1. health and fitness
2. disease

Vascular Dementia
Presented By Liz Graham
Brightwater Care Group
Training to care for people with dementia
Objectives
• To increase knowledge and
understanding of Vascular
Dementia
• To demonstrate the progression
of Vascular Dementia
• To discuss the importance of
team management of the person
with Vascular Dementia
Training to care for people with dementia
Types of Dementia
• Alzheimer’s Disease
• Vascular Dementia
• Dementia with Lewy
bodies
• Frontal lobe Dementia
• Korsakoff’s Syndrome
• Huntington’s Disease
• Substance abuse
• Creutzfelt-Jacob Disease (CJD)
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Progressive Supranuclear Palsy
Downs Syndrome
AIDS related
Encephalitis
Head Injury
And Others (over 80 causes)
Training to care for people with dementia
What is Vascular Dementia?
• Second most common form of dementia after Alzheimer’s
disease.
• Occurs when the blood supply to the brain is interrupted
by a blocked or diseased vascular system.
Training to care for people with dementia
A Little Bit of History
• Arteriosclerosis and senile dementia described as
different syndromes as early as 1899.
• Mayer-Gross et al in 1969 reported hypertension to
be the cause in 50% of patients.
• Hachinski in 1974 used the term multi-infarct
dementia.
• In 1985 the term vascular dementia was used by
Loeb.
Training to care for people with dementia
Different Types 0f Vascular Dementia
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Mild vascular cognitive impairment
Multi-infarct dementia
Vascular dementia due to a strategic single infarct.
Vascular dementia due to lacunar lesions
Vascular dementia due to haemorrhagic lesions
Binswanger disease
Subcortical vascular dementia
Mixed dementia (combination of AD and
Vascular)
Article by
Kannayiram Alagiakrishnam
Training to care for people with dementia
Multi-infarct dementia
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Most common form
Caused by a series of small strokes or TIA.
Damage caused to the cortex of the brain
Area associated with learning, memory and
language.
• Can be temporary but over time with repeated
incidents become permanent
• Symptoms include severe depression, mood swings
and epilepsy
Training to care for people with dementia
Binswanger’s Disease
(or Subcortical vascular dementia)
• Associated with stroke-related changes.
• Damage to tiny blood vessels of the white matter,
deep within the brain.
• Symptoms develop more gradually and include
• Slowness, lethargy, difficulty walking, emotional ups
and downs, lack of bladder control.
Training to care for people with dementia
Signs and Symptoms of Vascular Dementia
Physical signs/symptoms
• Memory problems, forgetfulness
• Dizziness
• Leg or arm weakness
• Lack of concentration
• Moving with rapid, shuffling steps
• Loss of bladder or bowel control
Training to care for people with dementia
Behavioural signs/symptoms
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Depression
Slurred speech
Language problems
Abnormal behaviour
Wandering/getting lost
Laughing/crying inappropriately
Difficulty following instructions
Problems handling money
Training to care for people with dementia
Risk Factors that increase risk of developing
Vascular Dementia
Training to care for people with dementia
Risk Factors
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High blood pressure
Smoking
Diabetes
High Cholesterol
History of mild warning strokes
Evidence of arterial disease elsewhere
Heart rhythm abnormalities
Lack of physical activity
Fatty diet
Gender – Men are at a slightly higher risk.
Age – Usually between 60 and 75, incidence
increases with age.
Training to care for people with dementia
GOOD NEWS
Unlike Alzheimer’s Disease, there are ways to prevent
and reduce the severity of vascular dementia.
Training to care for people with dementia
Medical management of:
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High blood pressure
High Cholesterol
Heart disease
Diabetes
Administering medication to prevent clots forming eg Aspirin
Drugs to relieve restlessness or depression
Recent research indicates that cholinesterase inhibitor
medications which are helpful with Alzheimer’s disease may be
of benefit in Vascular Dementia eg Aricept, Reminyl.
• In some cases surgery such as carotid endarterectomy may be
indicated.
Training to care for people with dementia
Unlike Alzheimer’s Disease, there are ways to prevent
and reduce the severity of vascular dementia.
A Healthier Lifestyle:
•A healthy diet
•Regular Exercise
•Stop smoking
•Moderate intake of alcohol
Receiving Rehabilitative
Support:
• Physiotherapy
• Occupational Therapy
• Speech Therapy
To help the person regain
lost functions.
Training to care for people with dementia
Progression of Vascular Dementia
Onset gradual or dramatic
Stabilise
TIA/Stroke
Stabilise
TIA/Stroke
Typically Vascular Dementia progresses gradually in a stepwise fashion in which
a person’s abilities deteriorate after a stroke, then stabilise until the next stroke.
Training to care for people with dementia
Mortality/Morbidity
• In community-based studies in Australia, the
prevalence rate for vascular and mixed dementia is
13% and 28%, respectively.
• In patients with dementia who have had a stroke, the
increase in mortality is significant. The 5 year
survival rate is 39% for patients with vascular
dementia compares with 75% age matched controls.
• Vascular dementia is associated with higher mortality
rate than AD, presumably because of the coexistence
of other atherosclerotic diseases. (Alagiakrishnan)
Training to care for people with dementia
Case Study
• 74 year old male admitted to High Care from CAP
unit
• Diagnosis – Dementia
• History of Hypertension, TIAs.
• Supportive family, wife and 2 daughters
• Transfer information
- Communication poor.
- Mobility: Non-ambulant, hoist transfer.
- ADLs: Full assistance, resistive in
showering/dressing.
Doubly incontinent.
Full assistance with meals.
Training to care for people with dementia
Personhood
• “A standing or status that is
bestowed upon one human being,
by others, in the context of
relationship and social being. It
implies recognition, respect and
trust”
• (Kitwood 1997)
Training to care for people with dementia
Philosophy and Principles of Person Centred
Care
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Attend to the whole person
See each person as unique and special
Give respect to the past
Focus on the positives
Stay in communication
Nourish attachments
Create community
Maximise freedom – minimise controls
Maintain environment of trust and value
Training to care for people with dementia
Team assessment and planning of care
GP
OCCUPATIONAL
THERAPIST
CARER
JIM
FAMILY
RN
SPEECH
PATHOLOGIST
PHYSIOTHERAPIST
Training to care for people with dementia
From Assessment
• GP – Reviews and monitors medication for hypertension and
administers aspirin.
• RN – Monitors health status and specifically blood pressure.
Works with team to implement care strategies.
• Occupational Therapist – Establishes grabbing and gripping
is behavioural. Implements strategies to assist during
washing/dressing including good communication, time, use of
smiling, careful handling.
• Carer – Works with Jim implementing strategies and feeding
back responses.
• Family – Guided by all staff in understanding and supporting
Jim’s needs. Involved during mealtimes, activities to support
Jim.
Training to care for people with dementia
From assessment Contd.
• Physio – Works to promote effective transfers and walking with
assistance of 2, 20 metres. Works with OT to ensure active
upper limb range present for washing /dressing. Works with
team to implement care strategies.
• Speech Pathologist – Establishes dysphagia status and
assistance for meals (along with OT). Soft diet, promoting
assistance to initiate ability to feed himself especially with finger
foods.
Communication requires one stage commands, time to respond
and friendly smiling face. Works with team to implement care
strategies
Training to care for people with dementia
Example of Jim’s Progress
Walks 20m with 2, Feeds himself with
help, Strategies assist during washing.
Gross motor activity, Entertainment
Non-Ambulant, Smiles,
Whistles,
Resistive, Assisted with meals
TIA
Stand transfers, non-ambulant,
Distracter to hold during washing
Smiles, Whistles, Gross motor
TIA
Standing Hoist transfers,
Active-Assisted exercises.
Assistance with vitamised
meals.
Continue Distractor use.
Smiles but no whistling.
Assess
Implement
Evaluate
Review
Training to care for people with dementia
Take Home Message
The take home message is simple:
By reducing your risk for stroke, you
also
reduce your risk for vascular dementia.
Training to care for people with dementia
References
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www.brad.ac.uk/acad/health/dementia
www.helpguide.org/elder/vascular_dementia.htm
www.alzheimers.org.uk
www.nia.nih.gov/Alzheimers/Publication/dementia.htm
www.memorylossonline.com/pastissues/summer2000/
vasculardementia.html
• www.alzheimers.org.au
• www.emedicine.com/MED/topic3150.htm
Training to care for people with dementia