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Vascular Dementia

vascular dementia
Vascular dementia is a broad term that describes difficulties with memory, language, planning, judgment, reasoning, and other thinking processes.

Right after AD (Alzheimer’s disease), vascular dementia is the 2nd most popular cause of dementia.

With that in mind, vascular dementia affects about 1/3rd of people who are 70 years and above. It is a progressive disease which means it only gets worse over time. Here is all the essential information you need to know about vascular dementia.

Causes of Vascular Dementia

Brain damage causes vascular dementia, which happens during the reduction of the supply of blood to some sections of the brain. This can be as a result of clogged blood vessels, a series of small strokes, or a stroke.

With time, the areas of the brain cells will stop working and dementia warning signs start developing. The disease can also develop from other medical conditions that damage blood vessels resulting in reduced circulation which robs the brain of essential nutrients and oxygen.

Lack of adequate oxygen and nutrients inhibits brain function because it leads to the death of brain cells.

Vascular Dementia Risk Factors

Several factors have been documented as vascular dementia risk factors and these include:

History of Strokes/Mini-Strokes and Heart Attacks

Individuals who suffer heart attacks are at risk of developing blood vessel problems in their brains. Brain damage that happens after a mini-stroke or stroke has also been documented as a potential risk factor for vascular dementia.

Diabetes

High levels of glucose damage blood vessels in the entire body which can increase the risk of stroke as well as vascular dementia.

Atherosclerosis (Abnormal Aging of Blood Vessels)

This normally happens when cholesterol deposits and other plaques build up in the arteries which end up narrowing blood vessels. Atherosclerosis increases the risk of vascular dementia because it reduces blood flow to the brain.

High Blood Pressure

When a person’s blood pressure is too high, it exerts extra stress on the blood vessels in the brain and the rest of the body. This escalates the risk of vascular issues in the brain.

Smoking

Smoking harms the blood vessels directly which increases the risk of developing atherosclerosis and an array of circulatory illnesses like vascular dementia.

High Cholesterol

High levels of LDL (low-density lipoprotein) also known as “bad” cholesterol is also associated with increased vascular dementia risk.

Increasing Age

The risk of vascular dementia increases as a person grows older. Only a few people get the disease before celebrating their 65th birthday. The risk increases significantly for those in their 90s. Some studies also state that the risk of developing progressive disease is higher for men than women.

Obesity

Obesity is known to increase the risk of developing vascular diseases implying that it might also increase vascular dementia risk.

History of Depression

Some evidence reveals that a person who has a history of depression is at risk of developing vascular dementia. It is; therefore, advisable for anyone who has depression to seek medical advice early.

Atrial Fibrillation

This is where a person experiences abnormal heart rhythm. The upper heart chambers start to beat irregularly and fast.

Genetics and Ethnicity

Researchers suggest that some genetic factors are among the risk factors for vascular dementia and most of these are associated with underlying cardiovascular diseases. A person who has a family history of heart disease, stroke, or diabetes may have an increased risk of developing progressive disease. However, the role of genes in vascular dementia remains pretty small.

An unhealthy diet, hardening of arteries, and little or no physical exercise are other vascular dementia risk factors. Controlling some of the factors above can help reduce the chances of developing vascular dementia.

Symptoms of Vascular Dementia

The vascular symptoms a person will experience will depend on the section of the brain where blood flow is limited. Keep in mind that the symptoms often overlap those that are seen in other types of dementia. Some of the warning signs of this progressive disease include:

  • Problems with concentrating and paying attention
  • Confusion
  • Challenges with the ability to organize actions or thoughts
  • Unsteady gait
  • Problems with memory
  • Challenges with money management
  • A decline in the ability to analyze situations, developing effective plans, and communicating plans with others
  • Agitation and restlessness
  • Getting lost in familiar places or wandering
  • Having a hard time with decision making
  • Losing interest in things that a person enjoyed before
  • Depression
  • Apathy
  • Challenges with performing tasks that came easy such as playing games or balancing checkbooks
  • Misplacing items
  • Frequent or sudden urges to urinate or the inability to control the passing of urine
  • Delusions or hallucinations
  • Loss of social skills and personality changes
  • Trouble with communication
  • Loss of vision
  • Crying or laughing when it is not appropriate

Vascular dementia symptoms usually become obvious when they suddenly occur after an individual suffers a stroke. It is also important to note that the symptoms appear suddenly, and in most cases, they will start mildly and worsen over time.

Types of Vascular Dementia

There are different types of vascular dementia, some that have similar symptoms while the rest have different symptoms.

Some of the different types of vascular dementia are:

Subcortical Dementia

Subcortical vascular dementia is caused by small blood vessel disease. It is known to be the most common type of vascular dementia. The small vessels located in the brain develop thick walls and become twisted and stiff interfering with the flow of blood.

Small vessel disease in most cases damages the bundles of nerve fibers that carry signals in the brain referred to as white matter. This can also result in small infarcts close to the base of the brain.

Stroke-Related Dementia

This is the type of vascular dementia that happens after a person suffers a stroke. A stroke occurs when the blood supply to a section of the brain is cut off suddenly.

In a majority of stroke cases, a blood vessel in the brain becomes narrow and is blocked by a clot. The clot may have formed in the heart and transported to the brain or it may have formed in the brain.

The severity of strokes varies depending on the location of the blocked vessel and whether the interruption of blood supply is temporary or permanent.

Post-Stroke Dementia

A major stroke happens when blood flow in a large vessel in the brain is permanently and suddenly cut off. Many times, this occurs when a clot blocks the vessels. In rare cases, it happens when the vessel bursts and bleeds in the brain.

The interruption of blood supply deprives the brain of oxygen which kills a lot of brain tissue. Worth noting is that not every person who has a stroke will end up developing vascular dementia.

However, 20% of people who experience a stroke will end up with post-stroke dementia within 6 months. This makes strokes one of the risk factors for vascular dementia.

Single-Infarct and Multi-Infract Dementia

These are kinds of vascular dementia that are as a result of one or many smaller strokes. They occur when clots block medium or large-sized vessels in the brain. At times, the strokes can be so small that they end up unnoticed.

This is where an individual does not notice any symptoms. On the other hand, the symptoms can also show up temporarily lasting a few minutes as the blockage clears up on its own. If the symptoms last for less than 24 hours it is known as a TIA (transient ischaemic attack) or a mini-stroke. When the supply of blood is interjected for a few minutes, it can cause the death of a small section in the brain. This area is called an infarct.

When only one infarct forms in an important area of the brain, it leads to single-infarct dementia. After a person experiences a small series of strokes over time, numerous infarcts spread across the brain. In this event, a person will develop multi-infarct dementia.

Mixed Dementia

Almost 10% of individuals with dementia are diagnosed with mixed dementia. This implies that a person has both vascular dementia and Alzheimer’s disease. Mixed dementia symptoms can be similar to those of vascular dementia or AD or they can be a combination of both.

Stages of Vascular Dementia

A person with dementia may go through 3 stages that we will discuss below.

Early Stage

At this stage, many people with vascular dementia will not have pronounced symptoms that can make them worry. Most affected individuals will have problems with decision-making, planning, and following steps. If vascular dementia is a result of one or more strokes, a person may also experience physical symptoms like weak limbs, speech, or vision problems.

Most of these symptoms show signs of improvement after rehabilitation. It is one of the reasons early diagnosis is important.

Middle Stage

Many people will know they have vascular dementia when it is in the middle stage. This is because the symptoms start to become worse to the extent that they can interfere with a person’s day to day activities.

It is advisable to consult a doctor at this point to get on a solid care plan. If a person wants to live at home, getting a caregiver is advisable because in most cases, they cannot complete all daily tasks on their own.

Because the symptoms are more apparent during this stage, many people with the illness will opt to withdraw socially something that can make the illness even worse.

Severe/Later Stage

This is the final stage of the progressive illness. In this stage, a person will experience a decline in both cognitive and physical functioning. Most people in this stage will require round-the-clock care.

The immune system also becomes weak where individuals become more susceptible to other infections or medical conditions that can cause death in persons with vascular dementia.

Vascular Dementia Diagnosis

It is usually not easy to diagnose vascular dementia because it can occur together with AD. The symptoms can also vary from one person to another. Doctors consider several factors to rule out other medical conditions when performing vascular dementia diagnosis such as:

1. Talking about developing symptoms. Doctors will want to know all the symptoms that have come up to help them determine whether a person has vascular dementia or not.

2. Analyzing medical history to find out if a person has any other conditions that may be linked to vascular dementia such as diabetes, high blood pressure, and heart problems.

3. Asking questions about lifestyle habits and mood. In regards to lifestyle, it normally helps medics gauge whether a person is indulging in habits that are among the risk factors for vascular dementia.

4. Performing memory tests. This can either be oral or written to know if a person’s memory has been affected.

5. Conducting image tests that help to see how much damage has been caused to the brain. These can include brain scans and MRI’s among others.

6. Taking urine and blood samples to check for other health issues that may be causing symptoms like thyroid problems, infections, or low levels of hormones or vitamins.

7. Checking the medications, supplements, and vitamins a person is taking to see if they are the cause of symptoms.

8. Speaking to loved ones about any changes they may have noticed

The entire diagnosis process may take some time before medics come up with conclusive results. A general physician may also work with other medical professionals to help with the diagnosis process like:

1. Old age psychiatrists. These are doctors who specialize in mental health conditions of older people.

2. Neurologists. These are doctors who are highly knowledgeable in how the brain works.

3. Geriatricians. These are doctors who mainly focus on the health of seniors.

4. Psychologists. They are non-medical clinicians who specialize in feelings and thinking.

5. Specialist dementia nurses (admiral nurses).

Vascular Dementia Prognosis

Vascular dementia shortens life span. The progression of the disease is not always visible. When a person does not treat the conditions that cause vascular dementia the outcome is usually bad.

An individual may appear to be okay without treatment until they experience more brain damage as a result of a stroke.

Without treatment, vascular dementia usually causes death from infections, heart disease, or stroke. Keep in mind that everyone does not experience dementia in the same way.

Vascular Dementia Life Expectancy

Persons with vascular dementia will live for about 5 years on average after the symptoms start showing. In most cases, death is caused by heart attack or stroke.

Vascular Dementia Treatment Options

There is no cure for vascular dementia because it is still not possible to reverse the damage that occurs in the brain. Early diagnosis is encouraged because it can help reduce the severity and impact of symptoms.

Medics try and enhance conditions that cause vascular dementia as a part of the treatment process. Other treatment options that people with vascular dementia have to live with the disease will include:

Making Lifestyle changes

This is something that can help slow down the progression of symptoms and prevent further damage. Persons with vascular dementia may be put on a strict diet as well as regular physical exercise to prevent stroke, heart attack, and clogged arteries.

Reducing alcohol intake, keeping diabetes under control, and quitting smoking can help reduce the damage that vascular conditions cause.

Medication

Some drugs can help to improve some of the symptoms that people with vascular dementia have. Doctors can prescribe medication that can enhance mood when a person is feeling depressed or down. Certain types of medications might also improve confusion and other behavioral problems.

Rehabilitation Therapy

If vascular dementia is causing physical issues, it may be beneficial to work with a physiotherapist who can improve them.

An occupational therapist can help make sure the sick individual remains as independent as possible throughout the course of the disease. A language and speech therapist can also help individuals who have communication problems.

Other Types of Therapy

Several other therapies can help persons who have dementia. Examples of these are reality orientation therapy that assists individuals to feel less confused and disoriented.

Cognitive stimulation therapy may also help individuals enhance their problem-solving skills, concentration, and memory.

Not all therapies will work for everyone. It is, therefore, important for an individual to consult their doctor first to choose the most suitable options. It is also best to work with experienced professional therapists for the best outcomes.

Support Groups

Joining support groups can also help people with vascular dementia. These open up a platform where people with the same illness can spend quality time with each other. It helps many cope with the disease because they are reassured that they are not the only ones with this type of dementia.

Such forums may also have professionals who can come in and offer advice on how the affected individuals can leave better with the disease. A quick search online will direct a person to the closest support group they can easily join.

Steps to Take After Getting a Positive Vascular Dementia Diagnosis

Getting the news that you have vascular dementia can be daunting. There are some steps you can take to get in terms with the illness and secure your future such as:

Talking to Someone

Confiding in someone you love and trust can help relieve some pressure after you get diagnosed with vascular dementia. It does not have to be someone you know as a professional is also a great pick.

Stay Informed

It is important to gather as much information as possible about the disease. It will help you know what to anticipate and how to tackle any changes that you may experience in life as a result of the progressive disease. Remember to only get details from trustworthy sources to avoid trouble.

Start Planning for the Future

This is where you should take care of things such as medical care and getting finances in order. It ensures you get the care you want when the symptoms start to become worse.

If the illness is still in its early stages it is also advisable to take care of legal matters like appointing a power of attorney, drafting a will, and taking care of everything else you need to handle when you can still make sober decisions.

Caring for a Person with Vascular Dementia

When a person gets a diagnosis for vascular dementia, they can continue to live independently for some time before the symptoms start becoming worse.

At some point, they may need the help of a caregiver to help them function well. Some of the caregiving tips carers can work with include:

Creating Routines

Most people with vascular dementia will feel less agitated and more comfortable when they are in familiar surroundings following a routine.

Use Clocks and Calendars

These can help the sick person reorient especially if they are fond of forgetting the time or date.

Offering Stimulation

Keeping a person with vascular dementia occupied is important because it gives them a purpose in life. Encouraging an individual to continue being socially and physically active can offer tons of benefits.

Nothing should be forced, but the person should participate in the things they love to avoid agitating them but making sure they have the best of times.

Communicate

Caregivers should try and communicate with the person with the progressive illness even when they are not sure they are understanding and even when they are not responding as expected.

Companionship can be shown in multiple ways including smiling, eye contact, or a reassuring touch.

During the first stages of the illness, most people can stay at home getting assistance from caregivers.

As the disease becomes worse and progresses to the final stages, the person with vascular dementia may have to move into a care facility where they will receive professional care until their last day on earth.