Tests For Vascular Dementia
There’s no single test for vascular dementia.
The tests that are needed to make a diagnosis include:
- an assessment of symptoms for example, whether these are typical symptoms of vascular dementia
- a full medical history, including asking about a history of conditions related to vascular dementia, such as strokes or high blood pressure
- an assessment of mental abilities this will usually involve several tasks and questions
- a brain scan, such as an MRI scan or CT scan, to look for any changes that have happened in your brain
Find out more about the tests used to diagnose dementia.
Caring For Someone With Dementia
Caring for a person with dementia can be physically and emotionally demanding. Anger, guilt, frustration, discouragement, worry, grief and social isolation are common.
Learn as much about vascular dementia as you can. Ask the primary care doctor or neurologist about good sources of information. Your local librarian also can help you find good resources.
Take care of yourself. See your doctors on schedule, eat healthy and exercise.
Seek support. People with dementia and their families benefit from counseling or local support services. Contact your Alzheimers Association local affiliate to connect with support groups, resources, referrals, home care agencies, residential care facilities, telephone help lines and educational seminars.
Encourage. You can help a person cope with vascular dementia by listening, reassuring them that life can be enjoyed and helping them retain dignity and self-respect.
Provide a calm environment. It can reduce worry and agitation. Establish a daily routine that includes comfortable activities for the person with vascular dementia.
New situations, excess noise, large groups of people, being rushed to remember or being asked to do complicated tasks can cause anxiety. As a person with dementia becomes upset, the ability to think clearly declines even more.
Paying attention to your needs and well-being is one of the most important things you can do for yourself and the person in your care.
Clinical Characteristics Of Ncd People With Epilepsy
Among the study cohort, 40 people had epilepsy. Their characteristics are shown in Table 2. The median age at onset was 57.5 and 75.2% of people fulfilled the diagnostic criteria for young-onset NCDs with the age of onset < 65 years . Seven people developed epilepsy prior to cognitive decline and 33 after cognitive decline. The median duration between the onset of cognitive decline and the onset of epileptic seizures was 2 years , with 80% of people experiencing their first epileptic seizures within the time frame ranging from 2 years prior through to 6 years after the onset of cognitive decline .
Table 2. Clinical characteristics of people with epilepsy .
Figure 2. Onset of epilepsy in relation to the onset of cognitive decline. The yearly distribution of new-onset seizures relative to the year of onset of cognitive decline: the median duration between the onset of cognitive decline and the onset of epileptic seizures was 2 years , with 80% of people experiencing their first epileptic seizures within the time frame ranging from 2 years prior through to 6 years after the onset of cognitive decline.
Regarding the semiology of seizures, 2 people had FAS only, 13 had FIAS only, 14 had FBTCS , and 11 had GTCS. Eleven of the 13 people with FIAS has non-convulsive seizures without motor symptoms. Among the people who had seizures before dementia onset, most continued to have seizures during cognitive decline.
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Nonconvulsive Seizures And Dementia: A Case Report
Assenza Giovanni
1Dipartimento di Neurologia, Università Campus Biomedico, Via Alvaro del Portillo 200, 00128 Roma, Italy
Abstract
Nonconvulsive status epilepticus is a severe medical condition that shows increased incidence in the elderly and is frequently underdiagnosed because of its pleomorphic presentation. We report an NCSE in a 76-year-old woman affected by dementia with acute change of cognitive status and behavior. Intravenous diazepam solved clinical and electroencephalographic manifestations. Neuropsychological assessment after NCSE conclusion showed impairment of several fields that remained unchanged at 3-month followup. NCSE should be considered when sudden and transient cognitive fluctuations appear in the elderly. Epileptic events in dementia occur frequently and are often underrecognized this could be a misleading factor when considering a quick progression of mnesic performances. Moreover, recent findings both in animal models and in humans demonstrated the deep link between epilepsy and dementia, also supporting the hypothesis that epileptiform activity could contribute to cognitive impairment.
1. Introduction
We report an NCSE in a 76-year-old woman affected by dementia.
2. Case Report
Ictal EEG.
EEG activity after diazepam administration.
3. Discussion
4. Conclusion
References
Copyright
Molecular Links Between Epilepsy And Dementia In Older Patients
Another possible explanation for the increased risk of dementia in epilepsy is that some dementia syndromes might also share underlying pathological mechanisms with epilepsy, or that seizures might trigger pathological changes that make the brain more vulnerable to developing dementia pathology. Limited histopathological work has been performed to better delineate these aspects. In their study examining 138 people with chronic epilepsy, found that there was a higher incidence of cerebrovascular disease in older patients, and a significant correlation with cerebrovascular disease and higher Braak stages of Alzheimers disease-type pathology. However, when age was factored out, the association between cerebrovascular disease and Braak stage was no longer significant . Importantly in this cohort of patients, 30% had evidence of traumatic brain injury and this, rather than the number of seizures, correlated with a higher Braak stage . Similarly it has long been recognized that traumatic brain injury can increase the rate of dementia . However, how traumatic brain injury, dementia and epilepsy, which may directly cause head injury through a seizure or indeed be a consequence of a previous head injury, intersect remains incompletely determined.
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Network Level Effects In Epilepsy And Dementia
Increasingly, epilepsy is considered to be a brain network disorder, with widespread functional connectivity changes associated with even focal pathologies . Moreover, it is now also appreciated that a major contribution to cognitive impairment in people with epilepsy is seizure activity, regardless of the underlying pathological cause of seizures . In fact, although it has long been acknowledged that status epilepticus or recurrent seizures can impact upon cognition, findings in both animal models and humans demonstrate that interictal spikes or IEDs can also disrupt cognitive function even if remote to the ictal onset zone .
In TLE, simultaneous functional MRI-EEG studies reveal that the medial temporal lobe BOLD signal is increased in association with IEDS . Furthermore, both structural connectivity and functional connectivity are decreased within the DMN, compared to healthy individuals . Recent investigations of epilepsy patients using either functional MRI and/or EEG provide further support for abnormal DMN connectivity , either in the presence or absence of IEDs . Thus there is now abundant evidence for long-distance effects on the DMN in people with epilepsy including TLE, both during IEDs and in their absence.
Signs Of Vascular Dementia
If you or the people around you notice any of the signs below, you should visit your GP:
- Not being able to understand or respond to things very quickly.
- Not being able to remember things.
- Finding it difficult to concentrate.
- Not being able to find the right word when youre speaking.
- Struggling to plan ahead for everyday tasks.
- Difficulty in learning new tasks
- Seeming down or depressed.
At a later stage, signs may include:
- Becoming confused.
- Behaving differently, especially if youre being aggressive or behaving inappropriately.
- Lacking motivation.
- Not being able to control your emotions.
- Finding it difficult to walk and keep your balance.
- Having problems controlling your bladder.
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Key Points About Vascular Dementia
- Vascular dementia is a disorder characterized by damaged brain tissue due to a lack of blood flow. Causes can include blood clots, ruptured blood vessels, or narrowing or hardening of blood vessels that supply the brain.
- Symptoms can include problems with memory and concentration, confusion, changes in personality and behavior, loss of speech and language skills, and sometimes physical symptoms such as weakness or tremors.
- Vascular dementia tends to progress over time. Treatments can’t cure the disease, but lifestyle changes and medicines to treat underlying causes might help slow its progress.
- Surgical procedures to improve blood flow to the brain can also be helpful. Other medicines might slow the progression of dementia or help with some of the symptoms it can cause.
- A person with vascular dementia may eventually need full-time nursing care or to stay in a long-term care facility.
Can I Reduce My Risk
By making healthy lifestyle changes, such as stopping smoking and exercising regularly, and treating any health conditions you have, you may be able to reduce your chances of getting vascular dementia.
This may also to help slow down or stop the progression of vascular dementia if you’re diagnosed in the early stages. Find out more about treating vascular dementia.
But there are some things you cannot change that can increase your risk of vascular dementia, such as:
- your age the risk of vascular dementia increases as you get older, with people over 65 most at risk
- your family history your risk of problems such as strokes is higher if a close family member has had them
- your ethnicity if you have a south Asian, African or Caribbean background, your risk of vascular dementia is higher, as related problems such as diabetes and high blood pressure are more common in these groups
In rare cases, unavoidable genetic conditions can also increase your risk of vascular dementia.
Page last reviewed: 05 March 2020 Next review due: 05 March 2023
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Living With Vascular Dementia
Vascular dementia is a progressive disease that has no cure, but the rate at which the disease progresses can vary. Some people with vascular dementia may eventually need a high level of care due to the loss of mental and physical abilities. Family members may be able to care for a person with vascular dementia early on. But if the disease progresses, the person may need more specialized care.
Respite programs, adult daycare programs, and other resources can help the caregiver get some time away from the demands of caring for a loved one with vascular dementia.
Long-term care facilities that specialize in the care of people with dementias, Alzheimer’s, and other related conditions are often available if a person affected by vascular dementia can no longer be cared for at home. Your healthcare provider can recommend caregiver resources.
Is Cerebral Atrophy Serious
Cerebral atrophy occurs naturally in all humans. But cell loss can be accelerated by a variety of causes, including injury, infection, and medical conditions such as dementia, stroke, and Huntingtons disease. These latter cases sometimes culminate in more severe brain damage and are potentially life-threatening.
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Progression Of Cognitive Deficits In Younger
Several investigations have now also reported that there is progression of cognitive deficits over short periods of time , in younger adults with epilepsy . The most extensively studied group is patients with TLE in whom it is now apparent that there are widespread brain structural changes beyond the medial temporal lobes and that progression of cognitive impairment over time may occur in a significant proportion . While cognitive reserve indexed by baseline IQ, years of education or occupational complexitymay mitigate some of these effects, duration of epilepsy appears to be an important factor in determining progression of cognitive impairment .
A recent study by Breuer and co-workers screened 287 adult patients for cognitive deterioration compared to expected premorbid IQ . A group of 27 individuals fulfilled the criteria . More than 77% of them had associated comorbidities . Analyses revealed that the most prominent factors that accounted for the variance in cognitive deterioration were those that might impact on cognitive reserve: low premorbid IQ and education level, later age of seizure onset and older age . These findings would be consistent with a double hit model in which pre-existing low brain reserve makes the brain more vulnerable to a second hit from the development of epilepsy.
Dementia Terms You May Hear
- Alzheimers disease: the most common type of dementia, caused by clumps of proteins building up in the brain.
- Mild cognitive impairment: this can happen after a stroke. This is when someone has memory and thinking problems but they are not severe enough to interfere with their day-to-day activities.
- Other types of dementia: you may hear about dementia with Lewy bodies, frontotemporal dementia and young-onset dementia, as well as other rarer types.
- Small vessel disease: damage to the blood vessels deep inside the brain, often caused by high blood pressure.
- Vascular cognitive impairment: this describes all memory and thinking problems associated with stroke. It includes vascular dementia and mild cognitive impairment.
- Vascular dementia: problems with memory and thinking due to reduced blood flow in your brain.
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The Role Of Seizures In Dementia
While studying seizures and dementia, scientists were also triggered on the topic of the role seizures in the illness.
A study was conducted towards this end. Researchers observed 55 patients aged 50-69 years.
They were all admitted to an Israeli medical center with their first known seizure. A quarter of the participants developed dementia later on.
Another study that was done in the US looking at almost 300,000 veterans who were all over 55 years uncovered that seizures increased the risk of people developing dementia over a period of one to nine years.
Why Do People With Dementia Develop Seizures
Ultimately, anything that changes the structure of the brain can cause seizures.
This happens for some people after a stroke, a head injury, or with a brain infection like meningitis. A similar problem is happening in the brain in dementia. As cells in the brain die and the brain shrinks this can lead to epilepsy.
In addition, we know that two proteins that build up in the brain of people with Alzheimers disease amyloid and tau affect how the brains nerve cells communicate with each other.
Sometimes these nerve cells can become ‘hyper-excitable’, meaning they can behave uncontrollably, causing epileptic seizures.
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Treatment Of Hallucinations & Delusions
Be sure to consult with a doctor in order to best understand why your loved one is hallucinating or having delusions and whether medication is indicated. For both delusions and hallucinations, medications called antipsychotics are sometimes prescribed. Antipsychotics, also called neuroleptics, are prescribed for health conditions including schizophrenia, and have been shown to help people with dementia who struggle with these symptoms.
Doctors may prescribe any of a number of antipsychotics after evaluating your loved one, but the drug most often used to help dementia-related hallucinations and delusions is Risperidone, which has been shown to alleviate symptoms in the short term. The side effects of risperidone and other antipsychotics can be severe including muscle tremors, weight gain, fatigue, and dizziness and non-drug treatments are typically preferred. A doctor may, however, conclude that medication is necessary.
People With Dementia Are At Risk Of Seizures
Alzheimer described this way back in 1911. What is not clear yet is how common the seizures are.
This is because some seizures can be quite complex.
Many people are familiar with the generalized tonic-clonic seizures that make people fall to the ground, become stiff and unresponsive and their bodies shake with convulsions.
However, there is another type of seizure that mainly affects individuals with dementia.
These are known as focal onset seizures.
They generally involve short periods of increased unresponsiveness or amnesia.
The person going through this can showcase involuntary repeating movements of the arms, hands, face like swallowing, lip-smacking, or chewing.
Because it does not go on for long, it can easily be missed.
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Rising Stroke Rates In The Young
The incidence of stroke among patients younger than 60 is rising. In part, this is because of an increase in physical inactivity, which can lead to weight gain, diabetes, and high blood pressure, said Lekoubou.
In addition, seizures are a frequent complication of stroke, and younger stroke patients appear to have more seizures than their older counterparts. The reason for this is unclear, said Lekoubou.
The researchers used a large commercial nationwide database to evaluate the role that late-onset seizures have on the subsequent development of dementia among stroke survivors. They identified 23,680 cases of stroke among patients aged 18 to 60 years from January 1, 2006, to December 31, 2009. These included 20,642 patients with ischemic stroke and 3038 with hemorrhagic stroke.
For all strokes, fhe mean age of the participants was 49.8 years for ischemic strokes, the mean age was 50.2 years and for hemorrhagic strokes, it was 47.0 years.
At baseline, participants did not have dementia, brain tumors, toxin exposure, traumatic brain injury, or neuro-infectious diseases.
Participants had been continously enrolled for at least 1 year before the index stroke diagnosis and for 5 years thereafter. The analysis included only patients for whom no insurance claims regarding seizure had been made within 1 year from the index date this increased the likelihood that seizures developed because of stroke.
Seizures And Dementia In The Elderly
Seizures can be described as uncontrolled and sudden electrical disturbances that happen in the brain.
This can cause levels of unconsciousness, feeling, or movements as well as changes in behavior.
While seizures are usually an indication that a person has epilepsy, not everyone who experiences seizures has epilepsy.
Naturally, persons who have dementia are at risk of seizures.
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How Vascular Dementia Develops
Symptoms of vascular dementia can appear suddenly if they are caused by a single stroke, or if they are caused by silent strokes they may appear gradually over time. Vascular dementia sometimes develops in steps, so that symptoms will stay the same for a while and then suddenly get worse. These steps are usually due to new strokes.
You can read more about treatments to slow down the progression of dementia.