Vascular Dementia


RLT

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My husband's stroke was three years ago. He showed steady if slow improvement for the first two years. This last year I observed a progressive decline in his cognitive abilities. I spent a lot of time reading posts and it was suggested to me that possibly my husband has vascular dementia. I DID NOT like the sounds of that but the symptoms lined up all too well. It took a couple years but I finally was able to get him into the VA program and he is still going the round of new doctors. I have asked each of them about vascular dementia and each time it seems that they turned around and typed that into their computer. I am still frustrated because they take my question as a definite diagnosis. This leaves me wondering if I suggested that he was a purple Martian if they would type that into their computer too! Along with this, I have been asking exactly what is vascular dementia. His primary care doctor spent a long time explaining that a stroke causes brain damage which is therefore dementia. Nah! I don't see that every stroke is dementia in my understanding of what dementia is. But maybe my definition is wrong. I have not had much luck learning about vascular dementia online either so I am turning to you all again.

 

So what I want to know is:

What is vascular dementia? Is it progressive? What causes it? What differentiates it from brain damage caused by the stroke? How would they know the difference between vascular dementia and Alzheimer's? Do all strokes ultimately lead to vascular dementia? Are there other questions I need to be asking?

 

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Guest lwisman

Here is a link to what the Mayo Clinic has to say about Vascular Dementia: http://www.mayoclinic.com/health/vascular-dementia/DS00934

 

I would be a bit concerned about a physician who indicated that a stroke causes vascular dementia. That seems a bit unlikely to me, at least not in 100% of the cases.

 

I, for one, had a stroke and do not suffer from any kind of dementia.

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Ray has had MULTIPLE strokes,TIAs and recently a seizure. This causes brain damage in scattered areas of the brain. The extra damage to the pathways that the post-stroke brain has re-aligned seems to be what causes vascular dementia. It is often not something you get after one stroke, but a series of strokes or TIAs over several years seems to most likely lead to the condition. In some diagnoses it will just be listed as "increasing cognitive impairment" hey! the doctor just doesn't want to use the word "dementia" I guess.

 

As far as I know there is no medication that will stop it although some are said to slow it down. Aricept and other meds like the Razadyne (called Reminyl here) also seem to slow down the effects. These meds are also being combined with Namenda (called Ebixa here) to strengthen or back-up the dosage. But they all seem to hold the effects back for a while but are not a cure. We associate the disease mainly with the elderly but anyone who has had significant brain damage from whatever source can get dementia of one kind or another.

 

I have been going to a dementia support group and am learning "behavioural modification techniques" which modifies MY behaviour and allows the behaviour generated by the dementia to have less impact on me particularly emotionally. I am learning to "smile and ignore it",walk away, re-phrase the question, seperate myself from the problem, use distraction techniques etc. This helps me deal with the problems that otherwise would have a devastating impact on my life. That is if my husband was being spiteful, abusive, ignorant etc instead of suffering from vascular dementia. It is the DISEASE!!! I keep telling myself that.

 

I have been told flippantly that Alzheimers can only be diagnosed acurately by autopsy! So I guess we will never know the full truth unless we pay for one! Did I mention doctors are a bit reluctant to explore the full impact lest the caregiver runs a mile?

 

Hang in there Ruth, I appreciate what you are posting now. It is hard to take sometimes, that honesty, but much appreciated.

 

(((Hugs))) from Sue.

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Thank you for your imput. The timing was perfect as my husband has an appointment this afternoon with his psycologist and I now have a list of items to discuss with the doctor.

 

My husband has indeed had numerous stokes which show up on his CT. At the time of THE stroke he actually had two with the the CT showing that one had accured prior to that which we did not know anything about. (In hind sight, it explains some behavioral changes that had bothered me.)

 

Sue said, "I am learning to "smile and ignore it",walk away, re-phrase the question, seperate myself from the problem, use distraction techniques etc. This helps me deal with the problems that otherwise would have a devastating impact on my life. That is if my husband was being spiteful, abusive, ignorant etc instead of suffering from vascular dementia. It is the DISEASE!!! I keep telling myself that." This will be my montra for the day!! It is a difficult lesson to learn to keep perspective. I need to learn some techniques for dealing with this on a daily basis.

 

Ruth

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My husband, and so I have been dealing with vascular dementia for almost two years now. My, how time flies! I began noticing changes in his behavior that led me to the internet to research "dementia" and that led me to "vascular dementia". It is my understanding that vascular dementia results from stroke. Dementia results from "old age" and Alzheimer's Disease is a specific type of dementia. Sue described the causes of vascular dementia very well. Additionally, I understand that those who suffer hemmorhagic stroke may be more susceptible to vascular dementia, as are those who have had a left-sided stroke

 

I learned that the difference in the way vascular dementia displays itself from Alzheimer's is that vascular dementia symptoms seem to remain pretty much stagnant for a period of time, then the symptoms increase and the patient's cognitive abilities take a dip. Alzheimer's symptoms steadily worsen - generally at a slow pace. Bill's condition is very much like this - his condition remains the same for a period of time (months) then whammo, something just doesn't click anymore. His staring off into the distance increases, his verbal skills decrease, his shuffling increases and he is just more distant. I notice the life in his eyes wanes and at times it's as if I'm looking at somebody who has gone away.

 

Problem solving and sequencing are really things of the past now. He doesn't understand most TV shows any longer and it is getting increasing difficult to find programs he enjoys. This person who was once extremely fastideous about himself, feels showering and shaving are a bother. "Accidents" are normal now.

 

Bill does take Aricept daily and Namenda twice daily. If he didn't I don't know what I'd do. The last time he was hospitalized the neurologist's first comment to me was, "Are you ready to give up yet?" The meaning was......are you ready for the nursing home route yet??? One of my biggest struggles as a caregiver is the loss of his memory. I'm really learning patience! The other thing is his inability to make a decision, even about what he wants to eat. It's tough. You would think it would be easy because food isn't important - think again! He knows what he wants, just can't verbalize it. There is a lot of trial and error.

 

Ruth, I know well your frustration with the VA... Bill receives some of his medications through the VA. Yes, it seems when I mention something to the doctor he simply inputs it in his computer. The other frustration I've had is that the appointments with his PCP are spent with him inputting all Bill's medications in his computer. Then we are shuffled off to the pharmacist who tells us which meds the VA distributes. Then we are off to the pharmacy to get the meds. I've even had the doctor tell me he hasn't got any more time for Bill. He barely listens to his heart. They are great at sending a patient on to a specialist. However, Bill takes about 23 prescriptions so the cost benefit outweighs the "personal treatment" we receive. Some folks swear by the VA system, we haven't been so fortunate!

 

I guess this post hasn't offered much support. Just know you aren't alone. We who deal with this issue really do so in a lot of silence. I have to deal with it a day at a time, knowing Bill has not chosen this. Your husband hasn't chosen it either. By keeping his helplessness in mind, I am able to gain the strength I need to carry on for us both. I like to involve him as much as I can throughout the day. I know it's good for him and it helps me keep some normalcy in our lives.

 

Warmly,

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I really appreciate your sharing about your experience. You manage to catch some symptoms that I could not quite put my finger on.

 

I have seen these things in my husband for the better part of a year. He still is not really all that bad most of the time. He has has his good days and he has his bad days. Mostly it seems that he is just there. He doesn't seem to enjoy life like he used to. And I am referring to post stroke there. I am still struggling with acceptance at times though it is good to have a name to the problem.

 

So, for those of you who have been there, can you share some coping strategies? I'll start with three of our many crazy difficulties to start you off. I know that some things can be changed but a lot of the time I expect the change will have to be with me.

 

This is gross but I really could use some help here. My husband is able to take care of most of his toileting - even his accidents. He doesn't always do the best job though and I am thinking of painting the bathroom brown!! I replaced the toilet seat a couple months ago and all ready the paint is coming off from my vigorous scrubbing. But here is the really difficulty, everything has to be done with his left hand which does not get really clean. He has always been a touching sort of person and he always wants to touch my face. You can imagine my reaction when I can tell by the smell where he has just come from. I have tried to explain the problem to him. He just sniffs his hand and said it doesn't stink (even though by then I can see stuff under the nails). When I don't let him caress my face his feelings are hurt. So I have a choice between hurting him or myself. How do I get him to understand that I am rejecting the poop not the love?

 

This too is disgusting but this is my life... He has lost bladder control and uses Depends all the time. He cannot tell when they are wet and will argue with me if I tell him to change. As a result all the soft furniture in the house smells like pee. I have pads for him to sit on but he will not use them.

 

Lastly, he can dress himself for the most part. He seems to wear the same things for a long while so say he has worn a shirt for several days, each day he puts it on and buttons it up. Then all of a sudden he comes to me and wants help putting the shirt on. He gets really upset if I say no and will argue,

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Hi Ruth,

 

These are really difficult issues. The thing we all have to remember is that dementia causes our husbands minds to lose their ability to reason. Here is the tough part, the part we don't want to face as a wife.............It's called tough love. I can no longer suggest my husband do something. Especially when it comes to hygiene issues. I have to direct that show. He doesn't have the capacity any longer to take care.

 

It's time to tell him what he is going to do. I can't be frustrated with Bill when I don't do what is necessary to protect him, me or the house from the behavior changes. For instance, he doesn't remember to use a Depends at night - he doesn't like it for one thing. So, when he doesn't remember and I don't hand one to him to wear and he has an accident the next morning that I end up cleaning up then it's my fault, not his. I know what's best so I have to use my head!

 

I have had to become a lot harder. Bill doesn't remember that he was upset because I told him he had to do something - I do. If he won't put a pad on a chair, that's ok - you do it and tell him this is the way it is.

 

I have a huge frustration with Bill using the toilet. He doesn't stand close enough and dribbles all over the rug ..........So frustrating and I just don't know what to do anymore, other than wash it continually - so that's what I do. Better than an argument in my book. I just have to keep my frustration level as low as I can. If cleaning up after him works best for that, I'll do it.

 

As far as the clothes go, I'd just replace the dirty ones with clean ones.......Try to remember that he might NOT remember how to button his shirt one day and be fine another. I don't know why it is - but it is that way with Bill, too. I have finally learned to take each day as a single unit. Some days when Bill goes to shower he sits on the shower bench........until I direct him in his next move. By the way, this man who used to shower twice a day doesn't even want to shower once a day now. I've given up with daily shaving!

 

So, dear - these are the hints I have! I know these are the difficult issues we are dealing with when we talk about vascular dementia..........I'll give you permission to be the drill sergeant!! Hygiene is important for the health of each of us and visitors!

 

Warm wishes,

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Whoa, this is one topic I hate but I will do my best with it. Ruth, you are bringing up some hard questions to answer here.

 

Dressing issues. Ray has a shower nurse three days a week so clean clothes come Tuesdays and Fridays, a clean shirt and trousers also on Sunday. Clean underwear every day if I change it after he gets out of it. If he has an "accident" I change all his clothes as the aroma lingers.

 

Toiletting issues. I guess this is no time to be houseproud, just careful with your health so I'd take Ann's suggestion and just clean up. I do that too. "Had an accident dear? Hang on, you go to the bathroom and get washed up and I'll just nip in and clean it up for you." It is about preserving dignity, mine and his. We've lived together almost forty years, so me doing things to help him will keep us together hopefully another few years.

 

The Depends issue I tackle in a different way. I just switch Ray's clothes around while he is having a shower. If he goes by and he smells I just follow him and suggest he hands his underwear out and I'll get him clean ones. For me it is taking the blame out of things, it is not his fault remember - "It is the DISEASE!!" Sometimes I run into the bathroom and cry - I'm emotional sometimes and I'm finding this is a hard period to go through. It is as if your husband is now your child but needs to be treated in an adult way to preserve the relationship the way it should be. No easy thing to do.

 

Your other problem I'll address privately as I don't want to give away all my secrets here...lol. After all this is over I'll be able to write a book and retire rich in my old age!!

 

Hang in there Ruth, you are doing well.

 

(((Hugs))) from Sue.

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See anything here that sounds familiar?

 

 

Vascular dementia symptoms can vary, depending on the portion of the brain that's affected. People with vascular dementia can exhibit:Confusion and agitation Problems with language and memory Unsteady gait, causing falls Urinary frequency, urgency or incontinence Personality and mood changes One of vascular dementia's earliest symptoms typically involves a decline in the ability to organize thoughts or actions. This makes it difficult to keep track of more than one thing at a time or to communicate details in a sequential manner.Vascular dementia symptoms often begin suddenly and may worsen in a step-wise fashion, following a series of strokes or mini-strokes. But some forms of vascular dementia develop gradually and can easily be confused with Alzheimer's disease. One difference is that memory loss is one of the first symptoms of Alzheimer's. In vascular dementia, memory problems typically occur much later in the disease process.Alzheimer's disease and vascular dementia often occur together. In fact, some scientists believe that it's more common for these two disorders to occur together than apart.

 

From http://www.mayoclinic.com/health/vascular-...0934/DSECTION=2

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Stu, thanks for the posting. I guess I have a lot of INFORMATION on vascular dementia but get to live with the REALITY of it. This means I need more information on how to deal with each manifestation as it comes along and how to mainitain a reasonable relationship with Ray as I deal with these problems.

 

Compounding the emotional impact it has on me is the fact that I had Mum live with me for two and a half years as she progressed from mild to moderate Alzheimers and so some of the things that Ray does echoes what Mum did and I get twice as agitated. That is why I have to practice the "taking one step back" routine. The steps go something like: there is a problem (incontinence issue), what equipment do I need? where is Ray? do I need to tend to him first? so I fix Ray, then I go back and fix up the spills etc. At no time do I try to "blame" Ray for how I am feeling while doing all of this. What I am feeling is my problem not his. I do check on how he is feeling about all of this though as I know that will affect the rest of our day.

 

I think I am getting better at detaching myself emotionally from the problem, though if I disappear into a mental health facility suddenly you'll know that isn't so...lol.

 

(((Hugs))) to Ruth and Ann and Sarah and all those who are also dealing with this problem.

 

Sue.

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Stu,

 

Thanks for the definition. It's sort of like someone posting the definition of stroke. That's only part of it........we who live with the situation are very well of the definition. As with others whose spouse is a lucky recipient of this complication from stroke we probably ALL diagnosed the problem before the doctor. In fact, I remember exploring the web looking for my husband's symptoms. I found this thing called vascular dementia. It sounded so familiar.......The next trip to the doctor when I mentioned vascular dementia as it related to his symptoms the doctor shook his head......yes, I was right.

 

As Sue put it, there is a huge emotional component to it on the part of us caregivers. We know and we understand the disease raises havoc with our spouse's ability to be a spouse. Our husbands now look like our husbands...but as time goes on they become more like our children. This is the aspect of stroke that we struggle with the very most. Our husbands are not the survivors who do get better. Our husbands aren't the ones who do web searches and post here. Our husbands aren't the ones who help around the house and drive again and encourage other stroke survivors to keep working because rehabilitation is possible long after that golden year.

 

Each survivor here is so inspirational to me. However, my heart goes out to the caregiver - who like me - is not fortunate enough to have a survivor who has had the capacity and has fought back and is able to share their inspiration here. Some who have vascular dementia have recovered and now find themselves on yet another challenging journey. I think maybe the blessing is they don't realize what is going on with them.......yes, much like Alheimers patients. Maybe it is a combination of two condiions...but it really doesn't matteer to me. We are dealing with not only the visible results of the strokes, we are dealing with the disease of vascular dementia and/or Alzheimers that robs one of their indpendence and dignity.

 

Caregiving isn't for sissies........

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The Mayo definition is one of the best that I have seen online. Seems like there is a lot available on Alzheimer's and not so much for Vascular dementia. This article did give me some more questions to go over with my husband's doctors.

 

One of the most difficult struggles is that post stroke we at least had hope that my husband would get better. Each accomplishment made me feel that someday I might have a "real life" again. Vascular Dementia only promises that things will get worse. That requires a whole new mind set. This is what I am working on. It is hard to have hope when there is no promise of improvement.

 

A friend had me buy a book a couple days ago called The Battlefield of the Mind. It deals with the fact if we think negative thoughts we become negative miserable people. I am trying to tackle the negative thoughts and feelings with positive action. I feel I need to learn ways to cope with some of the issues that bother me the most rather than letting them continue to beat me down. I am not very imaginative sometimes so need to bounce things off other people. So Thanks to all the input here and in PMs.

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i want to take my hat off to all the caregivers here and especially the ones dealing with this aspect. you are all much loved by all of us here. hang in there,you are all in my prayers.

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