Ultimate Guide to Vascular Dementia
Dementia is a common condition within the elderly, but one that we often generalize. For example, not all patients that exhibit signs of dementia have Alzheimer’s disease. Yet, we often make the mistake of using these terms interchangeably.
Also, there are many different types of dementia that can develop. They may share similarities in terms of their effect on a patient, but they also have importance difference in their causes and symptoms.
It is important that medical staff, caregivers and relatives are aware of precisely what type of dementia a patient has. Vascular dementia is a common problem, yet the term can be unfamiliar to the general public. A greater understanding of the disease means a chance to understand what a patient is going through, and how to help them.
In this guide, we will look at some of the most important facts about this form of dementia. It is important that carers appreciate the range of symptoms that can occur, as well as the 7 stages of progression. This allows relatives to monitor symptoms, but perhaps also to have some empathy.
We will also look at the causes of this type of dementia and the way that doctors can diagnose the illness. Beyond that, we will look at a range of treatment options to help carers and patients manage the condition more effectively. We will end with a section on prognosis and mortality rates. Before all of that, let’s take a closer look at the definition of vascular dementia.
What is the Difference Between Dementia and Vascular Dementia?
Vascular dementia occurs when the blood vessels to the brain become diseased and less their function. This could present itself in a way where the walls of the veins weaken and blood leaks out. In other cases, these vessels may be blocked. They cannot carry blood to the brain at the same rate, which also means that the brain doesn’t receive the same amount of oxygen and nutrients that it once did. As a result, the brain cells begin to die off, which is where patients start to develop dementia symptoms.
Vascular dementia actually contains four different categories:
- stroke-related dementia
- post-stroke dementia
- single or multi-infract dementia
- subcortical dementia.
Strokes are a big cause of vascular dementia. Strokes occur when a hemorrhagic event or clot occurs in the blood system leading to the brain. This can lead to a loss of blood flow and quickly result in a loss of oxygen. The dementia could be the direct result of this event, or of subsequent problems during recovery. 20% of people that have a stroke can develop post-stroke dementia within six months. The subcortical dementia is different. Here the blood vessel deeper within the brain between stiff and twisted, impairing their function. This may lead to a different type of decline.
What are the Causes of Vascular Dementia?
The most common causes of vascular dementia are from strokes and other cardiovascular problems. This could be the result of poor health, such as a bad diet, poor blood pressure and other contributing factors. It is also said that the risk of developing this form of dementia can increase if a patient has a history of depression. Furthermore, the risk of developing the condition doubles every five years or so once we reach the age of 65. Age is a big factor here. This form of dementia isn’t seen so often in those below this age bracket.
Then There is the Issue of Mixed Dementia
It is also important to remember that many patients suffer from what is known as mixed dementia. This makes it even more difficult to generalize symptoms and cause when dealing with individual patients. It is estimated that around 10% of dementia patients actually have what is known as mixed dementia. Their disease develops as a result of different factors combined. Some people with Alzheimer’s may have a vascular event that leads to vascular dementia. The combination of diseases means they are mixed dementia patients.
What Does it Feel Like to Have Vascular Dementia?
The direct impact of this vascular problem and dying brain cells is a loss of cognition. A cognitive impairment is not the same thing as dementia. It is possible for people to suffer a lack of oxygen to the brain and some brain damage – either through vascular defects or other complication – and to not have dementia. It all depends on the severity of the illness.
For example, there are three main elements of cognition – they are memory, thinking, and reasoning. There could be people that experience memory problems as their vascular health declines. But, they may not struggle so much with thinking and reasoning.
Others may have some difficulties in the way they approach critical thinking or approach a problem. But, it may not be enough of a problem to impair their lie in a major way. Severe impairment is where these cognitive issues develop into vascular dementia.
What are the First Signs of Vascular Dementia?
It is important that all relatives are aware of the early signs of vascular dementia. The sooner that we notice these issues, or suspect that dementia may be developing, the sooner a patient can be assessed. The main issues here are those problems with cognition. This means problems reasoning, planning or recalling information.
Sufferers may begin to be a little slower with their thought processes – perhaps less able to recall words or name. Some may struggle to follow a conversation or line of thought. This could be due to problems with the language or flow of the conversation, or it could be down to concentration issues. Other may show signs of mood swings, irritability, and frustration.
Dealing with Behavior Changes
One of the most important things to consider right from the start is the way that you will handle any behavior changes that occur. These early issues with mood swings and other behavioral problems will only worsen with time.
It isn’t uncommon for a dementia patient to become slightly child-like in their demeanor or the way that they respond to other people. They may suddenly get frustrated if things become difficult or they can’t remember something that should be easy. This switches can be quite sudden and alarming.
Relatives that are aware of this, and have a plan in place, are better able to handle the situation. Find a way to communicate and respond so that these mood and behavioral issues can be controlled more readily.
What are the Different Stages of Vascular Dementia?
While it is crucial that patients, carers, and doctors identify the early signs of this disease, it is is also important that everyone is aware of the progression of the illness. These early signs are a sign that a patient may have the first stage of dementia. From there, the condition can only get worse.
Vascular dementia is a degenerative disease that can progress fairly quickly. As you will see from the treatment options below, there are measures that you can take to slow this decline. However, patients will find themselves dealing with the following 7 stages.
It might seem strange to talk about stage 3 first, but this is the stage that is the first that is evident to family and physicians. This is when relatives may begin to notice those early signs of cognitive problems. In vascular dementia, this may not take so long as it would with other forms.
There has been a severe cardiovascular event that causes a sudden loss of oxygen to the brain. This results in damage that may set about those changes in cognition and behavior. At this point, physicians can begin to make their diagnosis and formulate treatment plans. But, in many forms of dementia, the disease has already been causing damage.
Stages 1 and 2:
These stages occur prior to the noticeable side-effects of Stage 3. There are no signs of dementia here at all because the individual is able to function at a normal level. With time Stage 1 transitions into stage 2, which is considered to be very mild cognitive decline.
However, the change is still so small that it may go unnoticed by relatives, doctors or even the patient themselves. There is a term called a “senior moment” where we may shrug off a lapse of memory or concentration. Yet, this may actually be a sign of stage 2 of dementia.
This is where the categories and order of progression continue to sound a little confusing. IT isn’t until stage 4 that we reach what is known as early stage dementia. Here we have a more moderate form of cognitive decline. This means a change in symptoms beyond the initial confusion and forgetfulness of Stage 3. Memory issues continue to be a problem here as patients struggle to remember events, conversations and the day of the week.
There is also an increased tendency to misplace items around the home. Other cognition issues include a problem with language, planning, and sequencing. Mood and behavior issues also increase, with deeper feelings of anxiety, irritability, and depression.
By stage 5, patients start the exhibit the symptoms of mid-stage dementia. This is where cognitive decline reaches levels between moderate and severe. This can lead to increase issues with memory loss, such as forgetting numbers, addresses, and personal history. The patient’s perceptions also weaken, with some struggling with delusions, hallucinations and becoming lost. There are also problems with behavior issues in social settings, increased aggression, and sleep disorders
With time, this can decline further into a deeper form of mid-stage dementia. Patients experience similar problems, but with greater severity. Their short-term memory can decline even further as they struggle with day-to-day activities. They may also begin to lose track of the names of their loved ones or where they live.
These issues, along with changes in mood and anxiety, meaning that many patients will need long-term care and help with basic living. Mid-stage dementia stages 5 and 6, last for an average of 4 years. This can vary between patients and stage 6 could progress faster in some people than in others.
Stage 7 of the disease is known as Late-Stage Dementia. This is the very end of the illness where patients experience a serve cognitive decline. This means that they can become highly confused, which may lead to aggressive outburst and an inability to communicate properly. The physical symptoms of the disease also deteriorate further. Many have difficulties eating and swallowing, which can result in weight loss. There are also problems with mobility, walking, and general health. Some struggle with immune system weaknesses and become susceptible to MRSA, pneumonia and other major illnesses. This state of the decline can last for around 2 and a half years.
How Do They Test for Vascular Dementia?
The first stage of a diagnosis for vascular dementia comes from a doctor’s appointment. Here your friendly family physician can run some basic tests on cardiovascular health and other symptoms. This means a physical exam and a test of some mental abilities.
In some cases, they may also take blood samples to test for deficiencies and hormonal issues. It is always better for patients to go into this exam with a second person. Carers and relatives can offer anecdotal advice on behavior that the patient isn’t necessarily aware of.
From there, a patient will most likely be referred to a specialist – such as a psychiatrist, neurologist and/or geriatrician – for a deeper analysis of symptoms. They are there to look at all possible causes. The aim isn’t to find dementia but to rule out all possible causes of symptoms.
Some patients will undergo a CT or MRI scan to take a closer look at the brain function and the health of the organ and its blood supply. Again, this is as much to rule out other causes and tumors as it is to look for signs of dementia. Once doctors can make a clear diagnosis, they can place patients on a treatment plan.
What is the Best Medication/Treatment for Vascular Dementia?
Can vascular dementia be cured? Sadly not. There is no cure, but it is possible to manage a condition and improve the quality of life. Treating cardiovascular disease to help limit the risk of developing further complications and slows the progression of the illness. It also helps to look at other courses of treatment to ensure that patients manage as many symptoms as possible.
The wider the range of activities and lifestyle changes, the better the chance of improvement. When we say improvement, we don’t mean any kind of reversal of dementia. What we mean is an improvement in the way that patients deal with their symptoms. The symptoms may worsen, but patients could find ways of handling them in a more controlled, positive manner. Carers can also help to improve the overall quality of life for patients. Therefore, they can have more fun and live pain-free even if their cognition continues to deteriorate.
Treatment can rely on a combination of different factors in order for patients to control their symptoms and slow the progress of dementia. It also helps to use a trial and error approach to get the best results. This includes the following:
- dietary changes
- physical exercises
- mental exercises
- creative therapies
- alternative therapies
The first consideration for most dementia patients and their carers is the use of traditional drugs. There aren’t that many options here because there are so few drugs relating to this form of dementia.
There are specific drugs for Alzheimer’s that may not be so helpful here – that is unless the patient is dealing with mixed dementia and Alzheimer’s and vascular dementia co-exist. The only major pharmaceutical option here seems to be to focus on medication for the cardiovascular side of the illness. Those that can control blood pressure, clotting and other related illnesses can reduce their risk of further complications.
Changes in diet can help patients with vascular dementia. There are many dementia patients that are encouraged to opt for what is known as the Mediterranean diet. This diet is rich in omega oils, healthy fish and vegetables, and olive oil. It is meant to promote brain health while also providing many other nutritional benefits.
There are also some dieticians that promote the use of a more colorful diet when treating seniors with dementia. This has a great potential for physical health because these foods often contain high levels of antioxidants. At the same time, these colorful meals can simply be far more engaging for patients
There are also carers that like to look into the potential of supplementation and natural substances to improve the health of vascular dementia patients. Some would argue that if there is no cure to be found, it may be kinder to work with natural remedies rather than too many chemical drugs.
Ginkgo Biloba is a common choice because it is so widely used and has so many antioxidants. There are some patients and caregivers that encourage its use because of the impact on mental function and circulation. Both are vital when it comes to cases of vascular dementia.
However, it is also important to note that there is little scientific evidence for the use of ginkgo biloba for dementia patients right now. Others are turning to turmeric as a well of aiding brain health and preventing against inflammation.
Staying mentally and physically active is essential. This true for all forms of dementia. It is proven that those that engage with physical and mental activity can reduce the impact of the disease. This doesn’t mean that seniors have to head into the gym or start any form of strenuous exercise. It simply means a chance to get the muscle moving and the blood pumping.
Carers often advise patients to enjoy regular, small walks. This could be as simple as a walk in a mall or a local park. Often, it isn’t the distance that is important, but rather the chance to engage with the outside world and sensory experience. This is why so many seniors with early signs of dementia are encouraged to continue gardening. The gentle movement and connection to the flower and vegetables can be highly rewarding.
As for activities for mental health, there are many seniors with vascular dementia that can benefit from puzzles. The daily crossword in the paper could prove to be a better healthcare tool that many relatives realize. Other card and board games can also help to provide that mental stimulation and keep the brain active. Jigsaw puzzles are a great help, especially those with nostalgic images that are specially designed for dementia patients. Seniors that enjoy bridge or poker are encouraged to keep this up. These games also offer a social benefit.
Art and Music Therapy:
Art and music therapy have become popular forms of treatment for seniors with vascular dementia. These activities encourage patients to use the right side of their brain, rather than focusing purely on the left side with those logic puzzles. Music therapy can bring people together and add another nostalgic element with songs from their youth. Art gives them the chance to be creative, play with color and perhaps also to improve their hand-eye coordination.
We also can’t overlook the potential of psychotherapy in a more clinical sense. Art therapy and music therapy have potential here, as seniors can talk about their past and their emotions as they create. But, some vascular dementia patients may benefit from deeper psychiatric help. Those in the early stages may experience fear, anxiety, and depression about their prognosis. Therapy may allow them to communicate these issues and offer ways to handle the prognosis more easily. This, in turn, could improve treatment plans and slow the progression of dementia.
Finally, there are some alternative therapies that individuals may find to be helpful in the fight against dementia. Some individuals with vascular dementia will find that they benefit greatly from massage therapy. Massage therapy is a great idea for those that are calm enough to handle the situation and have enough trust in the therapist. These massages can stimulate the flow of blood and lymph around the body. This may help with circulation issues and general health. There are also some potential psychological effects from turning to massage therapy. The stress relief could help those dealing with anxiety and depression.
Then there is the potential for a session of acupuncture. The aim here isn’t quite so straightforward in a physiological sense. The aim here is to use needles in key areas to redirect the flow of the body’s energy, otherwise known as Qi. Many people use this treatment for pain relief and depression. There is a chance that lucid, cooperative patients could enjoy the benefits. With both of these options, the results may be much better for those in the early stages of the illness.
How Long Can You Live After Being Diagnosed with Vascular Dementia?
It is easy to focus on all these ideas of care and treatment and overlook the issues of mortality and life expectancy. There are lots of ways to slow the progression of vascular dementia and offer a good quality of life to a patient.
Still, the disease will progress and the patient will eventually die. A lot of the time, mortality is the result of cardiovascular issues. Those that developed vascular dementia from a stroke will end up suffering another, fatal stroke. Others will deal with heart attacks.
Each person will experience dementia differently. Generally speaking, patients with vascular dementia can expect to live for five years after the start of the illness. This is actually less than the average for Alzheimer’s disease.
Relatives must remember that this 5 year period is just an estimate. Every case is different and life expectancy will depend on a number of different factors. For some, this time frame could be a little longer. Those that follow a careful, manageable plan and enjoy life could extend their prognosis a little and have a more peaceful end.
For others, other complications could cut this time short – even with the best plan in place. Carers and patients that don’t catch the signs early enough, or fail to take advantage of treatment plans, could see a much shorter life expectancy.
Preparation and End of Life Care for Relative and Patients With Vascular Dementia.
That is why it is important that carers take the time to use all the resources available to them. It is understandable if families don’t want to make drastic changes. Some don’t want to upset relatives, the payout for costly treatments or – in some cases – deal with the reality of the situation. The problem here is that early intervention and an openness to solutions could buy patients a lot of time. That is why family members need to stay realistic.
Taking a More Realistic Approach to This Disease with the Final Days in Sight.
We don’t want to have to think about the death of our loved ones, even if we understand that this dementia will eventually take them from us. However, those that are prepared and have a plan in place will find that the final days are much more manageable.
This means creating a plan for the final days and ensuring that the wishes of the patient are met. Relatives may want to talk with patients in earlier stages of the disease about their personal views and wishes. This is when they will have the cognition to understand the situation and give an honest answer.
From there, you can also set up an end of life plan including plans to move into palliative care and which treatment options to pursue. It is also important to contact a family lawyer to determine the power of attorney and any other legal obligations. A patient should be able to choose who has the final say over their care – rather than have the decision forced upon them when they are no longer able to communicate clearly.
What We Have Learned About Vascular Dementia?
There are some clear similarities between vascular dementia and other forms, such as Alzheimer’s disease. There is a similar route of degeneration and progression with a decline in cognitive ability. The main difference here is the focus on cardiovascular health. This form of dementia comes from a deterioration of the vascular system and the resulting death of brain cells.
Common causes are strokes and poor cardiovascular health. Treatment plans often focus on cardiovascular healthcare, diets, and exercise to help reduce the risk of further damage.
However, there are also other therapeutic options that can help once the disease progresses. Like other forms of dementia, vascular dementia is incurable. The disease will progress and the patient will eventually succumb to the illness. Again, the cause of death may also be rooted in cardiovascular health issues.
The outlook can be pretty bleak for anyone dealing with this illness. After a positive diagnosis, patients will experience a decline in their cognitive functions and eventually die. The best approach for all relatives and carers to find a treatment plan that slows this degeneration and makes life more comfortable and pleasant for all concerned.
Education and preparation from the start can help you to formulate a strong, effective plan of action. This means looking at medication, care facilities and different forms of therapy. It also means knowing how best to handle the patient as their personality changes and how to prepare for the end.
The important thing is to keep the best interests of the patient in mind. Work on their diet, exercise and activities, but don’t push them into something that may trigger those behavioral or psychological problems. Plan for the end stages and final days, but don’t forget to enjoy the better days in the early stages. Take care of your relative, lean on support where possible and you can find that it is possible to manage vascular dementia in a positive way.