What's happening to your memory? (Vascular Dementia)? Let's talk about this!

Do you or someone in your family sometimes forget things? Or do you feel like your behavior has changed in an unexpected way? While you may think that these things are normal conditions that come with age, sometimes this can be something to be a little more concerned about. Today we are going to talk about a disease of memory loss caused by reduced blood flow to the brain. This is what we medically call (Vascular Dementia) .

What is Vascular Dementia? Simply put...

Simply put, Vascular Dementia is a condition that occurs when the blood vessels that supply blood to the brain are damaged and some parts of the brain do not receive enough blood . As you know, our brain also needs oxygen and nutrients to function properly. These are obtained from the blood. So, when blood flow is reduced, brain cells are damaged. This damage is what causes our mental functioning, that is, the way we think, memory, etc. to be impaired. This condition can be so severe that we cannot perform daily activities. The main cause of this is (Stroke) , which means paralysis.

Vascular Dementia is one of the most common types of dementia in people over the age of 65. Some studies suggest that between 5% and 10% of people with dementia have vascular dementia alone. However, it is often seen together with Alzheimer's disease . In this case, we call it mixed dementia , which means that there is more than one cause of dementia.

Doctors sometimes use the term Vascular Cognitive Impairment (VCI) instead of Vascular Dementia because the changes in thinking caused by damage to these blood vessels can range in severity from mild forgetfulness (called Mild Cognitive Impairment (MCI)) to severe dementia.

When you are diagnosed with dementia, it can feel like your life is suddenly turned upside down. You and your loved ones may be afraid of what lies ahead. But remember, vascular dementia does not affect everyone the same way. So, work with your healthcare team to get guidance and talk about what to expect during this journey.

What are these symptoms?

Now you might be thinking, 'Okay, so what are the symptoms of vascular dementia?' Actually, the symptoms can vary from person to person. Do you know why? Different parts of our brain control different things. So, the symptoms vary depending on which part of the brain is damaged and the extent of the damage.

Just think, some people may have a very poor memory . Others may have difficulty walking and maintaining balance . Some may have difficulty forming and understanding words when speaking (aphasia is also a condition like this).

Furthermore, you can see the following features:

• It becomes difficult to focus on something , follow instructions, think logically, organize things, plan, and finish work.
• Mood changes . Maybe you just feel sad (like depression), or you get angry easily.
• You may notice changes in personality and behavior . You may feel like you are not the same person you used to be.
• Apathy can develop.
• Confusion may occur, especially at night (also known as Sundown Syndrome).
• You may be unable to control your laughter or crying for no reason (this is called Pseudobulbar Affect).
• It can be difficult to control urine and stool (this condition is called incontinence).
• It may be difficult to grasp small objects or perform delicate tasks, such as trembling hands and feet.
• Sleep problems may also occur.

The most important thing is that if you or someone you know has these symptoms, you should definitely see a doctor and seek advice.

Are there different scenarios for this too?

There is no specific stage for vascular dementia. This is because it affects everyone differently, and the disease progresses at different rates. It depends on which parts of the brain are affected and how severe the damage is.

Often, symptoms develop gradually over years. However, after a major stroke, symptoms can appear suddenly. Sometimes, symptoms may seem to improve for a short period of time. However, if you have more strokes, your condition can get worse.

Even when vascular dementia coexists with another type of dementia, such as Alzheimer's disease, the way symptoms develop can vary.

Why is this happening? What are the reasons?

The main cause of vascular dementia is damage to the blood vessels in the brain, or a complete or partial blockage of blood flow to the brain . When blood flow is reduced in this way, parts of the brain do not receive the oxygen and nutrients they need. Without them, brain cells begin to die.

Some of the main causes of Vascular Dementia are:

• Atherosclerosis is the hardening or narrowing of the blood vessels in the brain. This can also affect the small blood vessels that supply blood to the brain. This condition is called an ischemic stroke .
• A blood vessel bursts and bleeds inside the brain. For example, a condition called Hemorrhagic Stroke .

What are the risk factors?

There are some risk factors that can lead to damage to these blood vessels and the development of vascular dementia. They are:

• This is called atrial fibrillation (Afib).
• Diabetes .
• Heart disease .
• High blood pressure (Hypertension).
• High cholesterol level in the blood ((Hyperlipidemia)).
• Having had one or more previous strokes .
• Increasing age , especially for those over 60 years of age.
• Smoking .

Are there different types of Vascular Dementia?

Yes, doctors use different terms to describe vascular dementia, depending on the number and type of blood vessels affected, and how the symptoms develop. Some of them include:

• (Post-stroke Dementia): This is when vascular dementia can develop after a stroke. This is when the brain tissue that controls more than one of its thinking functions is damaged by the stroke. Language difficulties and memory problems are common. However, the symptoms depend on which part of the brain was affected by the stroke. These thinking difficulties must appear immediately after the stroke or within six months, and they must not get better, for doctors to classify this as (Post-stroke Dementia).
• (Multi-infarct Dementia): "Infarct" is the same as (Stroke). So (Multi-infarct) means that many (Strokes) affect the blood flow to different parts of the brain. The symptoms caused by these (Strokes) are often visible as they occur. Therefore, the changes in thinking ability occur gradually (that is, the condition suddenly gets worse over time).
• (Binswanger Disease) (Subcortical Vascular Dementia): This is caused by the narrowing of the small blood vessels throughout the white matter of the brain due to atherosclerosis over time. The symptoms do not develop suddenly, but develop gradually over time.
• Mixed Dementia: When dementia symptoms are caused by more than one cause, doctors call it Mixed Dementia. The most common combination seen with Vascular Dementia is Alzheimer's disease. However, it can also occur with other Neurodegenerative conditions.

Is this something that comes from generations?

Vascular dementia is not directly genetic . However, some of the conditions that cause it, such as high blood pressure and heart disease, can run in families.

However, there are two very rare forms of Vascular Dementia, which are caused by a number of strokes caused by changes (called mutations) in certain genes. Both of these mainly affect the small blood vessels in the white matter of the brain. They are:

• (CADASIL): The full name of this is (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy). For (CADASIL) to occur, one of the parents must have this condition, and the child must inherit it ((Autosomal Dominant Inheritance) is called this). The specific symptoms of (CADASIL) are migraines and recurrent strokes.
• (CARASIL): The full name of this is (Cerebral Autosomal Recessive Arteriopathy with Subcortical Infarcts and Leukoencephalopathy). For (CARASIL) to occur, both parents must be carriers of this condition, and the child will inherit it ((Autosomal Recessive Inheritance)). The most common symptoms of (CARASIL) are stiffness in the legs and difficulty walking.

How do you recognize this exactly?

To be sure that you have vascular dementia, you need to be examined by a specialist . Because there are many types of dementia, and the symptoms of this can be similar to the symptoms of other diseases.

Your doctor will do these things:

• I'm asking how your symptoms developed.
• Ask about your previous illnesses.
• They will look at what medications you are currently taking, as some medications can cause dementia-like symptoms.
• Ask about illnesses in your family.

After that, you will probably be advised to have several different tests. These may include blood tests, brain scans, and brain function tests. You will also need to see specialists in dementia, such as neurologists and geriatricians, to get a diagnosis.

Blood/sputum tests (Laboratory tests)

Blood tests are used to check for other conditions that are causing dementia symptoms, such as infections, inflammation in the body, hypothyroidism, and vitamin deficiencies (especially vitamin B12).

Sometimes, doctors perform a spinal tap to examine the cerebrospinal fluid (CSF) to check for conditions such as autoimmune conditions and neurodegenerative diseases.

Brain imaging tests

Your doctor may order brain scans like these:

• (Computed Tomography - CT) and (Magnetic Resonance Imaging - MRI): These (Scan) tests look for things like a stroke, bleeding, a tumor, or fluid buildup in the brain. Doctors prefer to do an (MRI) test to see if there is (Vascular Dementia).
• Amyloid PET scan: This is a special type of PET scan. It looks for abnormal deposits of a protein called amyloid in the brain. This is common in Alzheimer's disease. Doctors sometimes recommend this test if they suspect that you have Alzheimer's disease.

Neuropsychological testing

In this test, your doctor will use written and computer-based tests to check your mental abilities. These include:

• Problem solving ability.
• Learning ability.
• Decision-making ability.
• Memory power.
• Planning ability.
• Ability to think logically.
• Language ability.

Specially trained psychologists (called Neuropsychologists) look at the results of these tests and try to better understand the relationship between your brain health and your ability to think (called Cognition).

How to confirm Vascular Dementia?

Doctors use these criteria to diagnose Vascular Dementia:

• Neuropsychological testing is required to confirm whether dementia or MCI is present.
• There must be evidence from a brain scan (often an MRI) that you have had a recent stroke, or that you have other blood vessel changes in your brain that are consistent with your cognitive difficulties.
• There must be evidence that there are no other factors contributing to the decline in thinking ability.

These criteria are the most likely to indicate that Mild Cognitive Impairment (MCI) or dementia is caused by damage to the blood vessels and not by any other cause.

What are the treatments for this?

Unfortunately, there is no cure for vascular dementia. Once the brain has been damaged, it is difficult to fully restore it. Instead, the main goal of vascular dementia treatment is to control risk factors and stop or slow down further damage . It also helps people cope with the difficulties caused by brain damage and find new ways to do things.

Medication

Unlike Alzheimer's disease, there are currently no medications specifically approved by the FDA for Vascular Dementia. However, doctors can prescribe medications called Cholinesterase Inhibitors for Vascular Dementia. Studies show that these can increase blood flow to the brain and improve thinking skills.

Memantine is another drug that is approved for Alzheimer's disease and may also help with vascular dementia.

Your doctor may also prescribe other medications to control your risk factors for stroke. For example, medications for high blood pressure, high cholesterol, and diabetes.

Rehabilitation and advance care planning

You may need to work with a variety of specialists to manage your symptoms of Vascular Dementia. For example, physical therapists and occupational therapists can help you improve your physical abilities and find new ways to do everyday tasks. A speech and language therapist can help you learn other ways to speak, swallow, and communicate.

Other experts who can help you are:

• Recreational therapists.
• Registered dietitians.
• Psychologists or psychiatrists.
• Clinical social workers.
• Aged care managers.

These specialists work with you and your loved ones to ensure that you receive a consistent level of care that is tailored to your needs and goals. They also advise you and your family on future care planning, including financial and health decisions. They can also make referrals for palliative care or hospice when the condition becomes severe.

Is there a way to avoid this?

There are some risk factors that can affect this condition, such as your age or genetic factors, that you cannot change. However, there are many other risk factors that you can control to try to prevent this condition - mainly those that damage your blood vessels. Here are some steps you can take:

• Keep your blood pressure, cholesterol, and blood sugar (glucose) levels at healthy levels . This requires working closely with your doctor.
• Maintain a healthy weight for yourself.
• Exercise regularly . Try to do at least 30 minutes a day.
• Eat a heart-healthy diet , such as the Mediterranean diet or the DASH diet.
• Stop smoking .
• Limit alcohol consumption .
• Control your stress .
• Go for regular medical checkups and take the prescribed medications exactly as prescribed.

Vascular dementia is different from most types of dementia in that it is largely preventable . If you have any of these risk factors, talk to your doctor about what you can do to manage them.

What can you expect when living with this condition?

Vascular Dementia can get worse over time. These changes can happen suddenly or gradually. Everyone's journey is different. Treatment can help control the progression of the disease. Together, you and your doctor will develop the best treatment plan for your symptoms and stage of the disease.

Get support from your loved ones during this time. Together, you can create a plan that respects your quality of life and your wishes as dementia progresses.

How long will you be able to do your work alone?

A person with vascular dementia may need help with some of the things they do every day. For example, managing medication, paying bills, and preparing meals. Your loved one with this condition may be able to do many things on their own. However, depending on what abilities are affected, it may not be safe for them to live alone. Some people with vascular dementia may need more specialized care from facilities that specialize in caring for people with dementia.

How is the lifespan?

The life expectancy of someone with this condition is determined by the severity of the disease. Vascular Dementia varies in severity, and affects everyone differently.

People with vascular dementia have a shorter life expectancy than those with Alzheimer's disease. This is because people with vascular dementia are more likely to die from a stroke or heart attack than from dementia itself.

What are the symptoms of the end times?

It is difficult to say exactly what the final symptoms of vascular dementia are. It is sometimes more helpful to think about how dementia has affected your loved one as a whole. By the end of dementia, it will have severely affected many aspects of your loved one's life. They will need full-time care and support.

Late or end-stage symptoms may include:

• Severe memory loss.
• Physical difficulties that make it impossible to perform daily activities such as eating, bathing, and dressing without assistance .
• Almost complete loss of language ability.
• Sadness, lack of interest in anything ((Apathy)).
• Hallucinations and delusions .
• Restlessness, anger, or agitation.

Your loved one's medical team, critical care nurse, or palliative care provider are the best people to ask about time frames. They can tell you what signs to look for, so you can get a rough idea of ​​what to expect.

When should I see a doctor?

If you or your caregiver notice that your symptoms are getting worse, or if you develop new symptoms, be sure to see your doctor . Your doctor or healthcare team will evaluate any changes and make adjustments to your treatment plan if necessary.

If you or a loved one has Vascular Dementia, remember that you are not alone. Almost everyone has been affected by some form of dementia at some point. Knowing your diagnosis gives you and your family time to prepare and plan for the future. You can learn about the type of care you may need and where you would prefer to receive that care. Your entire healthcare team is ready to help you.

The Most Important Thing - Take-Home Message

Okay, so, from what we've talked about (Vascular Dementia), here are some of the most important things you need to remember:

• Vascular Dementia is a condition in which memory loss occurs due to decreased blood flow to the brain .
• The main cause of this is damage to blood vessels, such as stroke .
• Symptoms can vary from person to person . Memory loss, difficulty walking, and behavioral changes are common.
• Although it cannot be completely cured, the progression of the disease can be controlled by controlling risk factors .
• It is very important to control things like high blood pressure, diabetes, high cholesterol, and smoking.
• If you have symptoms, it is essential to seek medical advice immediately .
• You are not alone, you can get support and proper care .

I hope this information is useful to you. Stay healthy!

` Vascular dementia, memory loss, cerebral circulation, paralysis, dementia, geriatric health, brain diseases