Vascular Dementia?

[caracroft]

Hi to everyone

After a year or so battling to get my husband's mother to doctors/hospital appointments we eventually got the diagnosis of Vascular Dementia yesterday from the consultant.

I thought it would be Alzheimers and that she would be offered some medications but this is a different area alltogether.

On reading this site it says that Vascular Dementia is caused by heart disease, strokes, high blood pressure, diabetes and similar but she has never suffered any of this. She is a slim, active person who has never smoked or drunk alcohol, she doesnt eat red meat, in fact now she doesnt eat much at all.

Also the consultant has said there is no medication that can be offered, BUT if she was having mini strokes that were unnoticed surely she needs this investigating further? I am quite confused with it all. He said in one breath he would have no hesitation putting her into a care home that very day and in the next she doesnt need to see him anymore and an occupational therapist will be sent round ( after mum said no to staying in the hospital).

Can anyone advise me what I should do next? Should she be on any medication? How do I know if she has been having ministrokes? Should I chase this up to be looked into further? What do I do when she is so adamant there is nothing wrong and the consultant says she shouldnt be on her own? ( she lives alone in a first floor flat and we live 120 miles away with no other relative near who can help)

Thankyou for reading

Cara

 

[littlegem]

Hello, so sorry about your MIL's diagnosis.
Vas D is what my hubby has been diagnosed with in February and yes apparently there are no drugs to stop the TIA's. Hubby is on all the BP, cholesterol/diabetes drugs and it's all under control but he is still having TIA's.

The consultant also said we have no further need to see him but if there are any problems with behaviour in the future I have to get hubby's GP to refer him back to the memory clinic for a CPN (community phyciatric nurse)( excuse spelling can never get that right!!!!).
You will know when MIL has mini strokes, behaviour does alter even if it's just slightly and hubby usually sleeps a lot after one for a few weeks. I call it his internal battery running down as after each one he is a little bit slower and has more problems.

I'm sorry I cannot be more positive. Has your MIL had a CT scan at all? This is how hubby was diagnosed. If you are still unsure and she hasn't had one ask her consultant for one, just to confirm everything really.

 

[Coletta]

I dont know anything about vascular dementia, but just remembered reading that vitamin C strengthens blood vessels. It would make sense to me then if increasing Vit C intake might reduce strokes? I also remember reading that smoking reduces Vit C in the body. Just thought I would mention it for interest.

Coletta x

 

[jenniferpa]

Hi Cara and welcome to Talking Point

Am I right in thinking you feel that the consultant hasn't got the diagnosis right? Or that his reasons for making this diagnosis haven't been fully explained? I imagine that you were given the diagnosis and were sufficiently floored that it wasn't until you started researching it that you thought "hang on a minute..." but by that time there is no one to ask the questions of.

What sort of relationship do you have with her GP? (S)he might be able to answer some of your questions. I would also agree with littlegem about the CT scan. While even that may not give a 100% certain answer, when someone doesn't have the "normal" health issues it would seem fairly important to go that extra mile.

 

[hamish51]

Vascular Dementia

Hi

My father was diagnosed with what was called late stage cerrebellar syndrome 2 years ago, we now know this to be a form of vascular dementia, there is no help for this I am afraid from anyone, our Gp does not seem very interested and the consultant said there was nothing that could be done, he had a TIA last year and has seemed to be Ok since but gets very confused, angry and is extremely irritable most of the time. I am afraid he is also very demanding insisting on certain brands of food etc, so I end up running all over the place trying to get certain things from different supermarkets. My Mum I think has given up with him and really does not communicate with him during the day at all. I also work full time so it is hard to try and keep them on an even keel. My mother was very seriously ill at the bginning of the year so had to put Dad in a BUPA care home, the owrst thing I could have done, re really deteriorated the only consolation was that he was safe, warm and fed. He is better now he is at home but it makes me very concerend about the future and what I may have to do

 

[Jancis]

Brain Food

Hello Cara and welcome from me too.
If you mother-in-law is not eating much then she could be suffering from lack of nutrients which will not help her condition and general health. It may be a good idea to look into her general nutrition as she might benefit from supplements such as Omega 3 fish oil. There has been much research undertaken about the benefits of high quality fish oil and I recommend doing some googling but here is one link I found for you.
http://www.livestrong.com/article/443404-omega-3-to-treat-dementia/
Just a thought.

 

[Nebiroth]

Hi to everyone

After a year or so battling to get my husband's mother to doctors/hospital appointments we eventually got the diagnosis of Vascular Dementia yesterday from the consultant.

I thought it would be Alzheimers and that she would be offered some medications but this is a different area alltogether.

On reading this site it says that Vascular Dementia is caused by heart disease, strokes, high blood pressure, diabetes and similar but she has never suffered any of this. She is a slim, active person who has never smoked or drunk alcohol, she doesnt eat red meat, in fact now she doesnt eat much at all.

It is more true to say that these are known risk factors. It's possible to get vascular dementia when you have no known risk factor - they just increase the chances of getting the disease. It's a bit like obesity or a high intake of saturated fats - they increase the risk of heart disease rather than being an absolute cause.

As with so many such conditions some people live "good" lives and go down with them, whilst others live "bad" lives and do not.

Dementia (of all types) remains a poorly understood disease. What happens is known - but the underlying processes are not.

There is surely a genetic factor, although inheritance does not seem to play a strong role.

Also the consultant has said there is no medication that can be offered, BUT if she was having mini strokes that were unnoticed surely she needs this investigating further? I am quite confused with it all. He said in one breath he would have no hesitation putting her into a care home that very day and in the next she doesnt need to see him anymore and an occupational therapist will be sent round ( after mum said no to staying in the hospital).

There is no known treatment for vascular dementia, to prevent or to reverse the damage. The usual advice is to avoid the risk factors (see above) in the hope that this will slow down the progress of the dementia.

It's unusual for a consultant to say they will never need to see a patient again, because there are normally reviews to monitor progression and sometimes to prescribe medication that can help with some of the symptoms (anxiety or agression, for example)

The occupational therapist will likely do an assessment of how well your mum can manage at home and whether there are any aids or support needed.

How do I know if she has been having ministrokes?
Cara

The mini-strokes associated with vascular dementia are often so minor that they produce no symptoms at all. It is the cumulative damage that results in the dementia. Sometimes a TIA (Transient Ischemic Attack) will be more obvious (often described as a 'funny turn')

Although all are strokes, this is not like the medical emergency that is a major stroke which produces acute symptoms that are immediately both obvoius and serious. Vascular dementia can be caused by a major stroke, which tends to be a one-off but major event; it depends on the area of the brain that is involved.

Strokes are also known as infarcts. Dementia caused by one large stroke is called single-infarct; a ongoing series of minor strokes is called multi-infarct.

The other form is small-vessel vascular dementia. In that case, the damage occurs in small blood vessels - often deeps within the brain. It is sometimes accompanied by difficulties with mobility.

A CT or MRI scan of the brain can sometimes confirm (or otherwise) vascular dementia. However, sometimes the damage can be both subtle and widespread and scans may be inconclusive.

Very often diagnosis is made without scans. They can be unhelpful and also distressing to the patient, particularly MRI scans which are claustrophobic and very noisy.

 

[Loopiloo]

Hello Cara and welcome to TP, although very sorry your husband's mother had been diagnosed with vascular dementia. I cannot add to what others have said except that my husband also has vascular dementia, and the diagnosis included a CT brain scan.

I think at first the consultant at the memory clinic thought he had Alzheimer's, she was listing various drugs she might prescribe in future. But after the CT scan and diagnosis we were 'dismissed', referred back to our GP. We were really left to get on with it ourselves.

CT scans are not perfect but my understanding is that it ruled out Alzheimer's. It also showed that my husband's carotid arteries at the back of the neck, which feed blood to the brain, were "seriously calcified".

I would second the advice to ask for a CT scan.

PS added after reading Nebiroth's excellent post. We were told by our GP the scan showed small-vessel damage.

Loo xx

 

[Saffie]

Hello there.Unlike Loo's Henry above, my husband has never had a scan to confirm his vascular dementia. The consultant psychiatrist who visited said that there was no point.The diagnosis was based on his medical history of long-term diabetes and subsequent peropheral artery disease.

However, the cons. psychiatrist did prescribe Aricept as he thought there might be some Alzheimers involved - but I've never been convinced of this. My husband thought the Aricept helped but that could be psychological and anyway, that has since been withdrawn.

It is something that an occupational therapist is going to visit. We never saw any body, not even a mental health community nurse. I hope the OT can help your MIL. good luck.

 

[edgetop]

Hi, my mum has vas d she was diagnosed in July.she has been deteriorating for most of this year.My sister & myself are looking after her.At the moment we are finding it hard going dealing with all the things we need to put into place.She has carers coming in mornings to wash & dress her & give her breakfast,we keep having to ring them as some just ask her if she wants food instead of just making it for her.She goes to daycare on Mondays which most of the time she likes.Ive not noticed if she has had any strokes yet but some days she is very tired & more mixed up than normal.

 

[caracroft]

Thankyou all so much for all your replies, I was so surprised and it is encouraging to know I can ask things on here and get advice.

For all of you that have partners or parents with this condition my heart goes out to you, and I really appreciate hearing all your experiences - it can be very difficult dealing with the person with dignity and respect when they are so hard to reason with etc, and looking at the symptoms of later stages this will be even more challenging for many of you.

My MIL had a CT scan earlier in the year, she surprisingly took this step in her stride but convinced herself the "girl there told me it was all ok" so getting her to go back for the results ( which has led to this diagnosis) has been a battle we have had for the past 7 months!!

Hi Cara and welcome to Talking Point

Am I right in thinking you feel that the consultant hasn't got the diagnosis right? Or that his reasons for making this diagnosis haven't been fully explained? I imagine that you were given the diagnosis and were sufficiently floored that it wasn't until you started researching it that you thought "hang on a minute..." but by that time there is no one to ask the questions of.

What sort of relationship do you have with her GP? (S)he might be able to answer some of your questions. I would also agree with littlegem about the CT scan. While even that may not give a 100% certain answer, when someone doesn't have the "normal" health issues it would seem fairly important to go that extra mile.

Jennifer - you seem to have hit the nail on the head. Its not that I doubt his diagnosis as MIL has had CT scan but he didnt elaborate and we just left speechless or "floored" as you put it. Her GP is not easy to talk to, but she did refer her to the specialist when I wrote to her last year with my concerns so I suppose that shows she listens a bit even if face to face she doesnt look like she wants to talk. Trouble is we live in Essex and MIL is in Lincolnshire so I have only seen the doctor with her a couple of times. MIL herself hates going to doctors etc she has a huge distrust of anyone who is trying to tell her what to do.

Coletta and Jancis - I am worried about her not getting enough nutrients in her diet. She was offered meals on wheels when the Memory team came to do a memory test, as she does not cook at all ( she stopped cooking a couple of years ago, but we didnt realise it was because she just didnt know how to anymore) but she refused point blank. She doesnt trust anybody, doesnt think there is anything wrong with her and is fiercely independant!! She seems to live on bits and pieces, it is almost impossible to find out what she buys, her fridge and cupboards are nearly empty and she wont let us help her get any shopping. She has made a point of telling us nearly every time now that she has been eating loads and is sure she is putting on weight, just to stop us keep asking!!!

Nebrioth - What can I say? You have given me so much information, I really appreciate the time you have put into such a concise post. Do you feel it is important to know if the Dementia is caused by several ministrokes or by small vessel disease? I dont want to be fighting for information that is irrelevant to MIL's treatment from now on.

Thanks again to you all


Cara

 

[bulmer]

Your mum in law sounds like my mum maybe she is having the mini strokes in her sleep. My mum keeps falling I've been told this could also be a mini stroke. My mum is very independant but somewhere a long the way I may have to put my foot down and do what I think is best for her. My mum is also forgetting how to cook. Maybe your mil things she is eating many people forget if they have eaten or not. As for medication there isn't anything for vas dem. Good Luck

 

[Saffie]

Do you feel it is important to know if the Dementia is caused by several ministrokes or by small vessel disease?

Others may disagree but I really believe that dementia is dementia and even with the same diagnosis, the disease will progress at different speeds - and in different ways, according to the parts of the brain affected either by vascular or alzheimers dementia. It is a case of taking one step at a time and - in my case, anyway, not trying to look too far into the future. Therein lies despair.

 

[Nebiroth]

Nebrioth - What can I say? You have given me so much information, I really appreciate the time you have put into such a concise post. Do you feel it is important to know if the Dementia is caused by several ministrokes or by small vessel disease? I dont want to be fighting for information that is irrelevant to MIL's treatment from now on.

Thanks again to you all


Cara

Sadly it would seem to make little difference - although some people do find a comfort in being able to precisely identify their condition - because, as Saffie says, the dementia has the same hallmarks of being irreversible, untreatable and progressive. The progress goes at different rates in different people and depending on the cause, it also affects abilities depending on which part(s) of the brain are affected but none of this can really be predicted. I believe that people with small vessel disease have a tendancy towards physical problems as well, such as walking, so knowing might help to plan for that - but it doesn;t happen with everyone.

The drugs used for dementia, such as Aricept, are only licensed in the UK for use with Alzheimer's. This is not the same as banned, but it does mean they are not routinely prescribed. They are often given to patients where there is doubt about the diagnosis, because this means Alzheimer's is a possibility and the drugs do no actual harm if the cause is actually for example vascular. Also, some people have more than one disease (called mixed dementia) so again the drugs are often given in that case.

As I understand it in some countries the drugs are routinely used for the different dementias.

 

[caracroft]

Thank you Saffie and Nebrioth

 

[BeckyJan]

Hello caracroft:

You have received excellent advice and information so far. I am just giving this link as it also gives some explanation on Vascular Dementia. It all adds to your knowledge next time you speak to a medic about your Mother.
http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=161

Best wishes

 

[choccy]

My Dad has Vas Dementia too. He was fit as a fiddle and no history of strokes. Until the brain scan..... showed he had had a massive stroke a few years ago... when and where we don't know, he did have a 'feint' a few years back but the hospital said there was nothing else and ruled out stroke!

Anyway... He is on blood thinners, statins, iron, the usual. However, they have started him on some epilepsy drug of late, only 3 weeks into it, can't see much difference as yet, he's still on starter dose.

It's supposed to help with hallucinations and agitation. Personally, I find 2 paracetamol work better for the agitation.

He's still seeing things but to be fair he hasn't had any really bad paranoid episodes for the last 2 weeks, so maybe they are working??!!

p.s. Welcome to TP x

 

[caracroft]

Thanks for the link Becky, it was very helpful.

Thanks Choccy for your experience.

My MIL is as fit as a fiddle too, but I was just wondering that if the scan had shown strokes then should she be on tablets like statins etc. At least I am more genned up for talking to someone about it all!

The trouble we are having is with MIL's distrust - she hasnt spoken to us since Monday!! At least she has answered the phone (and dismissed us straight away) which is something because after the last doctors appointment it led to her not answering the phone or door for weeks!!

So although we have a diagnosis, it is going to be hard to move forward from this point. But thankyou all for all your help

Cara

 

[grannyannie]

vascular dementia

my beautiful Mum in Law has had vascular dementia for a couple of years or so, luckily she is mostly a happy loving lady but if she has say a chest infection she becomes very withdrawn and agitated. We have found that vas d is different for each person and even day to day. Luckily she does not mind us doing things like making our coffee etc at hers as she comes along to assist. i have found it best to love the person for who they are today as it can be very upsetting remembering how they were

 

[caracroft]

Thankyou Grannyannie, I appreciate your post