Vascular Dementia

Vascular dementia is a degenerative cerebrovascular disease that leads to a progressive decline in memory and cognitive functioning. It occurs when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system.

To be healthy and function properly, the brain cells need a good supply of blood. The blood is delivered through a network of blood vessels called the vascular system. If the vascular system within the brain becomes damaged and blood cannot reach the brain cells they will eventually die. This can lead to the onset of vascular dementia.

 

Vascular dementia is the second most common form of dementia after Alzheimer’s disease.

 

 Vascular dementia affects different people in different ways and the speed of the progression varies from person to person. Some symptoms may be similar to those of other types of dementia.

 People with vascular dementia may particularly experience:

Problems concentrating and communicating.

Depression accompanying the dementia.

Symptoms of stroke, such as physical weakness or paralysis.

Memory problems (although this may not be the first symptom.)

A ‘stepped’ progression, with symptoms remaining at a constant level and then suddenly deteriorating.

Epileptic seizures.

Periods of acute confusion.

Other symptoms may include:

Hallucinations (seeing things that do not exist)

Delusions (believing things that are not true)

‘Wandering’ and getting lost

Physical or verbal aggression

Restlessness

Incontinence.

 There are two main types of vascular dementia: one caused by stroke and one caused by small vessel disease. For many people, however, the causes of dementia may be mixed.

Certain factors can increase a person’s risk of developing dementia.

These include:

A medical history of stroke,

high blood pressure,

 high cholesterol,

 diabetes (particularly type II),

heart problems,

or sleep apnea (where breathing stops during sleep)

A lack of physical activity,

drinking more than recommended levels of alcohol,

smoking,

eating a fatty diet,

 leaving conditions such as high blood pressure or diabetes untreated.

A family history of stroke or vascular dementia.

Gender – men are slightly more likely to develop vascular dementia.

An Indian, Bangladeshi, Pakistani, Sri Lankan or African Caribbean ethnic background.

How long have I been here?

 

The walls are all white, there is just a bed.

Why is there a warm, cozy place in my head?

Pictures surround me, a lifetime of joys.

Those people look familiar, who are those boys?

 A nurse comes in directs me here or there.

They all look alike and they don't seem to care.

How long have I been here? Where is my wife?

I can only remember scattered bits and pieces of my life.

Could someone take the time, a moment or two?

 I'm confused, worried, scared and not sure what to do.

How long have I been here, I'm supposed to go home.

The panic sets in, I begin to roam.

They call them behaviors, I need to be heard.

 I try to explain but I can't find the words.

How long have I been here? Do I have to stay?

Everything I love has been taken away.

I hear the word dementia over and over again,

I guess that's the name of the Hell that I'm in.

 

 

By:

alznurse929

 ~~Night Shift Thoughts~~

January 19, 2007

 

Hope is the thing with feathers

That perches in the soul.

And sings the tune

Without the words,

and never stops at all.

 

-Emily Dickinson-

(1830 - 1886)

 

http://brijoy2006.blogstream.com/

 

Recently, I visited Pretty Rubble's blog and she shared with us her mother-in-law had had an accident, broken a hip. This is the story of Mae, I'm hoping she will read it and find a little hope.

 

"Mae"

Mae is in her early 90's. I would describe her as an "old broad," and in doing so she would only chuckle and say..."you're damn right."

The only medication I provide for Mae is 4 oz. of Kessler's Bourbon at night. That is no lie. She lives totally independent in her one bedroom apartment. Although she is legally blind, she maneuvers around the facility with no guidance at all. She has no signs of dementia.

~~~~~~~~~~~~~~~~~~~~~~~~~

About 2 months ago a police officer arrived at the door of the facility around 1 a.m. He asked if we had any residents there by the name of "Mae." I escorted him to her room only to find her on the floor near the bed, angry as a hornet.

I did my assessment, she was in a moderate amount of pain, and with movement she would grab her groin area and cuss. I knew, or I suspected a broken hip. I sent her out via ambulance.

~~~~~~~~~~~~~~~~~~~~~~~~~

 Two weeks later, Mae was readmitted to the facility. She had orders to go to a nearby facility for rehab but lasted one day there. She didn't like anyone at the facility, and she didn't want anyone taking care of her. They still insisted it was not a broken hip.

 

She started physical therapy in our facility, and with a follow-up appointment with her primary physician, found out 3 weeks later that there was indeed a fracture in her left hip.

(I knew it! )

They, doctor and physical therapist, ordered her to be in a wheel chair. They prescribed narcotic medication for the pain.

Mae was not having any of the B.S. She had been walking for the last 3 weeks.  She never once asked for pain medication.

 

"Who the hell do these people think they are??"

 

They were exploring the possibility of surgery, not happening for Mae.

 

"Why is everyone making such a big deal?"

 

Mae is one of the most colorful people I know. I spend a lot of time just chatting with her in the evening. She reminisces, stories that are always funny and interesting.  She continues to walk to all meals and live independently.

 

My prayers are with PR and her family. I hope the outcome is as amazing as Mae's has been.

 

Nursey

There is no cure for Alzheimer's disease.

It is managed with medications that have shown, in some studies, to slow the disease process.

 

Cholinesterase Inhibitors

Cholinesterase inhibitors are a group of drugs commonly prescribed to individuals with Alzheimer's disease and other forms of dementia in order to slow the disease.

For individuals with dementia, brain function decreases in part because their brain cells are no longer able to communicate with one another as well as they used to. Cholinesterase inhibitors act to increase levels of the neurotransmitter acetylcholine, a chemical which helps brain cells communicate and work better.

In practical terms, you may find that your loved one may be better able to remember names and details or perform activities with fewer problems.

Aricept

(generic name: donepezil)

 

Razadyne

(generic name: galatamine)

 

Exelon

(generic name: rivastigmine)

 

Cognex

(generic name: tacrine) 

 Less commonly prescribed, Cognex was the first drug in the treatment of Alzheimer's disease. It was approved by the FDA in 1993 but today it is seldom prescribed due to side effects it may have on the liver.

 

Namenda

(generic name: memantine)

Approved for use in U.S in 2004. Memantine is a new type of drug that works differently from currently available anti-cholinesterase inhibitors, which are generally only effective in milder forms of the disease.

 

Memantine has been found to slow deterioration in individuals with moderately severe Alzheimer’s Disease.

 

There are conflicting reports and views whether any of these drugs are helpful.

 

Some studies say early use of these medications can delay nursing home placement by 6 months to a year, while other reports say they have no real benefit at all.

 

My thoughts.

In taking care of the people who use these drugs regularly, when taken off the medication there is an increase in behaviors and a decline in mental function. Not in everyone, it seems to be very individual.

The newest drug, Namenda, is usually taken with the cholinesterase inhibitors (usually Aricept.) Again, in some people I did see an improvement in function, while others had side effects such as agitation and increase in behaviors.

It is all we have for now.

I think, for the most part, family members feel obligated to take any action available to slow the disease process. The medications are very costly.

I would opt for the only available treatment for my loved one in hopes it would slow the process and make their days a little more tolerable.

 

Nursey