Jul 10, 2014

Vascular Dementia: does your loved one really have this instead of Alzheimer’s?

Vascular dementia is considered to be the second most common type of dementia surpassed only by Alzheimer's disease. Vascular dementia occurs when blood vessels in the brain narrow, reducing the amount of blood flowing to the brain. 

Carole Larkin
If you don’t get a “fully baked” diagnosis for your loved one, see - Dementia and Depression -- How to get a "Fully Baked" Diagnosis, you may think your loved one has Alzheimer’s disease, when in fact they don’t.

They may have another type of dementia altogether.

These dementia(s) can and do coexist with Alzheimer’s disease, resulting in something neurologists called “Mixed Dementia”, but for purposes of this article, I’m going to treat them as if they existed alone in a person’s brain.

By Carole B. Larkin
Alzheimer's Reading Room

This article is generated from a lecture I attended given by two leading local geriatric psychiatrists/neurologists (yes they are both!) and a leading local neuropsychologist.

They lectured on three dementia(s) that are not as common as Alzheimer’s, but are more common than you would believe. Each doctor lectured on one of the diseases and I will try to briefly summarize what each said in a series of three articles. This is the first of those articles.

Dr. David Crumpacker spoke about what is now called Vascular Dementia. VD comes from strokes and mini strokes (called TIA’s).

Strokes and mini strokes happen when the veins and arteries that bring blood, containing oxygen and food to the brain cells burst. The cells in that area don’t get the food and oxygen they need and so the cells die. Where in the brain the strokes and mini strokes happen will dictate what symptoms the person will have. Also the severity of the stroke or mini stroke will dictate the severity of the symptoms and behaviors the person will have.

Dr. Crumpacker says Vascular Dementia is really a spectrum of diseases, not just one disease. He says that Vascular Dementia can happen to a person gradually or suddenly. It used to be thought that the trajectory of Vascular Dementia was like stair steps going downward. The person would have a stroke or mini stroke and lose brain function, then level out for awhile (called plateauing) and then have a big drop in functioning again when the next set of strokes or mini strokes hit. Now some doctors think that it may sometimes be a smoother downward trajectory than was thought before.

Vascular dementia’s symptoms can fluctuate because some blood clots in the brain can resolve. That means that the blood flooding the area can be reabsorbed back into the local brain cells, thus feeding them again, and saving some cells from cell death for a little while. So, with some strokes and mini strokes, some people can get better in some aspects of their thinking and behavior. Not everybody and not all the time, but some people can get better, at least for a while.

That is wonderful (and confusing) for the care partner. Many of us have seen stroke victims get better with physical and occupational therapy for their body functions. It also can work that way with their thinking. So if possible, always ask the doctor to order physical, occupational and speech therapy for your loved one after a stroke or mini stroke. Speech therapy is the part of therapy that primarily addresses cognition and thinking.

Dr. Crumpacker says that Vascular Dementia can result in any or all of the following cognitive symptoms or behaviors, depending on where in the brain the bleed occurs.

Deficits can occur as:

Aphasia- the National Aphasia Association defines aphasia as an impairment of language, affecting the production or comprehension of speech and the ability to read or write. There are several different types of aphasia and different strengths of impairment from mild to impossible to communicate at all depending on how serious and where in the brain the clot was. Some affect speech only, some affect understanding speech when spoken to only, some affect reading or writing only.

Apraxia- the National Institute of Neurological Disorders and Stroke defines apraxia as a neurological disorder characterized by loss of the ability to execute or carry out skilled movements and gestures, despite having the desire and the physical ability to perform them. There are several different types of apraxia and different strengths of impairment depending on how serious and where in the brain the clot was. Some affect facial muscles like winking or licking your lips or moving your eyes on command. Some affect limbs, like moving yours arms and legs or fingers or toes.

Agnosia- the National Institute of Neurological Disorders and Stroke defines Agnosia as an inability to recognize and identify objects or persons. People with agnosia may have difficulty recognizing the geometric features of an object or face or may be able to perceive the geometric features but not know what the object is used for or whether a face is familiar or not. Agnosia can be limited to one sense such as vision or hearing. For example, a person may have difficulty in recognizing an object as a cup or identifying a sound as a cough.

Dysexecutiveness- the definition is from the Barkley Deficits in Executive Functioning Scale (the standard test used in measuring executive function). If a stroke or some mini strokes occur in the frontal or temporal lobes (behind your forehead and between your face and your ears on either side of the head) our executive functions are impacted. Executive functions are the parts of our thinking that make us human. That is, our capacities involved in time management, organization and problem solving, self-restraint, self-motivation, and self-regulation of emotions among other skills. Deficits in these functions impact our ability to function in society, and many times are the source of care partners’ embarrassment or shame.

Memory impairments-  If a stroke or some mini strokes occur in the general hippocampus area (deep inside the brain in the middle of the head) our memories and our ability to learn new things are impacted. Memories can be impaired in one of two ways, and maybe even in both ways. The ability to store new memories or learn new things can be impacted and/or the ability to retrieve current and old memories. This is the part of vascular dementia that looks like Alzheimer’s, but isn’t Alzheimer’s.

Dr. Crumpacker was clear in saying that there are NO current treatments for Vascular Dementia, period. 

He said that preventing the risk factors for Vascular Dementia is the only way to treat the disease. The number one risk factor is getting older, which one can’t really do anything about.

Risk factors we can do something about are: smoking, high blood pressure, high cholesterol, diabetes, having an unhealthy diet, lack of exercise, being overweight, and drinking alcohol excessively.

Considering that that risk factors can and do occur long before the age of 50, those of us over 50 need to rely on medicine to lower some of the risk factors. But other risk factors we can work on, even at this late date, to attempt to lower the current risk factors we have. That means no matter what your age, you can still do things to help yourselves and your loved ones.

Will it fix you? No, it won’t. but it might help hold it off a while longer, and maybe it will be long enough that you’ll die of other reasons first. Not a cheery statement I grant you, but you wouldn’t suffer the indignities of dementia along with your physical ailments.

Here’s what concerns me.

It’s no secret that there is a worldwide obesity epidemic, as well as an Alzheimer’s epidemic. If Vascular Dementia comes from the above risk factors, almost all intimately connected with obesity, then it stands to reason that we will now have 2 dementia epidemics on our hands.

As a matter of fact, I suspect that a great deal of Vascular Dementia is really undiagnosed, or incorrectly diagnosed as Alzheimer’s disease. I bet that even at this moment, Vascular Dementia rivals Alzheimer’s as the number one cause of dementia, we just don’t know it. Scary!

If each of us make a sustained, concerted effort to improve our heart health by diet and exercise, and make it a point to try and influence our children, grand children and great grand children to do the same, maybe we can head off the second dementia epidemic, Vascular Dementia.

About Carole Larkin

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