Overview Of Dementia
Dementia is a gradual and permanent loss of brain function. This occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.
Vascular dementia is caused by a series of small strokes over a long period.
Commonly Associated With
MID; Dementia – multi-infarct; Dementia – post-stroke; Multi-infarct dementia; Cortical vascular dementia; VaD; Chronic brain syndrome – vascular; Mild cognitive impairment – vascular; MCI – vascular; Binswanger disease
Causes Of Dementia
Vascular dementia is the second most common cause of dementia after Alzheimer’s disease in people over age 65.
Vascular dementia is caused by a series of small strokes.
A stroke is a disturbance in or blockage of the blood supply to any part of the brain. A stroke is also called an infarct. Multi-infarct means that more than one area in the brain has been injured due to a lack of blood.
If blood flow is stopped for longer than a few seconds, the brain cannot get oxygen. Brain cells can die, causing permanent damage.
When strokes affect a small area, there may be no symptoms. These are called silent strokes. Over time, as more areas of the brain are damaged, the symptoms of dementia appear.
Not all strokes are silent. Larger strokes that affect strength, sensation, or other brain and nervous system (neurologic) functions can also lead to dementia.
Risk factors for vascular dementia include:
- Hardening of the arteries (atherosclerosis), heart disease
- High blood pressure (hypertension)
Symptoms may also be caused by other types of disorders of the brain. One such disorder is Alzheimer’s disease. Symptoms of Alzheimer’s disease can be similar to those of vascular dementia. Vascular dementia and Alzheimer’s disease are the most common causes of dementia and may occur together.
Symptoms Of Dementia
Symptoms of vascular dementia may develop gradually or may progress after each small stroke.
Symptoms may begin suddenly after each stroke. Some people with vascular dementia may improve for short periods, but decline after having more silent strokes. Symptoms of vascular dementia will depend on the areas of the brain that are injured due to the stroke.
Early symptoms of dementia can include:
- Difficulty performing tasks that used to come easily, such as balancing a checkbook, playing games (such as a bridge), and learning new information or routines
- Getting lost on familiar routes
- Language problems, such as trouble finding the name of familiar objects
- Losing interest in things you previously enjoyed, flat mood
- Misplacing items
- Personality changes and loss of social skills as well as behavioral changes
As dementia worsens, symptoms are more obvious and the ability to take care of oneself declines. Symptoms may include:
- Change in sleep patterns, often waking up at night
- Difficulty doing basic tasks, such as preparing meals, choosing the proper clothing, or driving
- Forgetting details about current events
- Forgetting events in your own life history, losing awareness of who you are
- Having delusions, depression, or agitation
- Having hallucinations, arguments, striking out, or violent behavior
- Having more difficulty reading or writing
- Having poor judgment and loss of ability to recognize the danger
- Using the wrong word, not pronouncing words correctly, or speaking in confusing sentences
- Withdrawing from social contact
- Nervous system (neurologic) problems that occur with a stroke may also be present.
Exams & Tests
Tests may be ordered to help determine whether other medical problems could be causing dementia or making it worse, such as:
- Brain tumor
- Chronic infection
- Drug and medicine intoxication (overdose)
- Severe depression
- Thyroid disease
- Vitamin deficiency
- Other tests may be done to find out what parts of thinking have been affected and to guide other tests.
Tests that can show evidence of previous strokes in the brain may include:
- Head CT scan
- MRI of the brain
Treatment Of Dementia
There is no treatment to turn back damage to the brain caused by small strokes.
An important goal is to control symptoms and correct the risk factors. To prevent future strokes:
- Avoid fatty foods. Follow a healthy, low-fat diet.
- DO NOT drink more than 1 to 2 alcoholic drinks a day.
- Keep blood pressure lower than 130/80 mm/Hg. Ask your doctor what your blood pressure should be.
- Keep LDL “bad” cholesterol lower than 70 mg/dL.
- DO NOT smoke.
- The doctor may suggest blood thinners, such as aspirin, to help prevent blood clots from forming in the arteries. DO NOT start taking aspirin or stop taking it without talking to your doctor first.
The goals of helping someone with dementia in the home are to:
- Manage behavior problems, confusion, sleep problems, and agitation
- Remove safety hazards in the home
- Support family members and other caregivers
- Medicines may be needed to control aggressive, agitated, or dangerous behaviors.
Medicines used to treat Alzheimer’s disease have not been shown to work for this condition.