Are They Starving Or Dehydrating To Death
It may seem that the person is being starved or dehydrated to death, but they are not. In the end stages of dementia , the persons food and fluid intake tends to decrease slowly over time. The body adjusts to this slowing down process and the reduced intake. It is thought that by this stage the hunger and thirst part of the brain has now stopped functioning for most people.
The person may be immobile and so does not need the same amount of calories to sustain their energy levels. Having reduced food and fluid intake and decreased interest in this can be thought of as a natural part of end of life and dying.
Giving increased food and fluids artificially can be helpful for some other health conditions, but it is usually not considered to be helpful at the end of life in dementia as a way of managing reduced oral intake.
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Do Not Shy Away From Asking For Help
No one may have all the answers especially when it comes to taking care of a person with dementia. Try doing research on how their behavior changes and what needs to be done to help them live their lives without too many complications. Hire help when it becomes too much as it also ensures that you do not become too frustrated or drained. When you have multiple family members who can help, ask everyone to pitch in and look after the patient so that you can get some personal space to breathe and re-energize when it is your time to look after the patient. When you feel like you can no longer look after your loved one at your own home, it may be time to consider assisted living. In such case, look into dementia care homes that can provide specially trained professionals.
Dont Forget About Your Own Needs
You cant care for someone else if youre not taking care of yourself. So dont ignore your own needs. Look after your health eat well, stay active and go to the doctor when you need to. Make sure you use all the support thats available to you. Have a list of jobs that you can give to other people when they offer to help, for example, like going to the supermarket or doing some washing.
If you care for someone, you are entitled to have your own carers assessment to make sure that your local council is supporting you, as well as your friend or family member. This could include providing respite care, where someone else comes and looks after your friend or family member to give you a break. Or there may be a day centre they can go to, so that you can have a bit of time to yourself. Ask your GP or contact your local council if you havent had a carers assessment.
Find out more about vascular dementia.
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Clinical Definitions And Epidemiology
Vascular dementia represents a clinical syndrome that includes a wide spectrum of cognitive dysfunctions resulting from brain tissue death due to ischemia caused by vascular disease. A number of excellent reviews have been written on the topics of its diagnosis, pathogenesis, and epidemiology . It is believed that vascular dementia is a distinct clinical and pathological entity from Alzheimers dementia, Lewy body dementia, or fronto-temporal dementia, although elements of vascular disease may be present in all of these conditions. Treatment of vascular dementia has also received extensive coverage . The prevailing conclusion of these reports is that most vascular dementia trials have produced disappointing results. It is important to note that so far no drug has been approved by regulatory agencies to treat vascular dementia . Epidemiologically, vascular dementia is considered the second most prevalent type of dementia after Alzheimers disease although this point of view maybe brought to doubt by our increasing understanding of Lewy body disease . From a clinicians point of view, vascular dementia represents a major source of frustration because of its relatively high prevalence and lack of effective treatment options.
Types Of Vascular Dementia
Vascular dementia can be divided into two types: post-stroke dementia and multi-infarct dementia .
POST-STROKE DEMENTIASymptoms are most obvious when they arise suddenly following a stroke, resulting in the blood supply to the brain being suddenly interrupted due to a blocked artery. This disruption can lead to damage or death of brain tissue. Not all stroke victims develop dementia it is estimated that approximately 20% of stroke patients develop post-stroke dementia within six months. Post-stroke dementia can result in physical symptoms and/or problems with vision or speech. Symptoms depend on what area and how much of the brain is affected.
MULTI-INFARCT DEMENTIAThis type of dementia results from a series of mini-strokes in vessels located deep within the brain . These mini-strokes may not lead to any sudden obvious onset of symptoms however, even these âsilent brain infarctionsâ still increase the risk of dementia, a result of disease of the brainâs blood vessels. Over time, the effects of this damage can result in dementia. Progression is referred to as âstep-wiseâ because symptoms worsen after any additional mini-strokes and then remain the same for a time. Symptoms that may develop include changes in reasoning and other thinking skills such as memory, as well as mood and behavior problems, including depression and apathy.
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How Does Vascular Dementia Develop
Changes in a persons condition as a result of TIAs or a larger stroke are often sudden, before their condition plateaus. But the damage caused often means the person does not function quite the same way as they did before.
The signs and symptoms of vascular dementia depend on which area of the brain has been affected. Language, reading, writing and communication can be affected in vascular dementia. Memory problems may not be an issue initially, if this area of the brain has not been damaged, although they may occur later on.
Is Artificial Nutrition And Hydration A Good Idea
Most health professionals now feel that a person with advanced dementia and in the end stage of their illness should not be fed by tubes or drips. This is because inserting tubes or IV drips requires hospital admission, which can be very distressing for the person. They may then pull out the tubes and drips, and the site of the tubes and drips can become infected and sore.
He was very distressed in hospital and kept pulling out his tubes he didnt understand what was happening to him and they didnt know how to help him.
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Cancer: How To Care For Ageing Parents
Cancer is typically a disease that affects older people. In 90 percent of all cancer cases, the person is over 50 years of age. The majority of these cases occur in people aged between 50 and 74, but a third of all cases are in those aged 75 and older. Prostate, breast and lung cancers are all quite common in older people, but this section of the population is susceptible to all form of cancer.
How Important Are The Stages Of Dementia
The stages of dementia are just a guide and there is nothing significant about the number three. Equally, dementia doesnt follow an exact or certain set of steps that happen in the same way for every person with dementia.
It can be difficult to tell when a persons dementia has progressed from one stage to another because:
- some symptoms may appear in a different order to the stages described in this factsheet, or not at all
- the stages may overlap the person may need help with some aspects of everyday life but manage other tasks and activities on their own
- some symptoms, particularly those linked to behaviours, may develop at one stage and then reduce or even disappear later on. Other symptoms, such as memory loss and problems with language and thinking, tend to stay and get worse with time.
It is natural to ask which stage a person is at or what might happen next. But it is more important to focus on the person in the present moment. This includes their needs and how they can live well, and how to help them with this.
And for more information about treatment and support for the different types of dementia go to the following pages:
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Stage : Second Last Stage Late Vascular Dementia
This is the last but very important out of the vascular dementia stages that I would like to reveal in this entire article and want you and my other readers to know for good.
In case the condition has still progressed, there is not much medicine can do. People in this stage have basically no ability of speaking or communicating. The only thing you can do is to give people who are in the last stage of vascular dementia the possible care and love. They really need the help for all of their activities including eating, walking and using the toilet. This is known as the late vascular dementia.
Each individual with vascular dementia experiences the illness in their own way. However, these signs and symptoms described below often occur in the later stages of most cases.
Communication problems: The people with vascular dementia will experience problems with understanding what is happening around them. They find it hard to communicate with other people. Gradually, they may lose their speech or repeat a few words. However, their expression and body language can give you clues about their feeling. Many people can still return and receive emotional signals after they lose the ability to speak.
There are some things that can put you at risk of suffering from vascular dementia. Some of the risk factors can be controlled such as lifestyle, but some others cannot be controlled such as age and genes. Some risk factors contribute to underlying cardiovascular dementia.
Symptoms And Disease Course
Symptoms differ depending on what part and how much of the brain is affected, and can overlap with those of other types of dementia. Symptoms are likely to be more gradual and less dramatic in multi-infarct than in post-stroke dementia. For example, in multi-infarct dementia a gradual decline in some aspects of speech and language may be noticed, whereas immediately following a stroke there can be a sudden change in speech.
Vascular dementia does generally progress, but the speed and pattern of cognitive decline, motor skills slowing, and mood changes can vary. Some individuals may experience memory loss, whereas others may exhibit changes primarily in mood and behavior.
Like all dementias, individuals in later stages will show overall cognitive changes and will depend on others for care. Symptoms common in both post-stroke and multi-infarct type dementia can include:
- confusion and difficulty problem-solving
- changes in mood including loss of interest in regular activities
- trouble finding the right word
- motor symptoms including clumsiness and slow or unsteady gait disturbance.
Family caregivers may find it difficult to know how to provide help when symptoms are so variable. Getting a definitive diagnosis will make it easier to provide care now and in the future.
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End Of Life And Legal Issues
If you have been diagnosed with dementia, you might want to make arrangements for your care that take into account the decline in your mental abilities.
This may include making sure that your wishes are upheld if you’re not able to make decisions for yourself.
You may want to consider:
- creating an advance decision, which makes your treatment preferences known in case you’re unable to do this in the future
- having a “preferred place of care” plan, which outlines where you would like to receive treatment
- giving a relative lasting power of attorney, enabling them to make decisions about you if you’re unable to
Vascular Dementia Clinical Trials
Memantine
Memantine belongs to the aminoadamantane chemical class and is structurally similar to amantadine, an antiparkinson and antiviral drug. It was initially developed to treat Parkinsons disease and was first tested in Europe in the 1990s, and later in the US, as a neuroprotective compound. In addition to its propensity to release dopamine from dopaminergic terminals, memantine is a weak, noncompetitive, open channel antagonist of the glutamate NMDA receptor . Since NMDA receptor-mediated excitotoxic nerve cell death is considered of paramount importance in ischemic nerve cell damage, NMDA antagonist properties make memantine an attractive neuroprotective compound. On the other hand, NMDA receptor antagonists have been well known to cause hallucinations and impair cognition, attributes which have seriously hampered their clinical development.
Galantamine
Donepezil
Rivastigmine
Rivastigmine is a nonspecific inhibitor of two enzymes: acetylcholinesterase and butyrylcholinesterase . Rivastigmines efficacy in in vascular dementia has been studied insufficiently to draw any meaningful conclusions. One study conducted on 16 patients with vascular dementia showed some benefits of rivastigmine on executive function and behavior . More studies are needed to understand if rivastigmine could be used for treatment of vascular dementia.
Hydergine
Nicergoline
Nimodipine
Blood pressure-lowering therapies
CDP-choline
Folic acid
Validation therapy
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Who Gets Frontotemporal Dementia
FTD can affect anybody. It typically affects people at a younger age than Alzheimers disease, with symptoms beginning in the 50s or 60s, and sometimes younger.
Almost a third of people with FTD have a family history of dementia. However, only about 10-15% of cases have familial FTD, in which a gene mutation is passed on that causes the disease.
The genetic basis of FTD is not fully understood and is actively being researched.
Stage : Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
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What You Can Do For Your Loved One
As an individual with dementia declines, you can help them by providing a loving and supportive presence. Sit with them. Hold their hand. Play music they enjoy.
One of the greatest gifts you can give your loved one is helping to get their affairs in order. Ensure that financial and healthcare powers of attorney are put in place, so you can make decisions when your loved one is no longer able. Look into funeral arrangements before you need them, so you dont need to make important decisions in a time of crisis.
Talk to your loved ones physician about the possibility of palliative care support in the home and hospice care when your loved one is ready.
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Outlook For Vascular Dementia
Vascular dementia will usually get worse over time. This can happen in sudden steps, with periods in between where the symptoms do not change much, but it’s difficult to predict when this will happen.
Home-based help will usually be needed, and some people will eventually need care in a nursing home.
Although treatment can help, vascular dementia can significantly shorten life expectancy.
But this is highly variable, and many people live for several years with the condition, or die from some other cause.
If you or a loved one has been diagnosed with dementia, remember that you’re not alone. The NHS and social services, as well as voluntary organisations, can provide advice and support for you and your family.
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Find Someone To Talk To
Caring for someone else is emotionally as well as physically demanding. Even if youre not a full-time carer, coping with the fact that someone close to you has dementia is difficult. Talking to other carers or families that are dealing with dementia could be helpful. So find out about carers or other support groups that you could go along to.
Prognosis For People With Vascular Dementia
If the conditions that cause vascular dementia go untreated, the prognosis is not good. A person with vascular dementia may seem to improve for periods of time until another stroke takes away more brain function, memory, and independence. Eventually, untreated vascular dementia usually ends in death from stroke, heart disease, or infection.
Although vascular dementia is a serious condition, catching it early and preventing further damage are the best medicine. People with vascular dementia can work with their doctors and families to detect and manage the condition.
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Do Keep Eye Contact When Speaking
Communicating with a dementia patient requires a lot of patience, especially during later stages of dementia. It is vital to ensure that you talk in a place that has good lighting, a place that is quiet and without too many distractions. Do not try and stand over the person you are talking to, but rather try to be at their level and keep eye contact at all times. Take care to make sure that body language is relaxed and open. Prepare to spend quality time with the person so that they do not feel rushed or like they are a bother.
Do Make Sure That The Dementia Patient Gets Enough Rest Food And Water
Fatigue, hunger and thirst may cause combativeness. Ensure that the person with dementia is well fed, hydrates enough, and gets adequate sleep and rest. In line with this, they should also have enough bathroom breaks. Research also shows that it may help to reduce loud noises as well as clutter in the space where the patient spends most of his/her time, as both loud noises and clutter tend to over-stimulate people with dementia.
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