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Alzheimer's and Vascular Dementia - is there a difference?

Discussion in 'Researchers, students and professionals' started by Jude, Sep 30, 2004.

  1. Jude

    Jude Registered User

    Dear Sarah,

    Also a big Welcome from me too. This is a great idea.

    I would be interested to know a couple of points really. Firstly, what signals should we look out for with early vascular dementia and secondly, how this differs from mainstream AD.

    The second point came up only recently when I was reading posts on TP and it did occur to me that perhaps my father may have Vascular Dementia. He tends to phase in and out of confusion, unlike my mother who is pretty well confused all the time.

    Best wishes

    Jude
     
  2. Norman

    Norman Registered User

    Oct 9, 2003
    4,348
    Birmingham Hades
    Welcome to TP
    how can the initial diagnosis tell AD from Vascular Dementia.
    After taking Aricept could this confuse the issue?
    Norman
     
  3. Sarah Day

    Sarah Day Registered User

    Sep 28, 2004
    17
    Gordon House, London
    #3 Sarah Day, Oct 4, 2004
    Last edited: Nov 24, 2005
    Differences between Alzheimer's disease and vascular dementia

    Hi Jude and Norman

    Thank you for your replies. I will try to respond as best as I can to your queries but I am not an expert and I am sure some of you with direct experience of vascular dementia are in a better position to explain some of the signs and symptoms.

    The main difference between Alzheimer's disease and vascular dementia appears to be the way in which symptoms begin and progress. Since a common cause of vascular dementia is stroke, specific symptoms often begin quite suddenly but then the person may stabilise for a period. However, another stroke may cause a sudden deterioration in some abilities. People with Alzheimer's disease on the other hand, tend to experience a more consistent rate of decline in all cognitive abilities.

    The early symptoms of vascular dementia are often slightly different to those of Alzheimer's disease and depend on the area of the brain damaged by vascular disease (stroke is a type of vascular disease).

    Multi-infarct dementia is a type of vascular dementia caused by a series of small strokes. Each stroke in itself may not be noticeable but can cause lightheadedness, temporary blindness or weakness in the arms or legs. However, a build up of damage in the brain may start to cause symptoms of dementia such as memory impairment and difficulty solving problems.

    Vascular dementia may also be caused by a single larger stroke and in this case, symptoms are more obvious eg, speech difficulties or paralysis of one or more limbs together with cognitive impairments.

    Very often people with vascular dementia maintain their personality and retain some abilities until the later stages of the disease. This is different for those with Alzheimer's who are likely to experience a decline in all abilities. This is because vascular dementia can affect distinct parts of the brain whereas Alzheimer's disease affects the entire brain.

    Having said all this, the symptoms may be difficult to differentiate in many cases since it has been suggested that a large proportion of people with Alzheimer's disease also have cerebrovascular disease, i.e. 'mixed dementia'. At the moment, there are drugs such as Aricept that are used to treat Alzheimer's Disease however, there has been limited research into the effectiveness of drug treatments for vascular dementia. However, in the case of a dual diagnosis, Aricept might be useful in treating some of the symptoms associated with the Alzheimer's disease.

    Do these sort of symptoms sound characteristic of your experiences of vascular dementia? What do you think are the benefits or difficulties of a dual diagnosis?

    I have posted another thread to discuss diagnosis of vascular dementia and would be very interested in your feedback.

    Best wishes,

    Sarah
     
  4. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    Brucie's thoughts

    Jan was diagnosed with mixed dementia - Alzheimer's and vascular - although no-one thought to tell me it was more than Alzheimer's until she had been in her care home for nearly 2 years.

    It caused me a lot of confusion before I knew because everything I was reading seemed not to be appropriate to Jan, if she had Alzheimer's. Some things seemed right, some definitely not.

    I interpret most things visually, and I have attached my view of the different slopes of decline that seem to happen with the two dementias and their combination.

    I hasten to add, I am a complete layman so this is all observation, not knowledge, albeit from a person with more experience of Jan's illness than anyone else, bar none.

    The vascular stepped decline can be confusing, because the drops are variable, according to the severity of the stroke, and the times in between drops are also variable, so just when you think things are nice and stable...... wham, there's another drop.

    Another thing I have observed is that after a mini stroke, Jan actually improves a little for a short while. I guess the body is pushing blood into relatively unused and unaffected parts of the brain and they work for a while, similar to the effects of ECT, I understand.

    When the dementias are mixed, there is the added complication of a gradual decline in between strokes.
     

    Attached Files:

  5. Sheila

    Sheila Registered User

    Oct 23, 2003
    2,259
    West Sussex
    Hi all, I can identify very much Brucie with what you say, my Mum did the steps just as you illustrate for Vas/Alz dementia. She had lucid periods right to the end. She also had many little TIA's (Transient Ischemic Attacks), the little strokes you mention. She was always worse behaviour/sleeping etc. leading up to one and calmer though more confused once it passed. These were often accompanied or preceded by a chest infection. She also had terrible mood swings and was violent at times. Love, She.XX
     
  6. BeckyJan

    BeckyJan Registered User

    Nov 28, 2005
    18,972
    Derbyshire
    #6 BeckyJan, Dec 4, 2005
    Last edited: Dec 4, 2005
    Query vascular or AD

    I am vey interested in these thoughts but now more confused than ever. A few weeks ago after asking for review of medication the CPN (on telephone) said that my husband may have Vasc Dementia - this was after a diagnosis of AD some 2/3 yrs ago. He did have a mild stroke on hearing the diagnosis!. (I will swear he has been into AD for at least 5/6 yrs). So now I do not know!! The consultant came a fortnight after that comment and agreed to increase Aricept to 10 mg. - said she was not sure that it would help! No mention from the consultant about vascular dementia. The progress although very slow at first does now seem to be more marked. Mobility is dreadful but he is very stubborn about having a wheelchair. Some days he is definitely much worse than others - quite disorientated and confused - anther day he is much more lucid and aware of his own health difficulties.

    If it is a mixed diagnosis does this mean the progression is much faster?

    Comments would be helpful as I feel very unsupported in this area.
    BeckyJan
     
  7. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    My wife Jan was originally diagnosed with Alzheimer's, but I could never understand why her symptoms seemed to progress differently from the classical Alzheimer's profile - slow steady decline.

    A couple of years ago, her doctor at the care home where she lives told me that she has mixed dementias - partly Alzheimer's, partly vascular. This explained the difference, or appeared to, to me.

    I think the diagnosis has often been given of Alzheimer's because most people will have heard of it. If they just said it is dementia, probably the Alzheimer's form, then that would be better. There are few purely black and white situations where these things are concerned.

    I am no expert, except in Jan's decline, but I see the difference between the two dementias as:
    • Alzheimer's: relatively slow and steady, more predictable decline
    • Vascular: decline in a series of steps, with a step downwards happening after a stroke
    But there is also something else that confuses the picture.

    From the experiences I have had with Jan and with other dementia patients at her home, it seems to me there is also a difference in pattern that depends on the age of the patient.

    Someone with Early Onset dementia [that is, where it has happened/been diagnosed before the age of 65] seems to have a more difficult path as they appear to fight it more, and sometimes their decline is more marked and quicker. Not always, however - I have known people who have had less pronounced symptoms than Jan who have declined really rapidly and passed on very quickly. I have also known similar people who have declined slowly.

    I think immediate futures are less easily forecasted for Early Onset patients.

    Jan's symptoms often seem to get a little better just before - and often jiust after - a mini stroke. The overall pattern is one of heartbreaking decline though.
     
  8. David Purnell

    David Purnell Registered User

    Feb 22, 2006
    1
    Nottingham
    vascular dementia confusion

    I've just joined the forum and find the points raised in this thraed interesting. My wife was diagnosed, after a private consultation, as having VD some five years ago. Her progression is like the step function referred to but has no signs of a stroke or stroke induced damage, After being referred to a local memory clinic the clinicians ther talk about her having Alzheimers and seem to use that terma as a catch all. At first she was on Aricept which upset her badly and now is on Ebixa which we have to buy privately. This certainaly appears to have slowed down the rate of decline. At the end of the day to the carer, me, the difference betwenn VD and AD matters not one jot. The person I love is being hurt!
     
  9. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    David, warmest of welcomes to TP.

    Dementia, in any shape or form, is exceedingly puzzling, and for those with mixed diagnosis, doubly so. I agree with your comment about what difference does it make. Our loved ones are all we care about, whatever the label on the illness.
    Regards, Connie
     
  10. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    Hi David,

    yes, welcome.

    Jan has mixed Alzheimer's and vascular dementias. In the early stages the thing I noticed most was her fainting. I was never able to detect a mini stroke. There is some doubt about the cause of her faints, but TIAs they were not.

    So be aware that the strokes may not be visible when they happen. There are small ones, bigger ones and very big ones. Just depends on the person and the time during the development of the dementias, or so it seems.

    I often think that because of the difficulty of diagnosing which particular dementia - and even the fact of dementia, rather than depression etc - some doctors use Alzheimer's as a catch-all. Others say it must be a combination.

    Re-phrasing what both you and Connie say, and to muck up the Bard's words: "a nettle, by any other name still stings as badly"

    Best wishes
     
  11. jennifer3

    jennifer3 Registered User

    Apr 4, 2006
    14
    lancs
    vascular & alzheimers

    i have also just found this forum my husband who has always been my rock has been dignosed with first demntia then T,I,A'S now alzheimers does everyone feel that hurt that there is this thing removing the man you have known and loved into a stranger with a vacant look in their eye when they look at you in his body
    and then the next time they will not let you out of their sight to see this strong man so scared what can you do but hold them
     
  12. Sheila

    Sheila Registered User

    Oct 23, 2003
    2,259
    West Sussex
    Yes, only too well I'm afraid. You will find kindred spirits to share with here on TP so keep posting. Thinking of you, luv, She. XX
     
  13. Amy

    Amy Registered User

    Jan 4, 2006
    3,453
    Hiya Jennifer,
    Glad you have found us. The short answer to your question "Does everyone feel that hurt?" Yes. Looking forward to getting to know you.
    Amy
     
  14. Bets

    Bets Registered User

    Aug 11, 2005
    100
    South-East London, UK
    Hi Jennifer,

    As Amy says, many of us know only too well the hurt of losing a partner to dementia. I would go further than calling it a "hurt". I would call it grief. However, unlike the grief following a death, this grief is ongoing. As you say, the pain involved in seeing one's rock of many years become anxious and dependent, of finding yourself in the role of carer and mental nurse rather than wife, is awful beyond words. I hope, like everyone else on TP, you will find some comfort, and lots of support, from knowing you are not alone.

    Bets
     
  15. Kayla

    Kayla Registered User

    May 14, 2006
    621
    Kent
    Vascular dementia

    My mother has vascular dementia and is in a nursing home for the elderly and EMI. She lived in her own home until June last year but kept falling and was mixed up about times. She also had hallicinations. She chose to go into a residential care home which seemed to help her with routines.and she was happy. A fall caused her to need a hip replacement. The hospital environment was bad for her and she kept wanting to escape. She couldn't weight bear and her mind kept wandering so she had to move into the nursing home. On Thursday she told me she didn't have a daughter and she keeps crying. Her condition varies so much each time I see her. Sometimes she is quite normal and other times her behaviour is bizarre. It is as though I've already lost my mother but she is still there physically but mentally it's a different person.
     

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