stroke - ReaDementia

Stroke-Related Dementia: What Is It?

Petra Boh Blog, Types March 8, 2021October 16, 2021stroke, stroke-related dementia

When learning about the various types of dementia, it is important to talk about stroke-related dementia.

This is dementia that develops after the brain has been damaged by a stroke.

What is stroke-related dementia?

Strokes happen when there is an interruption of blood flow to the brain causing blood vessels to burst.

Worth noting is that not everyone who experiences a stroke will end up with dementia.

Strokes are normally associated with vascular dementia which is the second most common type of dementia.

In short, dementia is a general term describing problems with memory, planning, judgment, reasoning, and other thought processes.

Symptoms of Stroke-Related Dementia

The symptoms of this kind of dementia can appear suddenly, after a few days, weeks, or months in a gradual or stepwise manner.

The symptoms that a person will get depend on the kind of stroke they experienced as well as the section of the brain that has been damaged.

Cognitive decline normally happens within three months of a recognized stroke.

Examples of some warning signs of vascular dementia include:

Loss of memory especially with remembering recent events
Problems following instruction, inattention, and poor concentration
Poor judgment
Confusion
Getting lost in familiar places
Challenges with problem-solving, reasoning, and calculations
Depression
Mood and behavior changes
Crying or laughing inappropriately
Psychosis: loss of contact with reality, aggression, hallucinations, agitation, delusions, and inability to appropriately relate with other people and surroundings

The Diagnosis Process

It is not easy for medics to diagnose stroke-related dementia.

This is because several medical conditions can cause an individual to experience dementia-like symptoms.

Doctors have to identify the cause of the symptoms to determine whether or not a person has dementia.

It is important because there are some causes of dementia that are reversible with treatment.

The diagnosis process is not an easy one.

Health care providers will gather details from different sources to come up with the proper diagnosis.

They usually start with a medical interview where the doctor will ask questions like:

When the symptoms appeared
Past and recent medical problems
Medications a person is taking or was taking in the past
Lifestyles and habits

Physicians also conduct physical examinations to look for physical disabilities as well as signs of underlying conditions like previous strokes, high blood pressure, or heart and blood vessel diseases.

Doctors will also include mental status examinations to check memory, orientation, language, and attention.

Some professional practitioners will as well conduct neuropsychological testing which is a detailed cognitive assessment that helps them pinpoint and document an individual’s cognitive strengths and problems.

A doctor may also recommend laboratory tests such as blood tests to rule out blood disorders, infections, hormonal disorders, chemical abnormalities, and kidney or liver problems.

The lab tests are also important for identifying other health issues like diabetes and various vascular disorders that might underlie dementia.

Imaging studies can also be done to help detect stroke and rule out other conditions that can cause dementia.

Treatment Options for Stroke-Related Dementia

Sadly, treatments currently available cannot reverse brain damage that is caused by strokes if the injury has lasted for a few hours.

Treatment aims at enhancing vascular health in a bid to prevent the occurrence of new strokes and slow down the progression of cognitive decline and other related symptoms.

Treatment options include surgery, medication, and behavioral interventions.

Multi-Infarct Dementia: What Is It?

Petra Boh Blog, Types March 3, 2021October 16, 2021dementia, multi-infarct dementia, stroke, vascular dementia

A kind of dementia, multi-Infarct dementia (MID) is a type of vascular dementia that is caused by multiple strokes.

It is also considered to be the second-most common cause of dementia after Alzheimer’s disease.

The strokes interrupt blood flow to the brain, which ends up affecting how the organ functions.

A brain infarct or stroke happens due to the block or interruption of blood flow to any part of the brain.

Everything You Need To Know About Multi-Infarct Dementia

Blood transports oxygen and other essential nutrients to the brain. When the brain lacks oxygen, it causes the death of brain tissues.

Multi-Infract imply that multiple areas in the brain have been injured because of lack of blood from a series of small strokes.

There are times when blockages of the brain cause an infarction (stroke) without any stroke symptoms.

These are known as “silent” strokes which are known to increase an individual’s risk of getting vascular dementia.

If someone experiences a series of small strokes over time, they may end up developing infarct dementia.

Symptoms of Multi-Infarct Dementia

The type of symptoms a person gets often depends on the area of the brain that the stroke has damaged.

At times the symptoms appear suddenly after a stroke or they may appear slowly over time.

We can categorize MID warning signs into two major sections as seen below.

Early Dementia Symptoms

Loss of executive function
Getting lost in familiar places or wandering
Short-term memory loss or confusion
Losing bowel or bladder control
Walking with shuffling rapid steps
Crying or laughing inappropriately
Challenges performing routine tasks like paying bills
Personality changes
Losing interest in activities or things that were previously enjoyed

Late-Stage Symptoms

As the disease progresses, a person may also experience other symptoms such as:

Hallucinations/delusions
Problems with simple tasks like meal preparation and dressing
Changes in sleep patterns
Memory loss
Social withdrawal
Poor judgment
Depression

Some individuals may go through periods where they seem to improve and then decline after experiencing small strokes.

MID Risk Factors

Some of the risk factors that increase a person’s risk of getting this disease include:

Medical Conditions

Diabetes, heart failure, previous strokes, atrial fibrillation, high blood pressure, cognitive decline prior to the stroke, and hardening of the arteries are some of the medical conditions that increase the risk of MID.

Age

Increasing age is a common risk factor for all types of dementia including MID.

The disease mostly affects persons who are between the ages of 60-75. In some rare cases, some people get the illness before they celebrate their 60th birthday.

Research also shows that men are slightly more likely to develop the disease than women.

Lifestyle Risk Factors

These include alcohol consumption, smoking, little to no physical activity, poor diet, and low level of education.

Diagnosing Multi-Infarct Dementia

There is no single test that can determine whether a person has MID or not. Worth noting is that each MID case is not the same.

One person may experience severe memory impairment while another individual may only experience mild memory loss.

Diagnosis can also be difficult because it is possible for a person to have both Alzheimer’s disease and MID making it challenging for a doctor to diagnose either of the diseases.

Medics base diagnosis on a number of factors such as:

History of stepwise mental decline
Blood pressure reading
Neurological exam
Blood tests
Physical Exams: this is where the doctor will ask questions pertaining to diet, sleep patterns, medications, past strokes, personal habits, stressful events, recent illness, and other medical issues.
Ruling out other causes of dementia like depression, diabetes, anemia, high cholesterol, brain tumors, carotid stenosis, chronic infections, thyroid disease, drug intoxication, vitamin deficiency, and high blood pressure.
Radiological imaging tests such as X-rays, CT & MRI scans that detail tiny areas of tissue that died from lack of adequate blood supply, electroencephalograms that measure the electrical activity of the brain, and transcranial doppler that is used to measure the velocity of blood flow through the blood vessels in the brain

MID Treatment Options

Currently, there is no treatment for multi-infarct dementia.

Experts have not yet discovered how to reverse brain damage that occurs after a stroke. Treatment options mainly focus on preventing strokes from reoccurring in the future.

This is done by putting in place measures to avoid or control the medical conditions and diseases that put individuals at risk of experiencing strokes.

Stroke risk factors include diabetes, high blood pressure, cardiovascular disease, and high cholesterol.

Treatment is also tailored to a person’s individual and most of them will include:

Medications

Doctors may prescribe certain medications to help improve symptoms such as:

Folic acid
Memantine
Hydergine
Nimodipine
Angiotensin: these help to lower blood pressure by converting enzyme inhibitors
Calcium channel blockers that help with short-term cognitive function
Some serotonin reuptake inhibitors that are antidepressants which may help neurons grow in a bid to re-establish connections in the brain

Healthy Lifestyle Habits

Practicing healthy habits is also key when it comes to MID treatment and some of them include:

Maintaining a healthy weight
Not smoking
Moderately using alcohol
Exercising
Eating a healthy diet

Alternative Therapies

Herbal supplements are also common when it comes to treating MID. However, more studies are still necessary to prove their efficiency.

Some of the herbal supplements that are being studied for use in MID treatment are:

Lemon Balm: A great alternative to restore memory
Wormwood: It enhances cognitive function
Water Hyssop: Used to improve intellectual function and memory

It is important to consult a doctor before taking any supplements to be on the safe side.

Other treatment options include rehabilitation therapy for mobility problems and cognitive training to help regain mental function.

Caregiver Support

Relatives and friends of persons with MID can help them cope with their physical and mental problems.

This can be done by encouraging regular physical and social activities as well as daily routines to help reinforce mental abilities.

Alarm clocks, calendars, and lists are useful when it comes to reminding the affected persons of important events and times.

MID Prognosis

The prognosis for persons with multi-infarct dementia is not clear.

This is mostly because the symptoms of the disease can appear all over sudden after each small stroke mostly in a step-wise pattern.

Some individuals with the disorder can appear to improve after some time and then decline after experiencing silent strokes.

The disease will spiral downwards with intermittent periods of fast deterioration. Some people may die after a MID diagnosis while others will survive many years.

Death may also occur from heart disease, stroke, pneumonia, or other infections.

Post-Stroke Dementia and Cognitive Impairment

Rok Krivec Blog, Types March 2, 2021October 16, 2021dementia, post-stroke dementia, stroke

After suffering a stroke, many people will end up with post-stroke dementia (PSD).

This can be any type of dementia from Alzheimer’s disease, vascular dementia, degenerative dementia, mixed dementia or stroke-related dementia.

Post-Stroke Dementia Review

PSD is a common occurrence after a stroke covering for about 6%-32% of the cases.

However, not everyone who has suffered a stroke will end up with dementia.

Others will experience a degree of cognitive impairment that is not severe enough to be categorized as PSD.

ResearchGate reveals that many people will experience mild cognitive impairment after a stroke which may or may not progress to dementia.

Cognitive Impairments

Cognitive impairments are generally divided into several domains that include:

Attention

This can generally be defined as shifting, focusing, sustaining, or dividing attention on a particular task or stimulus.

Executive Function

This has a lot to do with abstract thinking, planning, conflict monitoring, inhibition, and organization of thoughts.

Memory

This mostly affects a person’s ability to recognize or recall verbal or visual information.

Language

It primarily affects an individual’s ability to be receptive or express themselves through language i.e. reading and writing comprehension.

Social Cognition

This defines the recognition of a person’s or other people’s emotional state as well as an understanding of the mind’s theory.

Perception and Praxis

For the most part, it primarily affects visuospatial abilities, apraxia, prosopagnosia, and agnosia.

Post-stroke cognitive impairment (PSCI) can be described as a failure in the cognitive domain that happens after a stroke.

Cognitive impairment is a threat to post-stroke recovery for persons of all ages. It can compromise a person’s ability to continue working hence the need to be dependent on others at an early stage.

Unlike physical disability that is caused by stroke, cognitive function normally becomes worse over time.

While cognitive problems usually become worse during the first months after a stroke, there is a chance they can become better as the brain starts to become more active in trying to repair itself.

It is a complicated process because recovery can start to slow down after six months.

Even when cognitive problems do not go away completely, they normally get easier to live with.

This is especially the case when cognitive issues do not lead to dementia.

What Causes Cognitive Impairment

Cognitive issues occur because of the damages that happen to the brain.

Different brain sections are responsible for controlling different aspects.

If one of the areas that control cognition is damaged by stroke, this can affect the way a person does certain things.

Cognitive challenges are quite common after a person experiences post-stroke dementia.

Risk Factors for Post-Stroke Cognitive Impairment

After a stroke, the risk factors for cognitive impairment are usually associated with an overlap of dementia and frequent cerebrovascular diseases.

Some of them include:

1. Age: this is a risk factor for both cognitive decline and dementia. The prevalence of cognitive decline increases significantly after the age of 65 according to research by the American Stroke Association.

2. Vascular risk factors like diabetes, smoking, hypertension, and atrial fibrillation increase the risk of cognitive impairment.

3. Recurring strokes are also documented as a risk factor for cognitive impairment.

4. Education level: this is a conflicting risk factor with some studies suggesting that higher education is related to better cognitive performance.

Diagnosing Cognitive Impairment after Stroke

A neuropsychological examination is one of the methods that is used to assess cognition after a person suffers from a stroke.

In clinical practices, this is conducted from one week to a month after the stroke.

It is different when it comes to research because the examination is performed three months after a stroke.

In some cases, it may not be possible to conduct a neuropsychological examination for persons who have had a stroke because they may be too fatigued or disabled to go through with it.

Shorter screening tests are done as an alternative in such cases for both research and clinical purposes.

Early detection of cognitive impairment is critical because it may help reduce the chances of progressing to post-stroke dementia.

Treatment and Management Options

When it comes to treating cognitive impairment caused by post-stroke dementia, the main options include strategies that range from preventing white matter changes, new strokes, to treating underlying vascular risk factors hypertension.

Stroke and Dementia: Is There A Link?

Petra Boh Blog, Signs February 19, 2021October 16, 2021dementia, stroke

Several studies confirm that there is a link between stroke and dementia.

A stroke occurs when brain cells are damaged or die-off because the flow of blood to the organ is interrupted.

This kind of damage can lead to the development of dementia because it results in problems with thinking and memory.

Dementia is a group of symptoms that result in cognitive decline.

This includes problems with communication, memory, and concentration.

Statistics indicate that having a stroke doubles the risk of developing dementia.

Understanding Stroke and Dementia

The conclusion was made after a large-scale study led by The University of Exeter Medical School. Researchers analyzed data on stroke and dementia risk from over three million people from across the globe.

The experts were building on research that has been previously done but had not quantified the extent that stroke increases the risk of dementia.

The research analyzed 36 studies where 1.9 million subjects had a history of stroke.

They went ahead and also examined twelve more studies where the participants had a recent stroke during the period of the research adding 1.3 million people.

Stroke increases the risk of dementia by 70%

Dr. ILianna Lourida who was part of the study from the university said that they discovered that a history of stroke increases the risk of dementia by about 70%.

Moreover, recent strokes increase the risk by more than double.

The link between dementia and stroke was prevalent even after the experts took into account other dementia risk factors like diabetes, cardiovascular disease, and blood pressure.

Findings from this study released strong evidence that having a stroke increases dementia risk significantly.

This was important given how common dementia and stroke are.

World Health Organization reports that 50 million people around the world have dementia and the number will continue to rise significantly.

Meanwhile, 15 million individuals experience strokes yearly.

The study on stroke and dementia is also useful because it can help with the prevention or treatment of dementia.

Dr. David Llewellyn who hails from the University of Exeter Medical School believes that about 1/3rd of the cases of dementia are preventable.

He reckons that protecting the supply of blood to the brain might help to reduce dementia cases.

The research was published in Alzheimer’s & Dementia: The Journal of The Alzheimer’s Association one of the top dementia journals.

What Type of Dementia are People with Stroke Likely to Get?

When talking about stroke and dementia, it is important to note that a majority of people who suffer from stroke will end up developing vascular dementia.

This is one of the most common dementia types.

It is not to say that every person who has a stroke will end up with vascular dementia.

The risk may also depend on sex, age, family history, and severity and location of the stroke.

In addition to damaged brain cells, vascular dementia can also develop after an individual experiences a series of silent strokes.

These usually cause small areas of damage in the brain.

They are known as silent strokes because in most cases, the strokes are usually so small that a person may not even know when they are happening.

Worth mentioning is that it is possible to confuse vascular dementia with the effects of stroke.

Both medical conditions can cause issues with memory, mood, and thinking.

If a person with stroke experiences these problems and they do not improve but seem to get worse, it could be an indication that they have vascular dementia.

If caused by a single stroke, the symptoms of vascular dementia can appear suddenly.

They tend to appear gradually if the symptoms are caused by silent strokes. In the absence of dementia, these symptoms will improve after some time.

Experts also believe that stroke can cause dementia at any age. As people grow older, their risk of stroke and dementia increases.

Nowadays, however, stroke risk factors are increasing even for younger adults.

The same case applies to dementia where individuals can start developing the neurodegenerative disease in their 40’s or younger.