Symptoms of vascular dementia manifest in a completely different way, and although they may eventually be similar to Alzheimer's, their first onset is caused by a vascular event, namely a constriction of the arteries supplying blood to the brain. Typically this results in a ‘stroke’. Initially, damage, if not fatal, can be severe and some individuals are rendered paraplegic from the outset. An unfortunate individual I have had the great pleasure of knowing received his stroke whilst asleep. He awoke to a new day with almost total paralysis. He was unable to get out of bed. However, this wonderful person, although permanently wheelchair bound, has quite remarkably retained his excellent sense of humour, and although his cognitions are impaired and he is unable to administer his many businesses, he manages to enjoy his life to the fullest extent possible and with the help of his 24 hour carers his symptoms are well managed. The blood supply to his brain has now been ensured with the help of antiplatelet drugs, and although the damage may not be reversed, the progress of the disease has been severely curtailed. However, if the initial vascular constriction is of a temporary nature and the supply of blood is rapidly restored, a ‘mini-stroke’ or, more correctly a transient ischemic attack (TIA) might take place. This may result in partial paralysis, in some cases only a temporary setback, although cognitive ability may be impaired. Thought processes may well be slower than before the event, with concentration and communication affected to a greater or lesser extent. Clearly, the individual suffering from a TIA is aware of the event (denial is unlikely) and fear of another episode can often result in anxiety and depression. Further symptoms are often ‘stepped’ as further TIAs, or seizures take place and sudden deterioration of the individual's condition can result. Physical weakness and partial paralysis can be the resultant symptoms of these of these events and memory problems may be apparent. Misconceptions, like mistaking a hanging coat for a person, or seeing a blue carpet as water is a symptom that can develop at any stage of the disease, accompanied with periods of acute confusion (see Alzheimer's Society factsheet 507). Unsteadiness and difficulty in walking can be experienced as well as incontinence and obsessive behaviour.