How Is Vascular Dementia Diagnosed
In addition to a complete medical history and physical exam, your healthcare provider may order some of the following:
- Computed tomography . This imaging test;uses X-rays and a computer to make;horizontal, or axial images of the brain. CT scans are more detailed than general X-rays.
- FDG-PET scan. This is a PET scan of the brain that uses a special tracer to light up regions of the brain.
- Electroencephalogram . This;test measures electrical activity in the brain
- Magnetic resonance imaging . This;test;uses large magnets, radiofrequencies, and a computer to make;detailed images of the brain.
- Neuropsychological assessments. These tests can help sort out vascular dementia from other types of dementia and Alzheimer’s.
- Neuropsychiatric evaluation. This may be done to rule out a psychiatric condition that may resemble dementia.
Alzheimers Disease Vs Other Types Of Dementia
Dementia is an umbrella term for a range of conditions that involve a loss of cognitive functioning.
Alzheimers disease is the most common type of dementia. It involves plaques and tangles forming in the brain. Symptoms start gradually and are most likely to include a decline in cognitive function and language ability.
To receive a diagnosis of Alzheimers, a person will be experiencing memory loss, cognitive decline, or behavioral changes that are affecting their ability to function in their daily life.
Friends and family may notice the symptoms of dementia before the person themselves.
There is no single test for Alzheimers disease. If a doctor suspects the presence of the condition, they will ask the person and sometimes their family or caregivers about their symptoms, experiences, and medical history.
The doctor may also carry out the following tests:
- cognitive and memory tests, to assess the persons ability to think and remember
- neurological function tests, to test their balance, senses, and reflexes
- blood or urine tests
- a CT scan or MRI scan of the brain
- genetic testing
A number of assessment tools are available to assess cognitive function.
In some cases, genetic testing may be appropriate, as the symptoms of dementia can be related to an inherited condition such as Huntingtons disease.
Some forms of the APOE e4 gene are associated with a higher chance of developing Alzheimers disease.
What Is Vascular Dementia
Vascular dementia is the second most common form of dementia after Alzheimer’s disease. It’s caused when decreased blood flow damages brain tissue. Blood flow to brain tissue may be reduced by a partial blockage or completely blocked by a blood clot.
Symptoms of vascular dementia may develop gradually, or may become apparent after a stroke or major surgery, such as heart bypass surgery or abdominal surgery.
Dementia and other related diseases and conditions are hard to tell apart because they share similar signs and symptoms. Although vascular dementia is caused by problems with blood flow to the brain, this blood flow problem can develop in different ways. Examples of vascular dementia include:
- Mixed dementia. This type occurs when symptoms of both vascular dementia and Alzheimer’s exist.;
- Multi-infarct dementia. This occurs after repeated small, often “silent,” blockages affect blood flow to a certain part;of the brain. The changes that occur after each blockage may not be apparent, but over time, the combined effect starts;to cause symptoms of impairment. Multi-infarct dementia is also called vascular cognitive impairment.
Researchers think that vascular dementia will become more common in the next few decades because:
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Apoe And Heart Health
Volgman tests for APOE E4 because it puts people at risk for atherosclerosis.
But she doesn’t think everyone should get tested.
In most cases, she explains, treatment for atherosclerosis risk factors such as high cholesterol or high blood pressure would be the same no matter what form of APOE a patient had. Sometimes, though, the test can help decide the best course of action.
“For example, if a patient has been eating well and exercising and her cholesterol levels still haven’t changed, it could help to know whether she has a higher risk,” Volgman says. “If she does, we might want to start medication earlier.”
Of course, treatment is not the only thing that can change in the lives of people who test positive for APOE E4. From then on, they know they have a high risk of Alzheimer’s disease.
Estimated Lifespan Is Considered
Depending on the level and type of dementia, a physician may determine that the patient has only a short time left, and that CABG with a recovery that may take several months just would not be worth it.
A patient with dementia might also have other issues such as diabetes, atrial fibrillation, poorly functioning kidneys or lung disease that would lower their surgical survival odds.
These comorbidities, along with the dementia, would factor into the consideration of the patients probable lifespan if they DID have the surgery.
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Heart Health And Memory Decline
The body is one unit that all works together in fascinating ways. When it comes to your brain and heart, the health of one directly affects the health of the other, and that means poor heart health can lead to memory decline.;
Fatty plaque and stiff arteries lower the blood supply to all parts of the body, including the brain. The small blood vessels inside the brain are more easily blocked, which can mean a higher risk of stroke and other issues. When a stroke occurs, large sections of brain tissue die, and many stroke survivors end up dealing with dementia as well.;
Theres a clear link between lowered blood flow and a variety of issues related to the brain, including Alzheimers. Beta-amyloid buildup, which is the main indicator of the disease, comes from hypoperfusionor a lack of blood to the brain over the long term. The type of dementia thats tied to blood flow is called vascular dementia. But even without dementia, your heart health can impact your memory.;
In one study, heart problems nearly doubled the risk of mild cognitive impairment. That includes coronary heart disease, heart failure, atrial fibrillation, and a whole range of other issues. Women were particularly at risk over men.
Heart failure itself causes a kind of brain fog that lowers cognitive function, especially early on after a heart attack. This can be overcome with training and rehabilitation, but it can affect quality of life for anyone whos had a heart attack.
What This Means For Patients And Families
This study will be integral in helping those suffering with Alzheimers disease. Because amyloid beta deposits can develop in the heart, it is important that the families and healthcare providers of people with Alzheimers be on the lookout for signs of heart disease.
There is still no cure for Alzheimers. However, there have been many advancements in treatment for the disease that have allowed people with Alzheimers to live longer than previously expected when first diagnosed. This is great news, but it does mean that there is a higher chance they may develop heart problems along the way due to their disease. Thanks to this new research, however, patients suffering from Alzheimers can now better avoid potential cardiovascular issues in the future by being aware of the high risk and monitoring their health closely.
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Vascular Dementia Risk Factors
Some of these risk factors can be controlled, but others cannot.
Age is the strongest risk factor for vascular dementia. A person’s risk of developing the condition doubles approximately every five years over the age of 65. Vascular dementia under the age of 65 is uncommon and affects fewer than 8,000 people in the UK. Men are at slightly higher risk of developing vascular dementia than women.
What do we mean by risk factors for dementia?
A risk factor is something that affects your chance of developing dementia. Find out more about what a risk factor is and how risks for dementia are identified.
Emotion And Behavior Treatments
The emotional and behavioral changes linked with Alzheimers disease can be challenging to manage. People may increasingly experience irritability, anxiety, depression, restlessness, sleep problems, and other difficulties.
Treating the underlying causes of these changes can be helpful. Some may be side effects of medications, discomfort from other medical conditions, or problems with hearing or vision.
Identifying what triggered these behaviors and avoiding or changing these things can help people deal with the changes. Triggers may include changing environments, new caregivers, or being asked to bathe or change clothes.
It is often possible to change the environment to resolve obstacles and boost the persons comfort, security, and peace of mind.
The Alzheimers Association offer a list of helpful coping tips for caregivers.
In some cases, a doctor may recommend medications for these symptoms, such as:
- antidepressants, for low mood
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Exclusive Look At Nih Investigation Into Covid Long
Long-term cognitive symptoms from Covid-19 appear to differ with age. Depression, anxiety and sleep trouble are more common among young people, and memory loss and speech impairment are more common in people over age 65, said Dr. Gabriel de Erausquin, director of the Laboratory of Brain Development, Modulation and Repair at the Glenn Biggs Institute of Alzheimer’s and Neurodegenerative Disorders in San Antonio.
According to one of the new studies presented Thursday, people who lose their sense of smell are more likely to experience cognitive impairment, which may show up as memory loss or troubles with speech. Loss of smell also predicts the severity of brain changes and cognitive decline in people with Alzheimer’s disease.
“If you have a loss of smell, you won’t necessarily have cognitive impairment, but if you do, the more severe the loss of smell, the more severe the loss of memory will be,” said de Erausquin, who is leading the research on a growing group of more than 300 Argentines ages 60 and up who have had Covid-19.
What Can You Do If You Want To Reduce Air Pollution To Lower Your Risk Of Alzheimers Disease
Directly or indirectly, we are all responsible for the air pollution in our cities, our country, and our planet. We should each work to do what we can to reduce our carbon footprint. We can work to reuse and recycle materials so that factories dont need to produce as much. We can buy local foods that dont need to be trucked across the country and shipped around the world. We can walk and bike instead of driving our cars . Lastly, we can elect public officials who will advocate for local, national, and international policy to reduce pollution. And those are just some of the things that we can do to clear the air.
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Risk Factors For Heart Disease And Stroke Also Tied To Alzheimers
By Lisa Rapaport, Reuters Health
5 Min Read
– Middle-aged people with risk factors for heart attacks and stroke are also more likely to develop changes in the brain that can lead to Alzheimers disease, a new study suggests.
Previous research has linked so-called vascular risk factors, including obesity, diabetes, smoking, high cholesterol and elevated blood pressure, to higher odds of dementia, cognitive decline and Alzheimers disease.
But its been unclear whether these factors contribute indirectly by restricting blood flow in the brain, or if they directly cause a buildup of amyloid protein fragments that are linked to Alzheimers.
In our study, we found an association between the number of risk factors that people without dementia had when they were middle-aged and the risk of having amyloid in their brain when they were older, said lead study author Dr. Rebecca Gottesman of Johns Hopkins University School of Medicine in Baltimore.
Each alone may not be enough to increase the risk of Alzheimers disease, but having a number of these risk factors appears to be associated with an even higher risk, Gottesman said by email. Although this doesnt prove causation, it suggests that vascular risk factors might directly impact Alzheimers changes in the brain.
At the start of the study, one in five participants had no vascular risk factors, while 38 percent had one and 42 percent had at least two.
SOURCE: bit.ly/2eRKuCu JAMA, online April 11, 2017.
Ups In The Brain And Heart
When the UPR fails, the UPS combats the accumulation of toxic protein aggregates. Therefore, it is not surprising that damage of this system would have severe consequences to the brain and heart structure and function. In both organs, failure of the proteasome activity has been described in degenerative diseases. Within the brain of AD patients, proteasome inhibition is sufficient to cause neuronal death . In the heart, an imbalance between ubiquitination rates and degradation of ubiquitin labeled substrates is implicated in cardiomyocyte’s cell death .
As misfolded proteins are central biomarkers in the pathophysiology of numerous neurodegenerative diseases, with aggregates of Aß being central to AD , several studies have shown that deficiency in Aß clearance may be a major cause of late-onset AD. Moreover, ubiquitin proteins have been observed within the intracellular tangles typical of AD . Since then, much attention has been given to the UPS in AD because of both its main role in intracellular proteolytic pathways and its presence within AD protein aggregates .
Myocardial hypertrophy is also modulated by the immunoproteasome, an inducible form of the constitutive proteasome. Inhibition or knockout of immunoproteasome subunits has been shown to attenuate cardiac hypertrophy a postulated mechanism underlying the effect of resveratrol . RES blocks immunoproteasome activity, thus preventing PTEN degradation and AKT signaling .
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Implications For Research And Practice
The results of this study show that CHD may accelerate cognitive decline in dementia. It is well established that cardiovascular prevention reduces the incidence of atherosclerotic diseases. It may also be effective at slowing progression of dementia, although evidence from randomised controlled trials is lacking.
Additional studies are required to examine the effects that preventing CHD by early treatment of its risk factors has on dementia and cognitive decline. A recent study showed that an excessive reduction in blood pressure in older patients with dementia or mild cognitive impairment can even promote the progression of cognitive decline. This demonstrates the importance of studies on the effects of cardiovascular prevention in older people.
As well as pharmacological treatment, physical exercise has a positive effect on dementia, possibly mediated by cardiovascular mechanisms. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability found that diet, exercise, cognitive training and vascular risk monitoring could improve or maintain cognitive functioning in older patients at risk of dementia. The transferability of the results to people with existing dementia should be examined in further prospective studies.
Mechanisms Of Cardiovascular Involvement In Alzheimer’s Disease
A potential head-to-heart link may be hypothesized in AD. This link has been ascribed to a reduction in cerebral perfusion. As the brain is highly vascularized, receiving 15% of cardiac output and consuming about 20% of the body’s total oxygen supply, it is particularly vulnerable to the impairment of cerebral perfusion, which is a frequent event in heart failure , particularly in the forms due to reduced systolic function. Cerebral hypoperfusion has been supposed to actively contribute in the formation of tau-containing neurofibrillary tangles and amyloid plaques which characterize AD, although, to date, data from human subjects confirming this hypothesis are lacking . Cerebral hypoperfusion causes a metabolic energy crisis of the brain cells, thereby leading to acidosis and oxidative stress . An acid environment stimulates activation of lysosomal enzymes, thus leading to the hyperphosphorylation of tau proteins. These hyperphosphorylated tau proteins cluster and give rise to so-called neurofibrillary tangles .
Furthermore, the altered metabolism of the neurons causes upregulation of beta-secretase 1, a protease which is responsible of the cleavage of the amyloid precursor proteins, thereby determining accumulation of A and the formation of amyloid plaques . Another mechanism which favours the formation of amyloid plaques, in cases of hypoperfusion, is the breakdown of the blood-brain barrier, which impairs the clearance of A .
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What Are Risk Factors
- Risk factors are aspects of your lifestyle, environment and genetic background that increase the likelihood of getting a disease.
- Risk factors on their own are not causes of a disease. Rather, risk factors represent an increased chance, but not a certainty, that dementia will develop.
- Similarly, having little or no exposure to risk factors does not necessarily protect a person from developing dementia.
There are some risk factors that can be changed, and some that cannot â read on to know which are which!
Read about risk factors for dementia in our downloadable, print-friendly infosheet.
This sheet also contains strategies and lifestyle changes that can help you reduce your risk of developing dementia.
Heart Disease Linked To Dementia In Women
Older women with a history of heart disease and heart-related issues were more likely to develop dementia as well as thinking and memory problems than those without heart disease, according to the study Cardiovascular Disease and Cognitive Decline in Postmenopausal Women released in the Journal of the American Heart Association on Dec. 18, 2013.Our study provides new evidence on a broad scale, including many different types of heart disease with a specific focus on postmenopausal women, said lead author Dr. Bernhard Haring, who is based at the Comprehensive Heart Failure Center at the University of Würzburg in Germany.
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Which Medicines Are Used To Treat Alzheimers Disease
There is no cure for Alzheimers disease, but available medications temporarily slow the worsening of dementia symptoms and help with behavioral problems that may appear during the course of the disease.
Four medications representing two drug classes are currently approved by the Food and Drug Administration to treat the symptoms of Alzheimers disease. These drugs are the cholinesterase inhibitors and a NMDA antagonist.
Cholinesterase inhibitors. The cholinesterase inhibitors are all approved to treat the symptoms of mild to moderate Alzheimer’s disease . Cholinesterase inhibitors include:
- Donepezil
- Rivastigmine and Exelon patch
- Galantamine
These drugs work by blocking the action of acetylcholinesterase, the enzyme responsible for destroying acetylcholine. Acetylcholine is one of the chemicals that helps nerve cells communicate. Researchers believe that reduced levels of acetylcholine cause some of the symptoms of Alzheimer’s disease. By blocking the enzyme, these medications increase the concentration of acetylcholine in the brain. This increase is believed to help improve some memory problems and reduce some of the behavioral symptoms seen in patients with Alzheimers disease.
These medications do not cure Alzheimers disease or stop the progression of the disease. The most common side effects of these drugs are nausea, diarrhea, and vomiting. Some people may have loss of appetite, insomnia or bad dreams.