Vascular Dementia: The A-Z's of the Second Most Common Dementia

Vascular Dementia: The A-Z's of the Second Most Common Dementia

Dementia is known to be a chronic disorder of the mental processes and is caused by brain disease or injury. It is marked by memory disorders, personality changes, and impaired reasoning, to name a few. In general, most people have at least some idea of what dementia is. However, what many do not know is that there are several types of dementia that can affect people, each with its own causes, symptoms, and diagnoses. After Alzheimer’s disease, Vascular Dementia (VA) is known to be most common type of dementia known.

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UNDERSTANDING THE BASICS OF VASCULAR DEMENTIA


Vascular dementia is the subtle progressive worsening of memory and other cognitive functions that can be attributed to vascular disease within the brain. In people with this condition, symptoms of dementia, such as memory loss and difficulty with thinking, language, and problem solving, occur due to brain damage caused by blood supply problems in the brain. The problems could be a block or lack of blood flow to the brain. Reduced blood flow in turn, deprives the brain of oxygen. Together, it can cause brain damage, even in a short period of time.
 
Also known as vascular cognitive impairment, the condition accounts for an estimated 10% of dementia cases, although, many experts believe that it is underdiagnosed. As with dementia in general, people above the age of 65 are at a higher risk of being diagnosed.

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HOW DOES IT HAPPEN?


Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells. This can happen due to a number of reasons such as the narrowing of small blood vessels deep inside the brain, aneurism, a stroke, or several mini-strokes. Sometimes, the damage could also be due to Alzheimer’s. In such cases, it is known as mixed dementia. 

Vascular Dementia - Ischemic Stroke Vascular Dementia - Hemorrhagic Stroke

 

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THE DIFFERENT TYPES OF VASCULAR DEMENTIA

Within the realm of vascular dementia itself, there are several different types identified. Two of the most common are Multi-infarct dementia and Binswanger’s disease. Below is a brief overview on both:
 

Multi-infarct Dementia

Thought to be the most common form of vascular dementia, this is caused by a number of strokes. The symptoms tend to develop progressively over a period of time. When the strokes cause damage to the area of the brain associated with learning, memory, and language, it leads to the corresponding symptoms of dementia. Other symptoms can include depression, mood swings, and epilepsy. Unlike Alzheimer’s, patients with this condition are more likely to retain their insight and personality intact for a longer period before worsening.
 

Binswanger’s Disease

Binswanger’s Disease, also known as subcortical vascular dementia, was thought to be a rare type. However, recently experts are reassessing and suspect that it may in fact be one of the more common types around. This condition is also related to stroke related changes, but in this case, it is the white matter deep within the brain that is affected. Causes include high blood pressure, thickening of the arteries, and a lack of blood flow. Symptoms for this condition includes lethargy and slowness, difficulty with movements, mood swings, and lack of bladder control, all of which appear early in the course of the disease.
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WHO IS MOST AT RISK?


As vascular dementia is caused by brain damage due to lack of proper blood and oxygen supply to the brain, there are a number of risk factors that can affect the likelihood of being diagnosed. Many of these factors also influence a person’s overall health. Below is a list of common risk factors:

  • High blood pressure—hypertension accounts for nearly half of the vascular dementia cases diagnosed. It can cause Binswanger’s Disease.
  • Diabetes
  • High cholesterol—can cause blockages in the arteries and end up obstructing blood flow to the brain.
  • Smoking

One big way to reduce the risk of illnesses that could cause vascular dementia, it is important to lead a healthy lifestyle through proper diet, exercise, and abstinence from smoking.

 

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WHAT ARE THE SYMPTOMS OF THE CONDITION?


Symptoms of vascular dementia can often overlap with symptoms of Alzheimer’s, but is largely dependent on the location of impaired blood flow within the brain. It is easiest to identify the symptoms when it occurs after a stroke. In cases where the patient suffers multiple strokes or mini strokes, the progression of the symptoms tend to be more stepwise, abrupt and noticeable rather than the steady decline you find in other cases of dementia. As is the case with all types of dementia, the progress of vascular dementia on each individual is different. However, it only worsens over time. The many signs of vascular dementia can be divided into three categories: mental & emotional, physical, and behavioral.
  Vascular Dementia Stages

Stage 1: Behavioral Deterioration

Unlike Alzheimer’s, the early symptoms of vascular dementia do not start with memory problems. Instead it involves a set of behavioral deterioration. This involves difficulties with planning or organizing, following instructions/steps, decision making, concentration. It can also include some mental and emotional deterioration such as slowness of thought and short periods of confusion.
 

Stage 2: Early Stages

During the early stages of progression, the person’s mental and emotional aspects tend to get further affected. They are very likely to suffer from apathy, mood swings, and even be unusually emotional. Anxiety and depression is also not uncommon. This is mainly due to the fact that they tend to be aware of the problems caused by their dementia. There are also several physical symptoms during this stage. They include weak limbs, problems with speech and vision, tremors, and other unsteady physical movements.

Stage 3: Middle Stages

As the progression of vascular dementia tends to be more step-wise rather than a steady decline, a person can reach this stage quite abruptly. Usually, the aggravation happens due to additional strokes and affects more areas of the brain. At this stage, the symptoms will grow to include severe confusion or disorientation, more problems with communication and reasoning. Memory loss will become quite bad. Behavior wise, the patient tends to become more irritable, agitated, and even aggressive due to the confusion. Disturbed sleep is also quite common at this stage. In some people, early signs of hallucinations and delusions can also develop. Due to all this, the person is likely to need support with daily activities like cooking or cleaning.

Stage 4: Late Stages

In the final stage of vascular dementia, a person suffering from it is aware of very little of what is happening around them. They will have difficulties eating and walking without help and become extremely frail. Severe memory problems and loss of speech control will also develop. At this stage, the symptoms will be almost identical to that of Alzheimer’s and patients will require full time assistance as they will not be able to care for their selves anymore.
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HOW TO DIAGNOSE VASCULAR DEMENTIA?


In the event that you have a family member or friend exhibiting mild symptoms and you suspect that could have vascular dementia, it is important to immediately have them consult a physician. The earlier it is diagnosed, the better the chances of limiting the progression of the symptoms and allowing the person to lead a normal life for a longer time.
 
While there are no ways to confirm it, brain scans such as CT scan, MRI or carotid ultrasound can be helpful in the diagnosis as it allows doctors to look for changes in blood vessels and identify clots. There are also some neuropsychological tests that doctors can conduct in order to look for any signs. Sometimes, possible cases of vascular dementia can even be predicted when a person suffers from stroke or an illness borne from risks listed above.

 

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HOW TO TREAT VASCULAR DEMENTIA?


Being a progressive disease, there is no cure for vascular dementia. However, there are several treatments available to control the speed of progression and allow patients to go through their daily lives more normally. For example, if detected early enough, the brain damage caused by blood vessel changes and blockages can be halted with lifestyle changes such as maintaining a proper diet and exercise regime.
 
There are also drug therapies available to treat the underlying conditions that lead to vascular dementia. These include anticoagulants, blood thinners, and other blood pressure medications. Rehabilitative therapies for speech and physical movement will also help to regain as much lost function as possible. For the patients themselves, psychological counseling, both individual and group therapies, are extremely important in order to cope emotionally with their diagnoses and motivate themselves to delaying their deterioration for as long as possible.

 

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CHALLENGES OF CARING FOR VASCULAR DEMENTIA PATIENTS & CARE ARRANGEMENTS AVAILABLE


As is the case with all dementias, caring for patients with vascular dementia will be challenging as the disease progresses.
 
Stage 1: Behavioral Deterioration
As the initial symptoms of vascular dementia involves behavioral deterioration, the first thing to do when caring for someone you suspect are showing signs of this illness is to treat them with patience. When the person is facing difficulties with planning, concentrating, or following instructions, it is important that you do not rush them or make them feel embarrassed. You should also seek professional opinion from a physician or dementia specialist to confirm the cause of the symptoms. Early intervention can help immensely.
 
Stage 2: Early Stages
When a patient is facing difficulties with their physical and/or mental symptoms, you can help them by breaking down tasks down into smaller steps and giving them plenty of time to think and speak. They should still be allowed to pursue their daily activities and interests without much interference from an outside source. Instead, create routines by setting reminders—visual or otherwise—to give them a gentle nudge. In addition, a person suffering from vascular dementia at this point would be quite aware of their condition and therefore would need adequate psychological counseling and therapy to come to terms with their situation.
 
Stage 3: Middle Stages
At this point, patients with vascular dementia will need some level of external support. They will need to be monitored full time and likely require some assistance with their daily activities such as eating and dressing. This can come from the primary caregiver as well as close family and friends. In cases, where the primary caregiver is not able to provide the necessary care or does not have the knowledge to take care of the person, they can opt to hire in-home care instead. This type of care arrangement allows the patient to remain at home with a sense of familiarity while receiving professional care. There are a variety of services that in-home carers provide, from companionship and personal care, to homemaking and medical care.
 
Another option that the patient can opt for is an adult day care center. Similar to child day care, these centers allows adults with dementia to spend their daytime in a safe environment and participate in various activities to help their symptoms. This way also allows for them to have more interaction socially. For primary caregivers, this is a desirable option when they are unable to take care of the patient on a full time basis or need time for other daily tasks.
 
Stage 4: Late Stages
During the final stage of the progression, the patient becomes incapable of taking care of themselves—especially if are unable to move or speak properly. In this case, they would need full time care by a family member or professional caregivers. For this, the primary caregiver can opt for full-time in-home carer or residential care. With a full-time in-home carer, they essentially look after the person’s physical and medical needs. On the other hand residential care in the form of assisted living or a nursing home comes with 24 hour care and safety for the patients. Ultimately the specific choice of care for the patient depends on the level of dementia deterioration the person is suffering from and the preference of the primary caregiver.
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RESEARCH & CLINICAL TRIALS FOR VASCULAR DEMENTIA


As is the case in almost any facet of the medical field, there is constant research and development being done with regards to vascular dementia. The following is a list of types of clinical trials that are being done:
  • Treatment trials—to find more effective blood thinners, anticoagulants, and any drug that can reduce the risk of blood clots and strokes.
  • Diagnostic studies—to find new tests and methods to diagnose vascular dementia earlier and more accurately.
  • Prevention trials—to explore various means of preventing the formation of blood clots and resulting strokes.
  • Quality of life studies—to explore ways to improve the quality of life for patients and caregivers at different stages of the illness’s progression.

     

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    RESOURCES AND SUPPORT FOR VASCULAR DEMENTIA


    For family members and friends who would like to educate themselves further on the details of vascular dementia, its symptoms, treatments, and challenges, you should seek the assistance of local or national Dementia or Alzheimer’s Association.
    Alzheimer’s Association
    1-800-272-3900 (toll-free) 
    1-866-403-3073 (TTY/toll-free) 
    info@alz.org
    www.alz.org
     
    Alzheimer’s Foundation of America
    1-866-232-8484 (toll-free) 
    info@alzfdn.org
    www.alzfdn.org


    Other websites to obtain more information on vascular dementia:

    Alzheimer’s.net
    MedlinePlus – Vascular Dementia
    Alzheimer’s Australia
    Alzheimer’s Society
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