The dementia we’ve been ignoring may finally be getting attention

Vascular dementia affects one in five people living with dementia. There are no approved treatments. New research from UNSW Sydney may be the beginning of changing that — and the people closest to this disease deserve to know why it matters.

It is the second most common form of dementia in the world. It strips away memory, thinking, and function. And until now, medicine has offered almost nothing to slow it.

Vascular dementia — caused by damage to the brain’s blood vessels — accounts for somewhere between 15 and 20 per cent of all dementia cases. Yet while Alzheimer’s disease has attracted decades of research investment, multiple approved treatments, and a growing pipeline of experimental therapies, vascular dementia has remained something of a medical orphan. No approved treatments exist in Australia. Management has largely meant controlling blood pressure and cholesterol and hoping for the best.

New research from UNSW Sydney’s Centre for Healthy Brain Ageing suggests that may be about to change — slowly, cautiously, but meaningfully.

Finding the doors worth knocking on

The study, published in Alzheimer’s & Dementia: Translational Research & Clinical Interventions, used a genetic technique called Mendelian randomisation to sift through more than 12,000 genes that could potentially be targeted by medications. Think of it less as finding a cure and more as identifying which biological doors might actually be worth knocking on.

Four genes emerged as candidates linked to vascular dementia risk. Two — APOE and TOMM40 — were already on researchers’ radar for their roles in brain health. Two others — ERAP and SAA1-4 — are newer signals connected to inflammation and immune processes, pointing toward biological pathways that haven’t yet been fully explored in this context.

What makes the findings particularly compelling is that the two strongest signals also showed up in brain imaging data associated with small vessel disease — the microscopic damage to the brain’s tiniest blood vessels that quietly underpins much of vascular dementia’s devastation. That alignment between genetic signals and physical disease markers gives the findings considerably more weight.

Why this matters beyond the lab

Lead author Dr Matthew Lennon is careful not to overstate what the research means right now. “This is an important first step,” he has noted. “By identifying potential targets, we can begin to better understand where future research and drug development efforts might be directed.”

That measured language is important. Genetics-led research of this kind is a long way from a treatment. Many promising biological targets never become drugs. Clinical trials take years. Regulatory approval takes longer.

But for those working daily with people living with vascular dementia — and with families navigating its progression — the significance of this research isn’t really about timelines. It’s about the shift it represents.

For too long, vascular dementia has sat in Alzheimer’s shadow: less funded, less studied, less visible in public conversation about dementia despite affecting hundreds of thousands of Australians. Research like this begins to close that gap. It signals that the scientific community is taking seriously what practitioners have known for years — that telling someone they have an untreatable condition and wishing them luck with their blood pressure isn’t good enough.

The overlap question

One thread in the research worth watching closely is what it reveals about the relationship between vascular dementia and Alzheimer’s disease. The two conditions share biological territory — the same genes flagged in this study have known connections to Alzheimer’s — and in practice, many people living with dementia have elements of both. A clearer understanding of where these diseases converge could eventually benefit research into both.

Professor Perminder Sachdev, Co-Director of CHeBA, framed the broader significance plainly: at a time when vascular dementia remains a major unmet medical need, genetics-led approaches offer a genuine path toward uncovering new treatment possibilities.

What to hold onto

This research won’t change a care plan tomorrow. But it is a signal — a meaningful one — that the field is moving. For those who sit with the weight of what a vascular dementia diagnosis means for a person and their family, knowing that the research community is finally turning its full attention toward this condition is worth something.

The people in care today deserve better options than currently exist. Studies like this are how those options eventually come to exist.