Dementia is a decline in memory and orientation. Due to the increase in life expectancy, the risk of developing dementia is also increasing. There are different forms of dementia, the most common being Alzheimer’s disease. About 20 percent of all dementia patients suffer from vascular dementia. Vascular means that the cause of this dementia is a circulatory disorder of the brain.
What is vascular dementia?
Memory training is usually applied in the early stages of dementia and orientation disorder adapted to each disease state. Dementia is the term for a decline in the mind. Vascular is a medical term for all diseases that affect the blood vessels. Vascular dementia is characterized by a steady decrease in a person’s mental, and in later stages also motor, abilities. As a result, retentiveness, as well as the processing of received stimuli, such as viewing and evaluating an image, are limited or canceled.
Causes
The cause of vascular dementia is a reduction in blood flow to the brain. The greatest risk factor for developing vascular dementia is age. The older people get, the higher the risk of developing vascular dementia. Another factor that promotes the development is arteriosclerosis (calcification and hardening of the blood vessels) in the brain. The main causes of arteriosclerosis are poorly controlled diabetes, disturbances in fat metabolism and nicotine. Obesity is also a risk factor for the development of arteriosclerosis. Small or large cerebral infarctions cause brain tissue to die, and function is impaired or lost. The severity of the disorder depends on the location of the damage caused by the cerebral infarction.
Symptoms, complaints, and signs
Vascular dementia does not occur abruptly. Overall, symptoms increase gradually. It happens that a patient remains in one condition for months and years and then seems to improve. However, this brief upturn is then followed by another abrupt downturn. Signs of vascular dementia occur in a combination. Patients appear confused to bystanders. They can articulate themselves only vaguely and search for terms with which they can express simple facts. They also find it increasingly difficult to cope with everyday life. For example, they can no longer operate technical devices such as a television. They are unable to decide for or against something. A choice of lunches, for example, can overwhelm them. Their sense of direction is also impaired. Affected persons with vascular dementia at times no longer know where they are. The symptoms described have a direct impact on personality. Anger and aggressiveness consequently set in with those affected. A sudden inner restlessness and constant mood swings are part of everyday life. They no longer understand their environment. The damage in the brain area sometimes also causes movement disorders. Affected persons walk unsteadily and fall easily. Incontinence occurs. Neurological deficits such as problems with vision set in.
Diagnosis and progression
The diagnosis for vascular dementia can only be made by a physician. For this purpose, a detailed medical history (patient interview) is required. Interviewing family members is also important in making the diagnosis. The main criteria include a disturbance of the memory, a circulatory disorder and high blood pressure. A confirmed diagnosis is possible by magnetic resonance computed tomography (MRI), as the damaged brain structures can be well visualized here. Before a diagnosis of vascular dementia is made, it is important to rule out other similar diseases (Alzheimer’s dementia or Parkinson’s disease). The course of vascular dementia is characterized by a decrease in short-term memory. As the disease progresses, the ability to remember also decreases significantly. Later, memories from the long-term memory, as well as motor, linguistic and social skills are no longer possible. Typical of vascular dementia is the early onset of gait disturbances and coordination disorders. The patient’s character does not change until later in the course of the disease. At this time, there are also perceptual disturbances and orientation disorders. In some cases, epileptic seizures occur in the patients. The behavior changes.Patients become apathetic, suffer from eating disorders, sleep disturbances and anxiety. Hallucinations and depression are also common.
Complications
If vascular dementia is not recognized right away, the condition of the person with dementia visibly worsens: self-neglect occurs, affecting household chores, personal hygiene, and nutrition. Orientation to time and place also increasingly fades, which can lead to serious accidents if the affected person moves freely without accompaniment. The day-and-night rhythm becomes unbalanced and there is a considerable lack of sleep. In general, the phases in which the person with dementia is asleep or awake are no longer linked to the time of day. A deterioration of memory occurs and the memory contents are replaced by delusional accounts of experiences that seem inappropriate to the environment. Dizziness also increases if treatment is not given, and the risk of suicide increases for those affected. In the late stages, dementia patients no longer even remember familiar people and neurological deficits occur. Food intake and elimination are permanently disturbed, which seriously affects the physical state of health. Urinary tract disorders, dysphagia and bedriddenness also occur. If the affected person is treated, aspiration often occurs during feeding. In this case, the smallest pieces of food reach the lungs and damage them. The tissue is damaged and even pneumonia is not uncommon. If vomit is aspirated, the bronchial mucosa in particular is severely attacked.
When should you go to the doctor?
If the affected person or close relatives notice a prolonged period of loss and irregularity of memory activity, a clarification of the symptoms should take place. Sleep disturbances, anxiety states and changes in personality are understood as warning signals in the medical field. To clarify the cause, a visit to the doctor is necessary so that various tests can be performed. Disturbances of orientation, a loss about factual knowledge of the personal area as well as changes of attention should be discussed with a doctor. Abnormalities of eating behavior, hallucinations or peculiarities of behavior should also be clarified. An epileptic seizure disorder should always be examined more closely by a physician after each seizure suffered. High blood pressure, loss of zest for life, and withdrawal from social life are considered worrisome. If the tendency to conflict increases, appointments are forgotten, or the affected person reproduces objectively false memories, a physician must be consulted. Gait insecurities, dizziness, coordination disorders as well as speech abnormalities are further complaints for which a causal investigation is required. Depressive or aggressive states, listlessness and apathy must also be examined more closely. A visit to the doctor is necessary in case of general dysfunctions, problems with the swallowing act and changes in breathing activity. If the general risk of accidents increases and the affected person’s usual personal hygiene fades, members of the social environment should point out the need to see a doctor.
Treatment and therapy
Treatment of vascular dementia should begin early. Medication, physiotherapy, and psychological treatment are all available here. To prevent further damage to the blood vessels in the brain, the physician will prescribe agents to thin the blood and thus improve its flow properties. Furthermore, antihypertensive agents should be prescribed cautiously to protect the blood vessels in the brain. The dosage must be adjusted slowly, otherwise the blood pressure would be lowered too quickly, resulting in reduced blood flow to the brain. The blood sugar must be optimally adjusted. In the later stages, psychopharmaceuticals such as antidepressants and [[neuroleptics6]] are required, depending on the patient’s findings and condition. In order to maintain the patient’s mobility for a long time, and to improve coordination, physiotherapeutic therapy is important. Here it is possible to work out a compensation of the disturbances caused by the vascular dementia by certain techniques. Furthermore, a psychotherapeutic treatment of the affected person is recommended in order to promote independence, orientation and personal responsibility.
Prevention
Prophylaxis of vascular dementia consists of a healthy lifestyle, the main goal of which is to avoid influences that damage blood vessels. This includes optimal adjustment of blood glucose, a balanced low-fat diet, sufficient exercise, and avoidance of nicotine. Regular checks of blood values give the physician the opportunity to recognize risk factors for vascular dementia at an early stage and to combat them with dietary or medicinal measures. Furthermore, a normal weight should be aimed for. Various studies have demonstrated the vasoprotective effects of red wine in small amounts.
Follow-up
In the follow-up of vascular dementia, the patient’s underlying disease must be taken into account. These are examined at regular intervals. Thus, if blood pressure, diabetes mellitus, cardiac arrhythmias or high blood lipid levels have been detected, these will be treated as part of the therapy. During follow-up, the course of the treated underlying disease of the patient with vascular dementia is regularly examined. In addition, the physician will work to ensure that the patient lives a healthy lifestyle and changes unhealthy behaviors: Reduce excess weight, exercise more, stop smoking. If these risk factors are identified and corrected in time during follow-up care, the progression of vascular dementia can be slowed. The brain disorders then no longer progress rapidly. In pure vascular dementia, brain cells have actually died. Here, rehabilitative aftercare measures can also be helpful. This makes it possible for healthy nerve cells to take over the tasks of the dead nerve cells one day. Occupational therapy, speech therapy and physiotherapy are used for this purpose during aftercare. Finally, follow-up examinations are used to monitor the permanent medication that has been set, to diagnose its effectiveness and to assess the side effects. For example, the use of blood-thinning medications must be monitored during follow-up.
Here’s what you can do yourself
Individuals suffering from vascular dementia need support in their daily lives. It is the task of the relatives to take care of the ill person and to give him attention and care. The first thing to do is to obtain the most important information about the disease. Literature on the subject and exchanges with other sufferers are essential in order to understand the condition. People suffering from dementia need consistency and habit. The daily routine must be clearly regulated and major deviations should be avoided at all costs. At the same time, the independence of the patient must be encouraged. For example, many patients are still able to cook for themselves or care for themselves. Relatives should also plan sufficient rest periods for themselves. The outpatient nursing service takes over important tasks and ensures the patient’s medical care. The patient himself can contribute to a harmonious coexistence by also informing himself about the disease and supporting the treatment through sports, a healthy diet and cognitive training. Brain jogging or simple board games, for example, have proven effective in promoting brain activity and counteracting the progression of vascular dementia.
