can have hundreds of microbleeds in their brain,\u201d Seshadri said. \u201cAnd as you can imagine, it causes a lot of disruptions to a person\u2019s daily tasks and functioning.\u201d<\/p>\n

Findings from the Nun Study<\/a>, a landmark study analyzing more than 30 years of aging and dementia patterns of 678 nuns from the School Sisters of Notre Dame \u2014 now housed at the Biggs Institute \u2014 discovered the integral role of damage to the small vessels of the brain in developing dementia.<\/p>\n

Researchers found that among elderly nuns whose brains had equal levels of amyloid plaques and tau tangles \u2014 the key features of Alzheimer\u2019s disease \u2014 those who had a large stroke were five times more likely to have dementia. But those with the small, silent strokes caused by cerebral small vessel disease were 20 times more likely to have dementia.<\/p>\n

\u201cBecause of this finding, today there is a lot of emphasis on what is causing this small vessel disease and how to treat and prevent it,\u201d Seshadri said.<\/p>\n

Prevention begins with awareness <\/strong><\/span><\/h4>\n

Fortunately, there are many lifestyle factors that, when managed, can greatly reduce a person\u2019s risk of developing VCID.<\/p>\n

\u201cThe same risk factors that lead to heart disease, like high blood pressure, diabetes and inflammation, are heavily involved in brain injury, too,\u201d Seshadri said. \u201cSo, managing blood pressure, staying physically active and avoiding smoking can all reduce your risk.\u201d<\/p>\n

Seshadri emphasized that maintaining good vascular health is always a good idea, no matter the condition.<\/p>\n

\u201cEven if someone has Alzheimer\u2019s or a different type of dementia, hypertension adds to more risk and more injury,\u201d she said. \u201cSo, regardless of whatever type of dementia someone may have, it\u2019s important to remember that there could be vascular factors that have the potential to be managed, which can slow down that disease.\u201d<\/p>\n

A new era of dementia care <\/strong><\/span><\/h4>\n

In South Texas, where dementia rates are higher than the national average, specialty care and focused research efforts are critical for the health of the community.<\/p>\n

\u201cWhile we don\u2019t fully understand why South Texans are at greater risk, we do know that this region has higher rates of vascular risk factors like diabetes and obesity, which contribute to vascular dementia,\u201d Seshadri said.<\/p>\n

At the Biggs Institute, vascular cognitive impairment and dementia are a key focus for clinical care, community outreach and major research initiatives. In addition, UT San Antonio\u2019s Biggs Institute, in collaboration with UT Rio Grande Valley,\u00a0holds the premier designation by the National Institute on Aging (NIA) as an Alzheimer\u2019s Disease Research Center (ADRC). The South Texas ADRC is one of 33 funded by NIA at major medical centers across the United States and is the first one in Texas.<\/p>\n

The recent opening of UT Health San Antonio\u2019s Center for Brain Health<\/a> in December 2025, which houses the Biggs Institute, will further bolster the university\u2019s efforts to serve the community. The new facility advances comprehensive brain health research and provides innovative expert care for patients with a wide variety of neurodegenerative diseases, movement disorders and complex neurologic conditions.<\/p>\n

The center\u2019s current and future research efforts will benefit from significant recruitment of South Texans into clinical trials, helping to expand the nation\u2019s understanding of how brain-related diseases affect populations in this region. The center also serves as a training venue for medical residents and postgraduate trainees, ensuring the future of sustained neurological care for the community.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Maintaining a healthy vascular system is also critical for another essential organ: the brain.<\/p>\n","protected":false},"author":608,"featured_media":12526,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[298],"tags":[],"ppma_author":[288],"class_list":["post-12304","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-winter-2025-2026"],"yoast_head":"\nDementia isn\u2019t destiny: A healthy heart is also good for the brain - Mission Magazine<\/title>\n<meta name=\"description\" content=\"Vascular cognitive impairment and dementia, or VCID, is the second-most-common cause of dementia after Alzheimer\u2019s disease, often overlapping with it. 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