Vascular dementia

Dementia is a description of diseases in which memory problems, mental disorders and behavioral changes are prominent. When the cause of these complaints has to do with the blood vessels (vascular), it is called vascular dementia. How often and in whom does vascular dementia occur? And is there a treatment for vascular dementia?

What is vascular dementia?

Vascular dementia is a collective name for a decline in cognitive functioning caused by a disease of the blood vessels, such as a stroke. In 1993, the International Workshop of the National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences (AIREN) compiled a list of criteria that a person must meet in order to develop clinical suspected diagnosis of vascular dementia. These criteria are often used in hospitals to determine whether or not to make the diagnosis.

According to the criteria in the table above, someone must have a disorder in episodic memory (remembering new information) and in at least one other cognitive area. Which cognitive functions are affected depends on the location of the brain damage . These disorders must limit daily life. When clinical neurological examination is performed, there should be focal neurological signs . These are signs of disturbances in the functioning of the nerves or brain that cause a specific part of the body to function less well, such as hemianopia (part of the visual field is blurred), balance problems or paralysis. In people with Alzheimer’s disease, there are basically no such focal neurological signs. When a brain scan is made, there must be evidence of damage to the brain, such as dead brain tissue.

Personality changes are also generally seen in everyday life. For example, people can develop depressive symptoms, show lack of initiative and become more emotional. Mood swings may occur and people may have a shorter fuse.

How often and in whom does vascular dementia occur?

Estimates of the incidence of vascular dementia vary widely. This is partly caused by the fact that people often do not have one type of dementia, but that several types of dementia can be present at the same time, for example Alzheimer’s disease and vascular dementia . In addition, in addition to the NINDS-AIREN criteria, there are other standards for diagnosing vascular dementia. It is estimated that vascular dementia occurs in 20 to 30 percent of people with dementia. Vascular dementia is therefore the second or third most common cause of dementia.

Vascular dementia appears to be hereditary to some extent. For example, in CADASIL (cerebral automsomal dominant arteriopathy with subcortical infarcts and leukoencephalopahth), a hereditary condition caused by a mutation of a certain gene (NOTCH-3 gene) that plays a role in healthy blood vessels. In people with CADASIL, blood flow to the brain can be disrupted, resulting in cerebral infarctions and dementia. People with CADASIL often suffer from TIAs or migraines with aura at a relatively young age (around age 50), for example.

There are a number of risk factors for developing vascular dementia. Vascular dementia results from bad blood vessels, so it is important to keep an eye on blood pressure and cholesterol. High blood pressure, lack of exercise, smoking and eating too much salt have a negative impact on the quality of the blood vessels.

Can vascular dementia be treated?

With regard to the prevention of vascular dementia, there is a possible role for blood pressure lowering agents. To date, no medications have been found that can improve the cognitive functioning of people with vascular dementia. There are a number of ways to deal with the cognitive and behavioral symptoms of vascular dementia. The environment in particular plays an important role.

Forgetfulness

People with dementia slowly but surely lose control of the world around them, and forgetfulness is a major contributor to this. People are increasingly having difficulty remembering telephone numbers, birthdays, names of family members and details of events. At an advanced stage, one may even forget events themselves. Forgetfulness can cause feelings of shame, annoyance and insecurity. This can cause people to develop depressive symptoms and panic more quickly. This can cause people to avoid social contacts and lose control over their emotions. Ultimately the world is getting smaller. What advice is there for forgetfulness due to vascular dementia ?

• Accept the forgetfulness and encourage the other person to accept the memory disorder: blaming yourself or the other person does not help, it does not improve the memory and certainly not the mood.
• Think about practical solutions: consider, among other things, the use of tools (agenda, calendar), a lot of structure (visits from family at a fixed time) and repeating important information.
• Take over tasks: take over things that the person with vascular dementia really can no longer remember, despite practical solutions. This prevents failure experiences, which have a negative impact on mood.

Mood swings

Mood swings are common in people with vascular dementia. One moment someone is still cheerful, the next moment they burst into tears for no apparent reason. How can you deal with these mood swings?

• Do not ask questions endlessly: the person with vascular dementia is often overcome by emotions and cannot properly explain what is going on. What you can do is ask how the other person wants you to respond. Comfort or leave alone for a while?
• Providing an explanation: explain to the person with vascular dementia that changing moods are part of the disease, this creates more mutual understanding.
• Medication: In some cases, medications can help reduce mood swings. Contact your doctor for this.

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