Vascular Dementia

Vascular dementia generally occurs as a result of a decrease in the required amount of oxygenated blood to the tissues of the brain. Following Alzheimer’s disease and Lewy Body disease, dementia related to decreased or inadequate blood supply is a very common form of dementia. Formerly, the condition was known as multi infarct dementia as it was considered to be due to the presence of minor strokes. The term vascular dementia is now used to describe the condition because there are a number of problems that can lead to the impairment of the blood supply to the cells of the brain. This form of dementia is sometimes seen occurring along with Alzheimer’s disease, a condition which is known as ‘mixed dementia’. The risk of developing vascular dementia has been seen to increase with increasing age. DSM-IV recognizes vascular dementia as a disorder and has separate diagnostic criteria for it.

Causes:

The primary cause of vascular dementia is the partial or total blockage of the vessels that supply blood to the brain. This usually occurs due to the narrowing of the vessels that constrict the lumen, and hence the cells of the brain are deprived of the normal amount of oxygen and nutrients that are required for their optimal functioning. Vascular dementia also results due to the presence of numerous minor strokes that can occur over a gradual course of time. It is for this reason that vascular dementia was formerly known as ‘multi infarct dementia’. It is a fact however, that there are various other conditions apart from strokes that can lead to the partial blockage of blood vessels, which include diabetes mellitus and elevated blood pressures.

High Risk Factors:

Patients, who present with medical histories of either one or more conditions that have been enlisted as follows, have a greater risk of developing dementia. The conditions that can lead to the development of dementia include:

  • Elevated Blood Pressure
  • Heart Attacks
  • Elevated Cholesterol Levels
  • Stroke
  • Diabetes Mellitus

Multiple strokes in the history of a patient are also seen as a significant indicator of vascular dementia, as they can cause more damage to the brain tissues with each successive stroke that occurs.

Symptoms:

There are several indications that are associated with the development of dementia occurring due to decreased blood flow to the brain. Patients show manifestations of cognitive problems which include difficulty in retrieving memories, along with agnosia, which is the loss of ability to recognize of objects and people, aphasia which is the impairment or dysfunction of the ability talk, make verbal communication or comprehend language, and apraxia, which is the inability comply to or comprehend orders and commands.

They also show problems in executing normal functions such as:

  • Difficulty in keeping a steady job
  • Carrying out responsibilities of the household
  • Maintaining social or personal relationships

Neurological Symptoms:

There are various neurological symptoms that are also associated with dementia occurring due to inadequate oxygenated blood supply to the brain, which include:

  • Exaggerated or abnormal reflexes
  • Difficulty in balancing or walking
  • Experiencing weakness or lack of energy of the upper and lower limbs

The patient may also show signs of confusion, delusions, dementia, nervousness, agitation, bladder control problems and depression depending upon the type, cause and extent of dementia.

In case of vascular dementia, memory loss occurs at a more progressed stage in contrast to Alzheimer’s whereby it develops at an early and progressing stage of the disease. The initial symptoms that are associated with vascular dementia include neurological symptoms that may result in problems related to weakness of the limbs, walking, balancing and reflexes. Memory and behavior related symptoms are the initial indicators of Alzheimer’s disease, which is an important diagnostic feature as well. The progression of the disease is also different in both cases, for example, the disease progression is usually in a gradual manner in case of Alzheimer’s whereas, it shows a distinct step ladder manner of progression in case of vascular dementia.

Treatments:

There are no drugs that can cause the complete reversal of vascular dementia rather the condition is symptomatically managed. Some of the medications and drugs that are used for Alzheimer’s patients have produced positive results, in which case many doctors prescribe cholinesterase inhibitors as well as Namenda for the treatment of vascular dementia. Selective Serotonin Reuptake Inhibitors have found to be helpful to treat symptoms of anxiety and depression. Antidepressants are usually not prescribed to patients of vascular dementia.

Lifestyle Changes

Since vascular dementia is related to cardio-vascular problems, making life style changes is always beneficial for the patients. This condition worsens with time, and avoiding unhealthy food, incorporating exercise in the lifestyle of patients (who are still capable of exercise) and controlling high blood pressure, obesity and diabetes can help the prevalence of more strokes. The patients pulse, blood sugar, cholesterol and weight needs to be closely monitored as well. All these make a difference to brain health.

Behavior Management

Patients of vascular dementia (and other types of dementia) who are elderly usually suffer from agitation and even aggression. Behavior management has to be done for such patients. The families of these patients also need to be counseled and taught techniques to handle the aggressive or over anxious behavior of such patients.

References:

DSM-IV The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, AP

http://www.mayoclinic.com/health/vascular-dementia/DS00934/DSECTION=symptoms

Zarit, J. M and Zarit, S. H (1998). Mental disorders in older adults: Fundamentals of assessment and treatment. New York: The Guilford Press.

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