Causes Of Vascular Dementia
Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells.
This can happen as a result of:
- narrowing and blockage of the small blood vessels inside the brain
- a single stroke, where the blood supply to part of the brain is suddenly cut off
- lots of “mini strokes” that cause tiny but widespread damage to the brain
Not everyone who has a stroke will go on to develop vascular dementia.
Read more about vascular dementia.
What Happens In Dementia
People with dementia may have different symptoms, depending on the type and stage of their particular dementia. A persons symptoms depend on which part of the brain is affected by the disease process, and they may change over time as the diseases progress to involve different areas of the brain. Different types of dementia tend to target particular parts of the brain. For example, the part of the brain that is important for the formation of new memories is usually affected early on in AD, which is why short-term memory loss is often one of the first symptoms of AD. Other common symptoms in dementia include difficulties with communication, planning and organization, navigation, personality changes, and psychiatric symptoms such as depression, anxiety, delusions and hallucinations.
Understanding Lewy Body Dementia
Lewy body dementia consists of two different conditions: dementia with Lewy bodies and Parkinson’s disease dementia. The two share many of the same symptoms and may often be considered to be the same.
However, one significant factor in how Lewy body dementia progresses is related to which disease is actually present. In Parkinson’s disease dementia, the physical challenges are usually evident first, while in dementia with Lewy bodies, cognitive changes may appear earlier than, about the same time, or shortly after, the physical changes develop.
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Stage : Moderate Dementia
Patients in stage 5 need some assistance in order to carry out their daily lives. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. Patients may become disoriented about the time and place, have trouble making decisions, and forget basic information about themselves, such as a telephone number or address.
While moderate dementia can interfere with basic functioning, patients at this stage do not need assistance with basic functions such as using the bathroom or eating. Patients also still have the ability to remember their own names and generally the names of spouses and children.
Stage : Age Associated Memory Impairment
This stage features occasional lapses of memory most frequently seen in:
- Forgetting where one has placed an object
- Forgetting names that were once very familiar
Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.
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What Is Mixed Dementia
It is common for people with dementia to have more than one form of dementia. For example, many people with dementia have both Alzheimer’s disease and vascular dementia.
Researchers who have conducted autopsy studies have looked at the brains of people who had dementia, and have suggested that most people age 80 and older probably have mixed dementia caused by a combination of brain changes related to Alzheimer’s disease,vascular disease-related processes, or another condition that involves the loss of nerve cell function or structure and nerve cell death .
Scientists are investigating how the underlying disease processes in mixed dementia start and influence each other. Further knowledge gains in this area will help researchers better understand these conditions and develop more personalized prevention and treatment strategies.
Other conditions that cause dementia-like symptoms can be halted or even reversed with treatment. For example, normal pressure hydrocephalus, an abnormal buildup of cerebrospinal fluid in the brain, often resolves with treatment.
Researchers have also identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:
Vascular Contributions To Alzheimers Disease
People with dementia seldom have only Alzheimers-related changes in their brains. Any number of vascular issuesproblems that affect blood vessels, such as beta-amyloid deposits in brain arteries, atherosclerosis , and mini-strokesmay also be at play.
Vascular problems may lead to reduced blood flow and oxygen to the brain, as well as a breakdown of the blood-brain barrier, which usually protects the brain from harmful agents while allowing in glucose and other necessary factors. In a person with Alzheimers, a faulty blood-brain barrier prevents glucose from reaching the brain and prevents the clearing away of toxic beta-amyloid and tau proteins. This results in inflammation, which adds to vascular problems in the brain. Because it appears that Alzheimers is both a cause and consequence of vascular problems in the brain, researchers are seeking interventions to disrupt this complicated and destructive cycle.
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Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
Loss Of Neuronal Connections And Cell Death
In Alzheimers disease, as neurons are injured and die throughout the brain, connections between networks of neurons may break down, and many brain regions begin to shrink. By the final stages of Alzheimers, this processcalled brain atrophyis widespread, causing significant loss of brain volume.
Learn more about Alzheimer’s disease from MedlinePlus.
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Support Groups And Counseling For Caregivers
Caring for a person with dementia can be very difficult. It affects every aspect of your life, including family relationships, work, financial status, social life, and physical and mental health. You may feel unable to cope with the demands of caring for a dependent, difficult relative. Besides the sadness of seeing the effects of your loved one’s disease, you may feel frustrated, overwhelmed, resentful, and angry. These feelings may, in turn, leave you feeling guilty, ashamed, and anxious. Depression in caregivers is not uncommon.
Different caregivers have different thresholds for tolerating these challenges. For many caregivers, just “venting” or talking about the frustrations of caregiving can be enormously helpful. Others need more but may feel uneasy about asking for the help they need. One thing is certain, though: If the caregiver is given no relief, he or she can burn out, develop his or her own mental and physical problems, and become unable to care for the person with dementia.
This is why support groups were invented. Support groups are groups of people who have lived through the same set of difficult experiences and want to help themselves and others by sharing coping strategies. Mental health professionals strongly recommend that family caregivers take part in support groups. Support groups serve a number of different purposes for a person living with the extreme stressof being a caregiver for a person with dementia.
Stage : Mild Cognitive Impairment
Clear cognitive problems begin to manifest in stage 3. A few signs of stage 3 dementia include:
- Getting lost easily
- Noticeably poor performance at work
- Forgetting the names of family members and close friends
- Difficulty retaining information read in a book or passage
- Losing or misplacing important objects
- Difficulty concentrating
Patients often start to experience mild to moderate anxiety as these symptoms increasingly interfere with day to day life. Patients who may be in this stage of dementia are encouraged to have a clinical interview with a clinician for proper diagnosis.
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Medications For Alzheimer’s Disease
Most drugs approved by the U.S. Food and Drug Administration to treat Alzheimer’s disease are called cholinesterase inhibitors. These drugs temporarily improve or stabilize memory and thinking skills in some individuals.
These drugs include:
- tacrine not used much due to side effects
Another drug is memantine hydrochloride , an orally active NMDA receptor antagonist used to treat moderate to severe Alzheimer’s disease. Doctors may also prescribe other drugs, such as anticonvulsants, sedatives, and antidepressants to treat problems that may be associated with dementia such as insomnia, anxiety, depression, and sleep disorders.
Social And Economic Impact
Dementia has significant social and economic implications in terms of direct medical and social care costs, and the costs of informal care. In 2015, the total global societal cost of dementia was estimated to be US$ 818 billion, equivalent to 1.1% of global gross domestic product . The total cost as a proportion of GDP varied from 0.2% in low- and middle-income countries to 1.4% in high-income countries.
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When Should I Call My Healthcare Provider
If you are diagnosed with FTD, you and your caregivers should talk with your healthcare providers about when to call them. Your healthcare provider will likely advise calling if your symptoms become worse, or if you have obvious or sudden changes in behavior, personality, or speech. This includes mood changes, such as increasing depression or feeling suicidal.It can be very stressful for a caregiver to take care of a loved one with FTD. It’s normal to have feelings of denial, anger, and irritability. Caregivers may also have anxiety, depression, exhaustion, and health problems of their own. Caregivers should contact their healthcare provider if they have any of these signs of stress.
Inflammation In The Brain Linked To Several Forms Of Dementia
- University of Cambridge
- Inflammation in the brain may be more widely implicated in dementias than was previously thought, suggests new research. The researchers say it offers hope for potential new treatments for several types of dementia.
Inflammation in the brain may be more widely implicated in dementias than was previously thought, suggests new research from the University of Cambridge. The researchers say it offers hope for potential new treatments for several types of dementia.
Inflammation is usually the body’s response to injury and stress — such as the redness and swelling that accompanies an injury or infection. However, inflammation in the brain — known as neuroinflammation — has been recognised and linked to many disorders including depression, psychosis and multiple sclerosis. It has also recently been linked to the risk of Alzheimer’s disease.
In a study published today in the journal Brain, a team of researchers at the University of Cambridge set out to examine whether neuroinflammation also occurs in other forms of dementia, which would imply that it is common to many neurodegenerative diseases.
The team recruited 31 patients with three different types of frontotemporal dementia . FTD is a family of different conditions resulting from the build-up of several abnormal ‘junk’ proteins in the brain.
Dr Richard Bevan Jones added, “There may be a vicious circle where cell damage triggers inflammation, which in turn leads to further cell damage.”
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What Are The Signs And Symptoms Of Dementia
Signs and symptoms of dementia result when once-healthy neurons, or nerve cells, in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.
The symptoms of dementia can vary and may include:
- Experiencing memory loss, poor judgment, and confusion
- Difficulty speaking, understanding and expressing thoughts, or reading and writing
- Wandering and getting lost in a familiar neighborhood
- Trouble handling money responsibly and paying bills
- Repeating questions
- Not caring about other peoples feelings
- Losing balance and problems with movement
People with intellectual and developmental disabilities can also develop dementia as they age, and recognizing their symptoms can be particularly difficult. Its important to consider a persons current abilities and to monitor for changes over time that could signal dementia.
Functional Signs Of Dementia
Functional imaging of the brain can include a functional MRI, a positron emission tomography , or a single photon emission computed tomography scan. This kind of imaging serves as a complement to structural imaging, focusing on the underlying brain chemistry and activity rather than its physical composition.
SPECT and PET are similar kinds of scans, and in most cases of degenerative dementia, can showcase bilateral, biparietal, and bitemporal hyperperfusion. Some ligand compounds can reveal the impaired integrity of presynaptic dopamine transporters, present both in degenerative dementias and Parkinson’s disease.
The external signs of dementia can often be mistaken for those of another condition, but neural imaging can analyze the internal signs of the disease and help draw a firmer conclusion about a patient’s specific condition, and the progression of that condition.
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Common Forms Of Dementia
There are many different forms of dementia. Alzheimer’s disease is the most common form and may contribute to 6070% of cases. Other major forms include vascular dementia, dementia with Lewy bodies , and a group of diseases that contribute to frontotemporal dementia . The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
The Role Of Inflammation
Inflammation has long been thought to be a side effect of dementias such as Alzheimers, as the body ramps up its immune system in response to the disease. But recent research has confirmed that inflammation actually contributes to the disease process. One clue was a report that people treated with anti-inflammatory drugs for arthritis had a lower incidence of Alzheimers. This has now been backed up by large genetic studies.
Normally, the brains inflammatory cells help to prevent damaging build-up of amyloid-ß by clearing it away, and its thought that mutations in inflammatory genes hamper this process. Inflammation is a sign of the immune system kicking into gear, and in the initial stages of disease, this is beneficial. However, in the case of Alzheimers, when the disease becomes more advanced, chronic inflammation can set in and add to the toxic insult the brain receives. The brains immune response to inflammation is therefore believed to play two critical roles in developing Alzheimers disease.
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Causes Of Dementia With Lewy Bodies
Lewy bodies are tiny clumps of a protein called alpha-synuclein that can develop inside brain cells.
These clumps damage the way the cells work and communicate with each other, and the brain cells eventually die.
Dementia with Lewy bodies is closely related to Parkinson’s disease and often has some of the same symptoms, including difficulty with movement and a higher risk of falls.
Read more about dementia with Lewy bodies.
Signs Of Dementia In The Brain
Patients exhibit multiple cognitive and behavioral symptoms upon entering the earliest stages of dementia, but these external signs are not the only indications that a physician uses to determine a patient’s mental health. Signs accruing and developing inside the brain are more significant, and may help to make a more formal determination of the type of dementia affecting the patient. Brain imaging, such as MRI or PET scans, can reveal these signs and contribute to a more accurate diagnosis.
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What Are Potentially Treatable Causes Of Dementia
The dementia in treatable conditions may be reversible or partially reversible, even if the underlying disease or damage is not. However, readers should note that if underlying brain damage is extensive or severe, these causes may be classified as irreversible by the individual’s physician.
There is no specific test for dementia. However, dementia may be diagnosed if at least two of the following core mental functions are significantly impaired, according to some researchers:
- Attentiveness/focus on a problem or subject
- Visual perception
In some people, the signs and symptoms of dementia are easily recognized in others, they can be very subtle. A careful and thorough evaluation is needed to identify their true cause.
An assessment of dementia symptoms should include a mental status evaluation. This evaluation uses various “pencil and paper,””talking,” and physical tests to identify brain dysfunction. A more thorough type of testing, performed by a psychologist, is called neuropsychologic testing.
Lab tests may be used to identify or rule out possible causes of dementia.
In some cases, imaging studies of the brain may be necessary to detect conditions such as normal pressure hydrocephalus, brain tumor, or infarction or bleeding in the brain.
Are There Medicines To Treat Dementia
There is no cure for dementia yet, but there are medicines that can help treat some of the symptoms of dementia. There are medications that may improve memory for a period of time. There are also medications that are effective for treating mood disorders, such as anxiety and depression, which commonly occur in people with dementia. It is also important that your provider carefully evaluates any medicine someone with dementia is taking, because some medications may make memory symptoms worse.
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What Is The Life Expectancy For A Person With Dementia
The outlook for most types of dementia is poor unless the cause is an early recognized reversible condition. Irreversible or untreated dementia usually continues to worsen over time. The condition usually progresses over years until the person’s death. Life expectancy after diagnosis averages about 8-10 years with a range from about 3-20 years.
Making decisions about end-of-life care is important.
- The earlier in the disease these issues are discussed, the more likely the person with dementia will be able to express his or her wishes about medical care at the end of life.
- The issues may be presented by your health care professional. If not, ask about them.
- These issues include use of aggressive interventions and hospital care, artificial feeding, and medical treatment for medical illnesses.
- These issues should be discussed by family members and decisions made about how to deal with them when the time comes.
- The decisions should be documented in the person’s medical records.