A Beginner’s Guide to Vascular Dementia

Photo by Cristian Newman on Unsplash

They say every cloud has a silver lining.  One good thing did come out of mother’s horrible hospital stay.  A CT scan.  As Dr Lipschitz put it, when I queried whether she might have mixed dementia: “The clinical picture … is more suggestive of a vascular causality”.

Knowing this sooner wouldn’t have made any difference to mother’s prescribed medications.  Both her geriatrician and her doctor have been taking this possibility into account for many years.

It’s more of benefit to me.  The Infoholic.  Who wants to better understand what’s happened to my mother.  So, here is what I’ve discovered:

Incidence of Vascular Dementia

  1. Vascular dementia is the second most common form of dementia (after Alzheimer’s disease), accounting for approximately 20 per cent of all cases.
  2. “Age is the strongest risk factor… A person’s risk of developing the condition doubles approximately every five years over the age of 65.”1
Photo by Ken Treloar on Unsplash

Vascular Dementia and Blood Supply to the Brain

  1. Vascular issues relate to the vessels, channels, arteries or veins that carry or circulate blood.
  2. Vascular dementia is the result of injury to the vessels carrying blood to the brain.
  3. Brain cells that are deprived of oxygen and nutrients will eventually die. This happens when blood flow to the brain is reduced, e.g. through arteriosclerosis (hardening and narrowing of the arteries), or blocked, e.g. through blood clots in an ischaemic stroke.
  4. Vascular dementia has also been “associated with a condition called amyloid angiopathy, in which amyloid plaques accumulate in the blood-vessel walls, causing them to break down and rupture.”2
  5. Stress can raise blood pressure and heart rate, resulting in the blood vessels becoming constricted, thus reducing blood supply to the heart and brain.
  6. High blood pressure, heart disease and diabetes can result in strokes or mini strokes (sometimes called TIAs or transient ischaemic attacks) that damage the brain.

Vascular Dementia and Strokes

  1. Not everyone who suffers from a stroke will develop vascular dementia. However, 25% to 30% develop vascular dementia within 3 months to a year.
  2. Vascular dementia due to one stroke is known as single infarct dementia.
  3. Vascular dementia due to multiple mini strokes is known as multi infarct dementia.
  4. These mini strokes “take place over time giving rise to many tiny, widespread areas of damage. These strokes can be so small that a person may not know they are having them, in which case they are called ‘silent strokes’.”3
  5. As the damage from these multiple mini strokes accumulates, so a decline in thinking abilities becomes evident. (This seems to be the case in my mother’s condition.)
  6. Vascular dementia due to lacunar strokes where small vessels deep within the brain become completely blocked is known as sub-cortical vascular dementia.

Extent and Progression of Vascular Cognitive Impairment

  1. Damaged and dead brain cells result in vascular cognitive impairment – a decline in thinking abilities.
  2. Vascular cognitive impairment can range from mild to severe, depending on a) the amount of damage to blood vessels and b) which region or regions of the brain have been damaged
  3. “Vascular dementia sometimes develops in ‘steps’, so that symptoms will stay the same for a while and then suddenly get worse. These steps are usually due to new strokes.”4

Treatments for Vascular Dementia

  1. There is no specific treatment for vascular dementia. You “may be prescribed medication to reduce the risk of further strokes and prevent further damage. This can include blood-thinning medicine like aspirin or warfarin to reduce the risk of clots forming, and medication to lower your cholesterol and blood pressure.”5

My Discoveries

My mother led a healthy lifestyle and still follows advice to control blood pressure, reduce the risk of clots and prevent cholesterol.  But none of this slows the onward march of vascular dementia.

Knowing how this form of dementia progresses, I cannot help but recall the major steps in my mother’s journey.  In particular, the corrupt, despicable person who caused her significant distress in her early eighties.  Which triggered the first dramatic changes in her demeanour and brain functioning.  Most likely via silent, mini strokes.

Ironically, years earlier I had confronted him about his abusive behaviour towards his own elderly sisters.

What is of note is that:

  • I have to make lifestyle changes if I am to have any chance at remaining mentally fit. (Easier said than done!!!)
  • Abusive behaviour, especially towards the vulnerable elderly, is immensely dangerous, and can have long term consequences. We all should be standing up against it.  Sadly, in my experience, too many people lack the moral fibre to do so.

These discoveries along the vascular dementia path with my mother are teaching me more than I anticipated!  Stuff about myself.  Stuff I need to fix.  But also:  stuff I’m proud of.

Yet, this blog is not just about me.  I hope you’ve learnt something new too, today!

 

Quotes from:

  1. The Alzheimer’s Association in the U.K.
  2. Alzheimer’s Weekly – What is vascular dementia
  3. The Stroke Association – Dementia after stroke
  4. The Stroke Association – Complete guide to vascular dementia
  5. The Stroke Association – Dementia after stroke

Other sources of information:

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