Vascular Dementia And Back Pain

Openuse A Tested Tool To Assess Pain

A number of different resources are available to help care staff establish whether a person with dementia is in pain, especially if the person cannot tell you in words. One example is the Abbey Pain Tool . The tool asks us to look for other ways in which the person may be letting us know they are in pain, perhaps through screwing up their face or rocking back and forth.

The Abbey Pain Tool can be used by care staff and suggests six possible signs of pain in a person with dementia:

Using a tool like this can help in your assessment of the persons pain. It can guide you to the cause of the pain, its severity, when it occurs and what helps to make the pain better or worse. It will also give you evidence to show a nurse or doctor if the pain is present or gone. If the pain is still present, always inform a doctor or nurse to review the persons medication.

Microglial Activation And Neuroinflammation Hastens Ad Pathogenesis Via A

Microglia are found clustered around amyloid plaques in both humans and AD mice and have been shown to regulate plaque dynamics . Under non-pathological conditions, microglia play an important role in regulating A deposition , and abundant evidence suggests that properly functioning microglia are involved in the clearance of A and limiting the expansion of plaques . With early exposure to A, activated microglia may phagocytose toxic A and produce survival-promoting trophic factors in the AD brain . However, some studies show that microglia become activated with prolonged exposure to A and will undergo a pro-inflammatory response , resulting in the secretion of synaptotoxic/neurotoxic cytokines, chemokines, and reactive oxygen/nitrogen species . This is highlighted by studies in post-mortem AD brains and mouse models, where prolonged A deposition leads to alterations in microglia, such as P2X7 receptor upregulation and activation of the innate immune response characterized by release of pro-inflammatory cytokines, acute phase proteins, and complement components that cause microglia-mediated synapse and neuron loss .

Early Symptoms Of Vascular Dementia

The most common symptoms during the early stages of vascular dementia are:

• problems with planning or organising, making decisions or solving problems
• difficulties following a series of steps
• slower speed of thought
• problems concentrating, including short periods of sudden confusion.

A person in the early stages of vascular dementia may also have difficulties with:

• their memory for example, they may have problems recalling names or recent events
• their language for example, their speech may become less fluent.

Different types of vascular dementia can have different symptoms.

Need advice on managing symptoms?Need advice on managing symptoms? .

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Microglial Activation And Neuroinflammation Increase In Ad

Recently, inflammation-associated PET studies demonstrated microglial activation in the brains of AD patients. In addition, microglial activation was found occurring before cognitive decline in AD patients, suggesting that it may be an early precipitant of AD progression . By using PET-MRI in AD patients, two peaks of microglial activation were detected during the trajectory of AD pathogenesis, which may represent an early protective peak and a later pro-inflammatory peak .

Microglial activation and neuroinflammation are found in the brains of AD animal models. For example, microglia show increased proliferation in well-characterized mouse models of AD, including APP/PS1, 5XFAD, and APP23 mice , and increased expression of pro-inflammatory markers such as CD36, CD14, CD11c, MHC-II, and iNOS .

How Is Vascular Dementia Treated

Vascular dementia can’t be cured. The main goal is to treat the underlying conditions that affect the blood flow to the brain. This can help cut the risk of further damage to brain tissue.

Such treatments may include:

• Medicines to manage blood pressure, cholesterol, triglycerides, diabetes, and problems with blood clotting
• Lifestyle changes, such as following a healthy diet, getting physical activity, quitting smoking, and quitting or decreasing alcohol consumption
• Procedures to improve blood flow to the brain, such as carotid endarterectomy, angioplasty, and stenting the carotid arteries are located in the neck and provide blood flow from the heart to the brain
• Medicines, such as cholinesterase inhibitors to treat the symptoms of dementia or antidepressants to help with depression or other symptoms

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Consequences Of Not Treating Pain For Persons With Dementia

When a person develops dementia and pain, some consequences that may arise when the pain goes undetected and untreated.

The most obvious is that the affected person will end up suffering unnecessarily.

The individuals may also receive inappropriate treatment in a bid to curb some of the behavioral changes they may adapt. For instance, a person may be put on antidepressants when chronic pain results in depression.

A person going through persistent pain may also experience decreased mobility which may affect the quality of life in the long-run.

Experts also agree that pain can affect thinking and other functions of the brain which can lead to worsening of dementia symptoms.

This is why it is crucial to recognize and treat any form of pain that a person with dementia may have before it results in poor medical outcomes and other proud negative implications in their lives.

Chronic Pain May Aggravate Ad Neuropathogenesis Through Lc

Chronic pain and AD brains not only display abnormal LC structure and function but also dynamic changes in NE turnover in LC-projecting areas . Although the shifts of NE content may not perfectly overlap in all brain areas in these two disease states, LC-NE pathological changes in select regions could be one of the initiators that leads to a final common outcome: pro-inflammatory activation of microglia and neuronal dysfunction.

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Pain Assessment In Patients With Dementia

Competent pain assessment is a necessary prerequisite for good pain management and ideally considers several pain dimensions, namely intensity, location, affect, cognition, behavior, and social accompaniments. In case of patients with dementia, many cognitive and linguistic barriers prevent individuals from focusing on all these aspects. Those responsible for pain management must be adequately informed at the least about the presence and intensity of pain. Thus, limited and one-sided pain assessment is almost the rule in individuals with dementia, leading to deleterious consequences for their pain treatment or lack thereof.12 The best-possible forms of pain assessment will be briefly reviewed in the next paragraphs.

When Do I Need To Call My Healthcare Provider After Ive Been Diagnosed With Vascular Dementia

You, or your caregiver, should call your healthcare provider if they notice any worsening of your symptoms or when new symptoms appear. Your healthcare provider or healthcare team will want to assess any changes and adjust drug dosages or change medications as needed or conduct more tests to determine whats causing the change in your symptoms.

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Can Vascular Dementia Be Prevented

Possibly the most important difference between vascular dementia and other types of dementia is that vascular dementia may be more preventable. The blockage of blood vessels that feed your brain is something that can be delayed or even prevented for many if risk factors are managed throughout your life. You can take steps to decrease risk factors for conditions that affect your blood vessels. These conditions include heart disease, atherosclerosis, diabetes, blood pressure and cholesterol.

Brain-protecting strategies include:

• Keeping your numbers within normal limits: blood pressure , cholesterol levels and blood sugar levels .
• Losing weight, getting fit. Exercise for 30 minutes on most days.
• Eating a healthy, well-balanced diet .
• Stopping smoking. Ask your healthcare provider if you need help or connection with quit programs.
• Cutting back on alcohol consumption. Men should have no more than one alcoholic beverage a day women should have no more than two.
• Managing your stress. Try relaxation exercises, meditation, yoga and other methods.
• Taking all your medications as prescribed by your healthcare provider. If your symptoms change or worsen, call your healthcare provider. Never stop or change your dose without talking with your healthcare provider first.

Some risk factors for vascular dementia cant be prevented, like older age or genetics, but many risk factors can be.

Stage : Second Last Stage Middle Vascular Dementia

Individuals in this severe stage begin to lose memory and usually recollect things happened and things they did in their past. They become more delusional and even cannot remember close friends and family members names. Some bodily changes also turn up including incontinence, difficulty with muscle and motor functions and difficulty with controlling bladder flow. They need assistance to do daily activities and finish tasks. These signs and symptoms are enough to diagnose middle vascular dementia.

Weight loss: Almost all of the people with vascular dementia lose weight in the later stages of this disorder, although sometimes some people eat so much and put on weight. In fact, weight loss can affect their immune system, making the people fight infections more difficultly. It can also increase the possibility of falling. Ensure that they consume enough food and water. They can need encouragement with drinking and eating. Besides, problems with swallowing and chewing are common as their muscles no longer work properly.

Problems with continence: Many people cannot control their bladder and bowels. This can occur most or all of the time.

This is also a stage one on the list of vascular dementia stages that people should not miss out but consider changing their lifestyles to prevent themselves from getting this disorder.

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Causes Of Pain In People With Dementia

When it comes to the topic of dementia and pain, several causes may make a person with dementia feel pain.

Note that potential pain causes for individuals with dementia are the same for everyone else.

Dementia on its own does not generally cause physical pain as this typically comes from other conditions.

One of them is the fact that persons with dementia are at higher risk of injuring themselves or falling.

Other factors that can make the suffering person feel pain include:

Sitting or lying on the same spot for hours without moving.

This increases the risk of joint stiffness, muscle contraction, constipation, or pressure sores which can cause discomfort and severe pain.

Also, there are other conditions as well:

• Leg ulcer dressings

Vascular Dementia Vs Alzheimers Disease

Both Alzheimers disease and vascular dementia are forms of dementia, distinct from each other as well as other forms like Lewy body dementia, Parkinsons disease, and frontotemporal dementia.

Unlike vascular dementia, Alzheimers disease isnt caused by stroke or low blood flow to your brain.

Vascular problems, such as stroke, high cholesterol, and hypertension, arent related to Alzheimers disease, as they are with vascular dementia. There is no known cause of Alzheimers, though your risk of developing it increases with age.

Alzheimers disease is the most common form of dementia, making up to 80 percent of all dementia diagnoses.

In Alzheimers, the noticed are often memory problems, as well as word-finding trouble, vision or spatial issues, and impaired reasoning or judgment. In vascular dementia, the first symptoms are often neurological.

Vascular dementia usually progresses in a stepwise fashion, whereas Alzheimers is more progressive in the decline.

Although vascular dementia and Alzheimers are not the same diseases, it is possible to have both at the same time.

In fact, according to the Alzheimers Society, about 10 percent of people who have dementia have a form called mixed dementia, and most of these cases include both vascular dementia and Alzheimers disease.

If your doctor detects neurological symptoms or changes in your memory and reasoning, they may request a detailed assessment and screening that includes:

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Support Their Cultural And Spiritual Needs

Its good to be aware of the persons cultural and spiritual needs and make sure these are respected and supported. You can make use of any advance care plans or documents, friends and family input and your knowledge of the person. Its important to try and meet these needs as much as possible, they are just as important as medical care.

What Abilities Are Affected

Forgetfulness and problems with reasoning or problem solving are often the most noticeable change in someone with vascular dementia but other abilities can be impaired, too, including thinking speed, communication skills, spatial skills , or attention and concentration. The size and location of damaged brain areas determine which abilities are affected. If additional strokes occur or problems with reduced blood flow continue, more and more brain tissue is damaged and more abilities are affected.

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Assessment Of Pain In Elderly With Cognitive Decline

Self-assessment scales are considered the gold standard for assessing pain, but the presence of cognitive impairment decreases their reliability. In 2002, the American Geriatrics Society established guidelines for the assessment of behavioral indicators of pain . More recently, the American Society for Pain Management, with the Nursing Task Force on the assessment of pain in patients unable to verbally communicate, recommended a comprehensive hierarchical approach, incorporating measures of self-evaluation and the observation of behaviors related to pain . On the basis of these recommendations, the assessment of pain in elderly patients affected by cognitive impairment should be carried out as follows:

New Developments In Recognition/assessment In Dementia

An essential requirement for acceptable pain management is a well-performed pain assessment that covers the different aspects of pain . However, communication difficulties and cognitive impairment in patients with dementia mean that it is not possible to focus on all of these aspects. Thus, limited and one-sided pain assessment cannot be avoided in individuals with dementia. Below we discuss several of the best pain assessment practices for persons with dementia.

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Provide Support For Family And Friends

Keep any family or friends informed about what is happening in a gentle, sensitive and supportive way. This will help reassure them that the person is getting the care they need. You could consider signposting them to appropriate services, such as an Admiral Nurse or local Alzheimers Society. It can also help to give them an opportunity to talk about what is happening.

When Should I Ask For Support

Supporting people with dementia at the end of their life requires a team approach. Often, there will be many people involved in the persons care at the end of their life. Good communication and information sharing helps to ensure the person receives the care they need.

If youre unsure about anything or have any concerns seek advice from a colleague, manager or another health care professional.

There may be certain professionals who can advise on specific issues. These may include a GP, district nurses, social workers, other care staff and specialists.

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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.

Show Sources

Support For People With Dementia And Carers

UCL covid-19 decision aid a tool to support carers of people living with dementia to make difficult decisions during covid-19

Alzheimers Society end of life care information for patients and families

Alzheimers Society information and fact sheets on all aspects of dementia including what is dementia, types of dementia and living well with dementia

Alzheimer Scotland specialist services for patients and carers

Dementia UK expert one-on-one advice and support to families living with dementia via Admiral Nurses

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Pain In Advanced Dementia

This section gives some ideas for what you can do to recognise pain in people living with dementia, and what you can do to help them better manage pain.

Pain is one of the most common symptoms that people with dementia experience. However, often it is poorly recognised and undertreated in dementia. The main reason for this is that, as dementia progresses, the persons ability to communicate their needs becomes more difficult.

Pain is what the person says hurts.

International Association of Hospice and Palliative Care.

What Are The Symptoms Of Vascular Dementia

The symptoms of vascular dementia depend on the location and amount of brain tissue involved. Vascular dementia symptoms may appear suddenly after a stroke, or gradually over time. Symptoms may get worse after another stroke, a heart attack, or major surgery. These are signs and symptoms of vascular dementia

• Increased trouble carrying out normal daily activities because of problems with concentration, communication, or inability to carry out instructions
• Memory problems, although short-term memory may not be affected
• Confusion, which may increase at night
• Stroke symptoms, such as sudden weakness and trouble with speech
• Personality changes
• Mood changes, such as depression or irritability
• Stride changes when walking too fast, shuffling steps
• Problems with movement and/or balance
• Urinary problems, such as urgency or incontinence

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