Vascular Dementia

[zigandzag]

Hi all,

My mom was recently been diagnosed with Alzheimer s and only been on meds for 6 weeks. The past fortnight has been a living hell for us all but especially for my lovely mum who has gone down so fast. I took her to the docs yesterday and he took one look at her and decided to stop all her meds (Mirtazapine just increased to 30mg and Aricpet 5mg) as he said she looked dreadful. She was a tad more lucid than she has been for days.

Today we went for an assessment regarding my mum suitability for therapeutic classes and and the nurse stated that she thought my mum was more likely to have vascular dementia rather than Alzheimers.

This afternoon/evening has been truly dreadful - my mum is totally and utterly convinced that the police are going to come to the house and arrest her as she "lied" to the nurse this morning. (She didn't)

She keeps saying she has been an evil and wicked mother (just typing that makes me cry as nothing could be further from the truth). I have tried everything to ease her anxiousness and sadness but nothing works after 6hrs of trying. Every sentence starts with "I'm scared"....

I know its doesn't mater whether its Azheimers or vascular as they are both equally s..t but I wondered if anybody could tell m how the differences manifest themselves and what meds are the norm.

The nurse also said that maybe why the Aricept did not seem to assist her but just make her worse.

I have to call the doc on Friday as she is no receiving no meds at all and let him know how she is. Again another distraught night for us all...... how I hate this evill evill disease and how much I love my mum.

Thanks for reading xx

 

[Contrary Mary]

I couldn't really tell you about the differences as Mum's VaD was mixed in with severe depression. However, I can confirm that she wasn't on medication specifically for dementia, such as Aricept. Only for things like BP,cholesterol,diabetes.

I'm pleased that the doc is keeping an eye on things. Let us know how it goes on Friday

Mary
x

 

[Time Traveller]

Hi Zigandzag,
I'm afraid I dont have any advice, just wanted to offer a bit of support and a hug. Hopefully you will get some answers form the doctor on Fri. xx

 

[Dave W]

I know its doesn't mater whether its Azheimers or vascular as they are both equally s..t but I wondered if anybody could tell m how the differences manifest themselves and what meds are the norm.

My Mum had a mixed diagnosis of both, but predominantly Vascular. The main difference is often the progression: VaD sufferers tend to have 'steps' in the pattern of their symptoms rather than a slope. Often its a result of TIAs or small strokes that knock them for six: they will noticeable 'worse' (and often sleepy) for a while afterwards, possibli slowly improving, but not always back to the previous level. I can't comment on medication, although the doctors did try my Mum on Aricept (which unfortunately had nasty side effects in her case).

The depression may be depression or it may be a symptom (rather than an effect) of the illness. Anti-depressants may help, but take the doctor's advice: some anti-depressants can raise anxiety levels.

Good luck with the doctor, and try to look after yourself too-it's too easy to forget to do that.

 

[NeverGiveUp]

Mum formerly diagnosed with VasD circa 6 years ago but signs were there before that in hindsight. Told that there are no meds whatsoever for VasD, not sure about that. Would be interesting to know if there are any meds. Anti psychotics should be used with EXTREME caution, if situation gets very out of hand a small dose .25, but that is only last resort and we have been told that this should be less than 2 doses a month. Mum's only medication is a tiny dose of thyroxine and co-codomal when she gets back pain.

VasD seems to be mini strokes. Fear symptoms are a large part of it as the person is very aware of what is going on. The slippery slope of Alzheimers seems to be a slipping into nothing, VasD nothing like that, the person seems about to go and back she comes. Very astute, in fact more astute now than before.

Lots of bouts of "I want to die", intention is there at the time, needs to be watched, but only wants to die when feeling bad, when on the flat tread of the 'staircase' doesn't want to die. After all these years mum still relatively lucid although sundowning is a positive pain the the posterior, lots of shouting at night which is far from great, but the person is still there.

I think the strange mindset is the brain trying to get a grip on what is happening, the brain doesn't want to accept what is happening. I see it like a computer when the processor is a bit dodgy, problem is that the person doesn't have a back up hard drive. The fear is natural I would be scared if I was in that position.

I've found that personality traits from years ago which have been magnified, can get very insulting.

I have wanted mum to have some sort of rehab to keep the brain going but told there is nothing. Would be interested to hear if this sort of thing does exist.

 

[lin1]

Hello
My Mum had mixed dementia Alz and VD

I found with my mum it took quite a few tries with different anti D's
to find the right one that suited her
One or two did nothing even on the highest dose
others cause horrific dreams , hallucinations then in desperation the gp said lets try Prozac , what a difference it made
when we told the gp this
she said she couldnt understand why the others didnt work and this one did as thery were all modern ssri's
So I am wondering if your mums anti D needs to be changed

Also It may be a good idea to get a sample of mums urine tested asap for a UTI as any infection will cause a sudden downturn that has to be seen to be believed
with older people and people with dementia their may be none of the usual outward symptoms such as a temperature

If mum gets worse dont hesitate to call out the out of hours gp , we had to do this many times with mum and I always found them very good when the came

As for the nurse saying she thought it was Vascular rather than Alzheimers
I do love it when someone says things like this when they have only seen the person for a short time
and probably not seen the results of any tests,, scans done

AS I understand It and I may be wrong as I am no medic
they dont normally give meds that may slow Alzheimer's down for those with VaD in uk as their is no proof that they help with VaD ,

its not to do with them doing harm, if they did all those with mixed dementia wouldnt be allowed to have these meds
I hope this helps to reassure you, but their is no reason why you cant ask a doctor if it would help to put your mind at rest

Also I believe they do prescribe ebixa (memantine) to those who have VaD as it can sometimes help with agitation
In some other countries they do give these drugs to those with VaD

It is possible that Aricept doesnt suit your mum though so do speak with mums consultant , cpn about this and also mums sudden worsening
I do hope you see an improvement in mum soon

 

[Onlyme]

Just a long shot but would giving your Mum something to cuddle help her with her being scared?

Mum is getting like this now and I have a large dog ready for the next stage.

 

[Izzy]

You might find these useful:

http://www.alzheimers.org.uk/site/scripts/services_info.php?serviceID=7

http://www.alzheimers.org.uk/site/scripts/services_info.php?serviceID=95

 

[Cal5]

Dad has moderate/severe VaD (though I wonder if it might be mixed).

Generally our experience concurs with what NeverGiveUp wrote. Bouts of depression and wanting to die, and spells of clarity. Dad seems at times to see through all strategies to try to reassure him.

He had a very bad reaction to Mirtazepine, and for a few days after it was withdrawn. He became very paranoid - terrorists, police, bombs etc all figured in his delusion. He was prowling round the house like a caged tiger.

He only really has meds for blood pressure, and anti-depressants (Escitalopram in his case). Psychiatrist has recently requested a scan, and is considering Memantine.

Best wishes

 

[North daughter]

My mother's experience

My mother has vascular dementia. She went through a stage of being rather aggressive but it doesn't mean the person will always be like that. After I moved her to a home where the staff really love the residents and enjoy their job she became much calmer and settled and mellow.

It's important to remember that feelings And behaviours can be very temporary and will stay much longer in your mind than in that of the sufferer. They will have forgotten about it long before you do. So try to treat each day afresh if you can.

Sharing problems with others always helps, I find, and I have had great help from this Forum as I hope you will.

 

[Saffie]

VasD seems to be mini strokes

Not always- my husband's is through m,any years suffering peripheral artery disease.
He was given Aricept though as Consultand Psychiatrist thought there could be some AD there too and he did say that it was like a fog lifting after being on it for some months so there probably was. Unfortunately he hasn't been given it since he went into hosptial and detertiorated so badly after amputation,anaesthetic, etc. etc.

 

[September Girl]

Hi Zigandzag,
Has your mother had an MRI scan? That seemed to be the clincher for my Mum's diagnosis with VasD as they were able to clearly see evidence of small vessel disease. She also had a medical history of angina, high blood pressure and raised cholesterol going back 20 years or so which is strongly supportive of VasD.

Her GP originally diagnosed depression and referred her to the psychiatric team for the elderly. I think the CPN who first assessed Mum suspected VasD from the word go and organised the MRI very quickly. Mum also got referred to a weekly memory clinic.

When she did see the consultant, AD wasn't even mentioned. We were told there was no specific treatment for Mum's kind of memory problems (I think it was too late) and the best he could do would be to optimise her current medication, particularly for blood pressure and cholesterol.

He also swapped ranitidine for lansoprazole (better suited to elderly patients with memory problems).

The consultant didn't think Mum was depressed but he left her on the antidepressant she had been prescribed as it helped calm the huge anxiety that she had developed, particularly at night. The original one made her a bit too sleepy so it was switched to citalopram 20mg and she's been on that for 3-4 years now.

From a behaviour point of view, if I look back, the difficult times have been when Mum has been scared. But even then, she has never been aggressive or angry - just frightened/bewildered/confused/mystified. I would never have called her "depressed" either - just withdrawn because she was scared.

But we did eventually get into a routine and because we also managed to keep her physical side quite stable, she has been more or less stable (and really lovely to look after) for 3-4 years, right up until recently in fact.

Unfortunately we're now going through stepwise declines at an alarming rate ... and I think she's getting scared again as I think she senses her situation.

 

[choccy]

My Dad has VasD. The psychologist told me it can have many causes. It's basically shrinking/blocking of the veins that feed the brain, they don't supply enough oxygen and parts of the brain start to die. It can be diff for everyone, it depends where the veins are as to which part of the brain gets damaged. Stroke, Smoking, drinking, old head injury, boxing. Or any head trauma, even many years ago can cause it. As far as I'm aware, the only treatment is blood thinners to aid the flow, but this doesn't improve the damage already done.
Hope this helps x

 

[Nebiroth]

I know its doesn't mater whether its Azheimers or vascular as they are both equally s..t but I wondered if anybody could tell m how the differences manifest themselves and what meds are the norm.

The nurse also said that maybe why the Aricept did not seem to assist her but just make her worse.

The main differences between Alzheimer's and Vascular are the way the disease progresses. People with Alzheimer's tend to experience a slow, steady decline whereas those with Vascular tend to have sudden declines spaced with periods of relative stability. However, each person is unique and will progress in their own way, so any predictions can only be based on averages and the path your mum goes down might be quite different.

It is also possible to have Alzheimer's and Vascular (this is called "mixed" dementia).

In the UK, Aricept is only licensed for use with Alzheimer's although in other countries it is commonly used for other forms of dementia. Because it is extremely difficult to differentitate between the two diseases, espescially in the early stages as they produce very similar symptoms, Aricept is commonly prescribed if there is uncertainty or if mixed dementia is suspected, on the principal that it is unlikely to do any harm.

Again, the reaction to this sort of drug is extremely variable and individual, and it is indeed possible for some people taking it to be made worse.

This could take the form of making symptoms like anxiety or agression worse.

Unfortunately there are no truly effective treatments for Vascular or Alzheimer's, even drugs like Aricept can at very best offer minor, temporary improvements.

There are, however, drugs that can help alleviate symptoms like anxiety or depression.

It sounds like you rmum needs to be reassessed urgently, by her GP, who is likely to make a referral to a specialist. This is normally a consultant who may be a dementia specialist, geriatric psychiatrist, etc. They are often attached to either specialist "Memory Units", which can either be stand alone facilities or attached to mental health or general hospitals.

 

[stanleypj]

I do feel for you zigandzag. You're by no means the first person to report on this site the confusion caused by 'diagnoses'. The nurse may be right, the original diagnosis might be right, she may have both...who knows? I've come to these conclusions after my own and other people's experiences:

Diagnosis of different dementias is extremely problematic...no-one knows for sure until the patient has died, and even then there can be disagreement.

Diagnosis can happen very early, or much later.

Mixed diagnoses are becoming more common, it seems.

Even when the diagnosis is fairly clear, everybody's different. It does seem highly likely that the treatment the person receives can make a big difference to the progression.

Even the most 'effective' drugs can have unpleasant side-effects particularly if, as is often the case, several medications are being taken at the same time.

Several things - UTIs, constipation, eating problems, hospitalisation, dehydration - can have a dramatically unpleasant effect in people who already have dementia.

People, even 'experts', sometimes jump to dodgy conclusions on the basis of a short observation at a particular time.

I could go on. Trying to make sense of it all is mind-boggling. But remembering that you are the expert when it comes to your own loved one can be very reassuring.

I'm reading 'I'm Still Here' by John Zeisel and finding it's messages very helpful and supportive of the idea that we, as carers, can make more of a difference than anything or anyone else.

 

[zigandzag]

Thank you all so much for your posts - so many of your comments resonated with me.....

I've started to keep a diary of my mums behaviour as it changes so frequently that I struggle to remember myself. I sent it to the doctor and he has just called me and is very concerned and is trying to get my mum in to see a psychiatrist next week as an urgent appointment.

Today is horrendous again - mum keeps going to the front door and asking where all the people are. She's been doing it constantly. My dad is crying again and my mum keeps saying she is scared. I can cope with the repetition its the "I'm scared" bit that gets me to the core.

She still doesn't sleep and will only eat a mouthful of something at a time.

Thanks for listening and god bless you all for being so kind and thoughtful. It really does help.

I hope to god we can get this appointment next week xx

 

[NeverGiveUp]

zigandzag

I think it is the weather, we have problems today as well, "them" get mentioned a lot, we are over run with insects - a giant spider strolled out from under her bed a couple of days ago (it had to be her bed and she had to be the one to find it ), I caught it and chucked it out of the window.

This morning she claims to have fallen or maybe was pushed by someone, difficult when there are only 3 people in the house, I was in the shower and I could hear ad in the kitchen. No injuries or bruises anywhere so suspect claim, i wondered if it was a TIA, I have called ambulance before when I suspect that, when they get here they find nothing wrong. It is a way of keeping me in sight.

The going to the front door, that's 'normal', just keep the keys hidden and door locked - same with other exits.

I've said it before and I will say it again - life is a total bum when dementia enters your home. Watch out for dad, they can take things very hard, there lives are being destroyed along with that of their wife.

My thoughts are with you.