- Stephen Des Georges
Dementia: Early diagnosis, behavioral interventions key in vascular dementia
By Stephen Des Georges
Desert Haven Home Care and Apollo Residential Assisted Living provides residents with high-quality supervision and treatment reflective of its proprietary three cornerstones of managed care for seniors: meaningful, patient-centered care, best-class service and passionate advocacy. Healthcare professionals at each residence are knowledgeable and respected servants, familiar with the latest evidence-based research and outcomes. It is our privilege to regularly share with you timely and topical insights into issues that impact elderly loved ones. In this installment, we unravel the complexities of dealing with vascular dementia and the rise of cases in the elderly population.
Dementia is a set of symptoms that can include memory loss and difficulties with thinking, problem-solving or language. In vascular dementia (VaD), these symptoms occur when the brain is damaged because of problems with the supply of blood to the brain. For many years, the most common cause of dementia in the elderly population was believed to be Alzheimer's disease. However, the statistics are now beginning to shift because of the increasing cases of vascular dementia reported in assisted living facilities. Studies have shown that at least 68% of individuals living in these senior living and assisted living group homes are suffering from dementia, while 25% are suffering from other mental health issues. And, the prevalence of VaD appears to double every 5-10 years after the age of 65.
Notes Mayo Clinic: You can develop vascular dementia after a stroke blocks an artery in your brain, but strokes don't always cause vascular dementia. Whether a stroke affects your thinking and reasoning depends on your stroke's severity and location. Vascular dementia can also result from other conditions that damage blood vessels and reduce circulation, depriving your brain of vital oxygen and nutrients.
What is vascular dementia?
Dementia is a generalized term used to describe the slow and steady decline in one's cognitive abilities, leading to increasing functional impairments. Experts describe dementia as a “deficit of one or more domains' of the brain that disturbs memory, attention span, language, executive functioning and visuospatial abilities.” Vascular dementia is one of the most common types of dementia experienced by the elderly population in assisted living environments, and may show varying and unavoidable disease progression.
VaD is diagnosed in an individual clinically by establishing/reviewing a detailed history of the patient, as well as performing a thorough physical examination. Numerous tests of cognitive performance in individuals residing in assisted living facilities may also be used to gauge the progression of vascular dementia. However, the diagnosis for this condition is not always clear cut and may be challenging for attending physicians, since there may be a variety of causes for the onset of dementia, including a chance of what is known as mixed dementia.
Causes and risk factors in assisted living environments
The most common risk factors associated with vascular dementia include diabetes, smoking, hypertension and hyperlipidemia (too many lipids, or fats, such as cholesterol and triglycerides, in your blood). Numerous studies have shown hypertension to be the most important risk factor among those mentioned above. However, it has been shown that proper management of hypertension in its early stages can prevent the onset of VaD altogether.
Vascular dementia is primarily caused by the onset of ischemia (a lack of blood supply to an organ or part of the body) in the brain – such a lack of blood retard’s the brain’s ability to function on all cylinders. Ischemia of the brain can be caused by a number of reasons: a blockage in the blood vessel as a result of the formation of a blood clot, known as a thrombus; a condition called atherosclerosis, a buildup of fatty materials on the inside of the blood vessel; or other conditions negatively impacting the function of these blood-delivering arteries.
The type of blockage responsible for VaD is divided into a number of subtypes:
Multi infarct dementia
Small vessel dementia
Strategic infarct dementia
Hereditary vascular dementia
Symptoms of vascular dementia
Individuals diagnosed with vascular dementia may present a number of signs and symptoms that can help to facilitate their diagnosis. These symptoms range from simple forgetfulness and slow thinking to eventual depression, disorientation and loss of the ability to carry out everyday functions. Each of these symptoms can affect a patient’s thinking, reasoning and judgment, resulting in a greater degree of difficulty of living a full or so-called normal life as problem-solving skills are eroded.
Is there a treatment for vascular dementia?
There is no established treatment to reverse the progression of VaD. There are, however, two strategies that may be followed by doctors: symptomatic management of the condition, or the necessary steps required in the early prevention of the disease.
Drugs that may be used to halt the progression of vascular dementia include:
Cholinesterase inhibitors (Note: some such inhibitors are associated with adverse effects, such as stomach upset and agitation.
One NMDA receptor antagonist, memantine, is an FDA-approved drug for the management of moderate to severe VaD. NMDA antagonists are a class of drugs that inhibit the action of receptors responsible for memory and learning functions. Studies have shown memantine, and other NMDA antagoinists to be effective for improving the functional levels in the elderly and lowering their level of assistance dependency.
Preventative measures for VaD include early control of comorbidities like diabetes, hypertension, and hyperlipidemia, as these play a significant role in enhancing the risk for a vascular event. Moreover, lifestyle habits like smoking or the use of other tobacco products, and alcohol consumption should be avoided, as these have been found to increase the chance of vascular disease.
With increasing cases of vascular dementia in low-income assisted living residents, interest by practitioners in the medical field has been correspondingly heightened. VaD is most commonly associated with the aging population, particularly those living in assisted living environments and care homes. Because of the rise in cases of VaD among the elderly, prompt preventative actions are necessary to decrease the progression and onset of the disease. This can be achieved by regular checkups and the regular monitoring of elderly individuals as a part of an assisted living regimen among caregivers.
At Desert Haven Home Care and Apollo Residential Assisted Living in Greater Phoenix, Arizona, professional healthcare team members are on hand to make certain the proper treatments for dementia, including VaD, are always in place and constantly practiced. Team members know the symptoms of the disease and are prepared to ensure all appropriate measures are taken to ensure the good health and comfort of their residents.
Among the foundations of our care, as endorsed by the Alzheimer’s Association Campaign for Quality Residential Care, are:
Quality relationships shared with residents by professional team members; a supportive environment
Assessment of each resident’s abilities for proper acre and planning; recognition of special needs
Person-focused strategies; working with residents to ensure the best-possible quality-of-life results
Meaningful, daily social interactions
Formal and informal activities that provide personal meaning and sense of community and choices.
For more information about Desert Haven Home Care and Apollo Residential Assisted Living, visit www.deserthavenaz.com.
 Vascular dementia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793.
 Boustani, Malaz, et. al. "Characteristics associated with behavioral symptoms related to dementia in long-term care residents." The Gerontologist. Vol. 45, Spec No 1, 1 (2005): 56-61. doi:10.1093/geront/45.suppl_1.56.
 Uwagbai O., and V. B. Kalish. Vascular Dementia. [Updated 26 Jan 2021]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430817/.
 van der Flier, W. M., and P. Scheltens. "Epidemiology and risk factors of dementia." Journal of Neurology, Neurosurgery, and Psychiatry. Vol. 76, Suppl 5 (2005): v2-7. doi:10.1136/jnnp.2005.082867.
 Simmons, Brent, et. al. "Evaluation of suspected dementia." American Family Physician. Vol. 84, 8 (2011): 895-902.
 Eggink, Esmé, et. al. "A Population Perspective on Prevention of Dementia." Journal of Clinical Medicine. Vol. 8, 6 834. 12 June 2019. doi:10.3390/jcm8060834.
 O'Brien, John T., and Alan Thomas. "Vascular dementia." The Lancet (London, UK). Vol. 386, 10004 (2015): 1698-706. doi:10.1016/S0140-6736(15)00463-8.
 McVeigh, Catherine, and Peter Passmore. "Vascular dementia: prevention and treatment." Clinical Interventions in Aging. Vol. 1, 3 (2006): 229-35. doi:10.2147/ciia.2006.1.3.229.
 Strub, Richard L. “Vascular dementia.” The Ochsner Journal. Vol. 5, 1 (2003): 40-3.