Ask Dr. Shadi: What is Vascular Dementia?

Not all dementias are the same. Dementia is a broad term for a group of diseases that impact cognitive abilities, such as memory or problem solving. Alzheimer’s disease is the most common type of dementia, affecting 60-80% of people living with dementia. The second most common form of dementia is vascular dementia, which affects 5-10% of people living with dementia. While there is no cure for vascular dementia, understanding the symptoms and stages informs our care approach and can support better outcomes for people living with dementia and their families.

What Causes Vascular Dementia?

Vascular dementia occurs when reduced or interrupted blood flow deprives the brain of oxygen and essential nutrients, leading to damage to brain cells.This can result from conditions such as:

• A stroke
• Chronic, uncontrolled high blood pressure (hypertension)
• Damage to the blood vessels in the brain

These conditions can deprive the brain of oxygen and nutrients. Without these important elements the brain cells become damaged and are no longer able to function as they once did.

What is the Difference between Vascular Dementia and Alzheimer’s Disease?

Dementia is an umbrella term for cognitive decline that is severe enough to interfere with the ability to lead an independent life. Various cognitive functions may be impacted, including memory, attention, problem solving, and social cognition. Vascular dementia and Alzheimer’s disease are both types of dementia, however, the way that vascular dementia presents and progresses can be different compared to Alzheimer’s disease.

There are 3 aspects that make vascular dementia unique:

• Sudden Onset: Vascular dementia can have a sudden onset, which is different from the slow decline that may be seen in Alzheimer’s disease. Often, this sudden decline will appear after a stroke or even after a series of mini-strokes.
• Stepwise Progression: There may be a period where your loved one exhibits few or no cognitive changes (i.e., a period of stability) followed by a sudden “step down” - a worsening of symptoms and decline in cognitive function.
• Type of Cognitive Impairment: Vascular dementia is often caused by damage to a certain area of the brain resulting in specific changes. For example, if your loved one had a blood clot in the part of the brain that controls planning skills, you will notice a distinct impairment in their ability to plan. You might also see changes in reasoning or judgment. Alzheimer’s disease will usually start with a more gradual decline in memory and skills.

Your loved one can have symptoms of both Alzheimer’s disease and vascular dementia, this is called mixed dementia. This makes getting a diagnosis and figuring out your care plan more complicated.

Early Signs and Symptoms of Vascular Dementia

If your loved one has progressed to a moderate or severe stage of vascular dementia, it is usually fairly obvious. The early stage of vascular dementia is where you are questioning whether certain cognitive and behavioral changes could be dementia or just anxiety or fatigue.

Remember, dementia involves much more than just memory loss. Check through this list to see if you notice any of these signs and symptoms:

• Difficulty with Planning and Organizing: Your loved one, who used to be good at planning, now struggles with problem solving. For example, unable to put together a dinner party or pay bills.
• Slowed Thinking: You might observe that your loved one is having trouble following a set of instructions or takes longer than usual to figure out what they need to do. They might become confused about the rules or steps of a familiar game.
• Memory Loss: While not as prominent as in Alzheimer’s, memory impairment can still occur. For example, your loved one may ask when breakfast is even though they just had breakfast an hour ago.
• Mood Changes: You might see that the person is increasingly frustrated, angry, or annoyed. Your loved one may become anxious and frightened. Or they may feel depressed and seem to not care about the things that mattered to them before.
• Unsteady Gait: Pay attention to any changes in how your loved one walks and to more frequent tripping or falling. You might observe them dropping things, walking off-balance or stumbling more often.
• Confusion: Your loved one might feel confused and unsure about their surroundings. For example, they may become confused about the time of day or what they are supposed to be doing.
• Attention Problems: A change in the ability to focus and finish a task or conversation. They start to bake cookies but have trouble following a familiar recipe and stop baking halfway through, for example.
• Problems with Language: You may see your loved one struggling with finding the right word, having trouble reading or writing, and not understanding what you are saying. They may stop attending activities that they loved because it is too frustrating to keep up with the conversations.
• Impaired Judgment: Damage to the brain can result in your loved one making risky decisions and not being aware of possible dangers. This can make people more susceptible to safety risks or financial scams.

Stages of Vascular Dementia

In the early stages of vascular dementia, it can be frustrating and confusing trying to figure out what is going on with your loved one. Vascular dementia is often broken down into stages to make it easier to map its progression.

These are the 3 stages, but keep in mind that dementia can be unpredictable, and the progression can differ, depending on which parts of the brain are affected.

• Mild Stage: Subtle cognitive changes, such as mild difficulties with complex tasks, may start to appear. You may also notice mood changes, such as anxiety or irritability.
• Moderate Stages: Cognitive decline becomes more evident, with significant impairments in activities of daily living and noticeable language difficulties. This can impact the person’s ability to care for themselves independently.
• Severe Stage: Severe cognitive impairment at this stage will lead to a need for comprehensive support for all activities of daily living.

Unique Care Considerations for a Loved One with Vascular Dementia

Understanding the unique challenges of vascular dementia helps you and your care team craft a care plan that focuses exactly on what your loved one needs.

Here are 8 specific care needs for a person with vascular dementia:

• Attention to Heart Health: What’s good for the heart is good for the brain! Vascular dementia is caused by reduced blood flow to the brain. It is important to manage conditions like hypertension, diabetes, and high cholesterol to keep the heart healthy. A healthy heart results in good blood flow and prevents further damage to the brain.
• After Stroke Care: The symptoms of vascular dementia often show up after a stroke. Rehabilitation following a stroke is vital to optimize both physical and cognitive recovery, potentially slowing the progression of vascular dementia
• Mental Health Support: Early identification and treatment of psychiatric symptoms like depression and anxiety can improve your loved one’s quality of life and support cognitive function.
• Structured and Predictable Environment: For someone with vascular dementia, a cluttered and chaotic environment can make the person feel overwhelmed, confused and agitated. A clutter-free environment and predictable routine can promote a sense of comfort and calm.
• Regular Medical Check-Ups: Staying consistent with doctor’s appointments and monitoring blood pressure, blood sugar levels, and cholesterol levels is critical to controlling risk factors and symptoms of vascular dementia.
• An Overall Healthy Lifestyle: Eating a diet rich in fruits, vegetables, and whole foods provides the nutrients that the brain needs to function. Regular physical activity and not smoking can help to improve the health of the heart and the brain.
• Medication Management: Your loved one’s health care professional will often prescribe a medication to help improve vascular health. These need to be taken as directed to achieve their full effect.
• Cognitive Engagement: Don’t forget exercise for the brain! Stimulating and enjoyable activities can help to sharpen cognitive function and slow the progression of dementia. What matters most is consistency, so finding an activity that is engaging that the person likes is key.

4 Ways that In-Home Care Can Help Someone with Vascular Dementia

TheKey can offer the necessary in-home dementia care that not only meets the needs of a person with vascular dementia but also of the family who loves them. TheKey provides these 4 essential elements of a targeted care plan:

• Personalized Care: TheKey’s care plans are tailored to the individual needs and preferences of your loved one, emphasizing the person’s likes, dislikes, preferred routine, and goal so that the approach is person-centered.
• A Consistent Routine: A consistent daily routine is vital but can be hard to implement. Routine helps to reduce anxiety and confusion and creates opportunities for moments of joy, connection, cognitive stimulation, and relationships. TheKey can help you figure out a routine that works for your family.
• Safety Planning: A well thought-out safety plan can help to prevent accidents and falls while also managing symptoms and meeting your loved one’s care needs. TheKey’s caregivers have the training, experience, and knowledge to help your loved one live safely and comfortably at home.
• Emotional Support and Respite: Respite care can provide important peace of mind for families, allowing family caregivers to recharge and maintain their own health.

Vascular dementia is a complex condition, and knowing the symptoms and avenues for support is important to establishing a viable long term aging plan for people living with the condition. Contact TheKey today to connect with a care team who understands the unique aspects of this condition and how best to support you and your loved one.