Vascular dementia what can I expect?

Pcred2- check dad's blood sugar level. I tend to think the diabetes is the bigger problem. Know when to call 911 for help. Ask the MD if it is time for Hospice, since that order comes from the doctor.

My father was diagnosed with vascular dementia about three years ago. He is eating little and sleeping about 22 hours a day. Is this normal progression of dementia. He is also diabetic.

I shouldn't think Kazzaa's mother's nurse was under any illusions. These people know what they're about: just because they don't directly challenge a patent untruth from their patient doesn't mean they've swallowed it whole.

Doesn't mean they're going to spring into action, either, of course…

It doesn't sound like the nurse did a cognitive assessment, just a health check.

When a trained psychotherapist, speech therapist, or social worker is doing a psych eval, they have the client do things to demonstrate short term memory, logical thinking, understanding the process behind things (for example, what"s happening in this picture, what is wrong with this picture?). It's hard to fake answers to these questions.

My husband always claims the therapist is stupid because some of the questions are so "stupid" and yet he fails the evals anyway.

You can ask your doctor to do that sort of an eval to see if she has dementia in addition to her other problems, and how much it is currently affecting her. The result can determine whether she should be allowed to take care of herself totally, and will let you know what sort of trouble is ahead of her. Until you know she has dementia, you're probably going to expect her to aspect like a sneak, stubborn, lying little old lady. With dementia, she is much more dangerous to herself and others than you can guess.

((Hug!!))

Thanks guys the NURSE FINALLY came yesterday? Mum lied through her teeth as usual! I just laughed as its quite funny sometimes to see them put on an act!
She wont go to her doc as hes useless infact she thinks all docs are useless she thinks her geriatrician was trying to kill her with the aricept? She told the nurse that she is not an idiot and takes her meds properly? thats why im finding them on the floor when im hoovering? She told the nurse that she POTTERS around the garden and house and does housework? (eh no you dont you sit in front of the tv all day watching dog bounty hunter smelling of pee!)
She wont go out because shes not well? shes not well because she sits around all day and gets no excercise?

I give up the nurse told me that if she continues to live like this her body will just pack in and she may end up in a wheelchair or worse a massive stroke which is my prognosis? So sad and so frustrating to try and give her some quality of life but I cant force her. I will have to get her to doc soon though as she needs her bloods and BP checked I may go and but a BP monitor as I should really be checking this at home as she has high BP which is dangerous with the diabetes.
Anywhoo my sister is here!!!!!!! I came in this morning and MUM is doing the dishes and sister putting on her makeup? Cant be bothered to fight her anymore im too tired and drained BUT I splept until midday today WOW! actually looked refreshed! Gosh what a thrill to just stay in bed and not have to worry My god us caregivers dont ask for much?

The company has a branch in my town and they showed the DVD at a support group meeting at a local church. It's pretty good.

kaazzaa, Sorry for your situation. I know self-help books and tapes are often regarded as useless or as stuff we already know, but I received a free dvd on how to deal with those with dementia that was so helpful and educational that I would have willingly paid for it. The company that makes it sells caregiver services, like home health help and such. It describes what parts of the brain are attacked first and then next and what to expect at each stage and how to best help them deal with it and how to deal with them. It's called Senior Gems and you can get one free here at this link. I hope life stays peaceful so you can enjoy the time you have left with your mum. This is such a caring discussion of how it feels on both sides of the problem.

Country Mouse, I run in panicked circles most of the day too. I only get to look at things logically when my husband goes to bed and I write things out. Knowing what to do when you can think about a problem is much easier than reacting when something surprises you. My hope is that, by writing about it, I'll actually remember it when it's time to take my own advice.

Co-morbidities really do complicate things. I'm lucky that he doesn't have too many of those, mostly making sure he doesn't get dehydrated, which sets off the UTIs, and taking care of his afib. He had to get dentures, which was a year-long ordeal (he got implants and then had some complications), but that has calmed down now. But when he gets sick, it does seem like Whac-a-mole. I never thought of it like that before, but that's at least a funny face to put on it. Thanks!

Appaloosa - "You're basically waiting to see which part of the brain gets hit next." Exactly! Really good description; and I applaud how well you're dealing with this - I feel as if I'm running round in circles with panic, sometimes, instead.

It's so weird. Our lovely Community Mental Health Nurse came over to do an assessment of my mother prior to the memory clinic: my mother got quite annoyed with some of her "trivial questions" and concluded that essentially we were all making a fuss about nothing. Mental arithmetic, no problem; I agree; recalling addresses at the end of the test, she's getting better at (I suspect she's been practising on the sly - good!). But some spatial skills are shot to hell: when she's working up to sitting down, it's like watching a dog circling in its basket, she just can't figure out where to put her hands to support herself or what position her feet should be in, and round and round she goes. Added to her existing falls risk this is actually a real worry; I'm trying to get her into a kind of dance routine pattern, hoping it'll somehow sink in as a new physical memory.

Do you find, too, that this makes you aware of just how many mental processes you perform without being aware of it? And how few of them need to go awry for the whole house of cards to collapse? My mother wanted to speak to her sister, then didn't want to ring her because "it will be very late in Hong Kong, she'll be in bed." Correct sister, correct time difference calculation, correct about bed time preferences, and correct location - only, some 50 years out. It seems so unfair! - you get almost every little thing right and still your smarty-pants daughter is giving you that funny look like you're crazy...

Good tips about the additional factors causing temporary glitches, too; thank you. But what with the "complex co-morbidities" plus the deafness, cataracts and fatigue it really is almost impossible to know what she will or won't be able to cope with. Sometimes I feel as if I'm playing Whac-A-Mole...

I think vascular dementia is an overall diagnosis that covers many types of brain damage. It might be caused by a blood clot, a hemorrhage, reduced blood flow from plaque in the blood vessels, high blood sugar from diabetes, or other illnesses. The type of damage that each person has is different because different parts of the brain are affected. Some vascular incidents are obvious, like a big stroke, but others can be silent, like little TIAs, blood sugar problems, and smaller clots or bleeds. The effect of each silent incident might be small but they add up and eventually you notice damage.

You're basically waiting to see which part of the brain gets hit next. I've been told to expect my husband to stay the same until he has another incident, which could be tomorrow or never. He could very well die of something else before the dementia gets worse, although having the dementia makes it harder to maintain his overall health.

His doctors never used the term "vascular dementia" when he was actively recovering from his strokes. It only came up when I was trying to explain why his stroke was having such a drastic impact on cognition, unlike other people I've known with strokes who had mostly language or physical impairments. It came up when I started talking to care facilities about the type of care he'll eventually need when I can't do it at home.

Because vascular dementia is caused by damage in varying places in the brain, symptoms will be different for each person. Because a later illness caused a "shower of emboli" (a quote from his neurologist), my husband has tiny bits of damage all over his brain. It's remarkable to observe how granular your brain's functions are. For example, a hit to a tiny piece of the right brain can cause trouble with "initiation" which is the ability to start doing something after you decide you need to do it. When you decide you're thirsty and need a drink, your body needs to initiate moving your arm to pick up your glass. Lucky for me, this part of his brain rewired itself during his recovery (or inflammation decreased and quit interfering with that part of his brain--no one is sure which). We haven't been so lucky with the language functions that some hits in the left brain took out. He can talk but can't think of the names, nouns, and numbers to put in those sentences. Verbs and adjectives are fine; nouns, almost none.

In my husband's case, his vascular dementia started with a huge blood clot in his right brain, which caused cognitive problems but didn't damage his memory at all. Most people couldn't tell in the hospital that he had any problem at all because he could speak and remembered everyone, and you don't usually do much higher thinking during a hospital visit. He has impulse control problems and can't follow simple instructions or learn new things, but stuff he already knew how to do, he could (mostly) still do. However, the cognitive impairments are a big problem--he can't live independently any more. and should definitely not drive anymore, although he doesn't believe it. We've had fights about that. Luckily, he's a law abiding guy. His driver's license expired while he was in rehab and he assumed he had to get a new one before driving but they wouldn't give it to him.

I found that books about Alzheimer's and other dementias are helpful when they talk about how to deal with a problem the affected person might have. For example, you can't reason with a person with a cognitive impairments when their logic circuits are broken. When they lose the ability to do things in a sequence (because of damage to a specific part of the right brain), you need to pre-sequence things by laying their clothes out in order or giving them fewer eating utensils. I've had to ask my husband many times, "Do you trust me?" when what he's trying doesn't work and no amount of explaining helps. Lucky for me, he remembers me and other people, so he knows who he can trust.

Books aren't much help when trying to guess what's going to happen to a person with vascular dementia. Everyone's dementia is different, but some dementias like Alzheimer's follow a general progression. Vascular dementia doesn't work like that. Like I said, you're just waiting for another incident, whether visible or silent. I try to get him to eat a healthy diet to prevent him from having another stroke or getting plaque buildup that partially blocks blood flow in the brain. He takes blood thinners to prevent another stroke; he's on the new generation of thinners (Pradaxa, Xarelto, and Eliquis), which are easier to manage than the old standby Coumadin/warfarin. I worry about diabetes, which he doesn't have, because he has a family history; high blood sugar can damage the brain too. I also have to keep him well hydrated, which is a chore, because dehydration makes his cognition worse.

One thing you need to be aware of is that when your loved one gets sick, has an infection, gets dehydrated, or needs surgery for some reason (like dental work), their level of function will temporarily decrease and they will be harder to care for. An example: my husband has no problems with incontinence except when he has an infection or right after dental surgery. Then he needs to wear the adult briefs for a couple of days until he gets his faculties back to his baseline. This was a big shock for me the first time it happened and I was alone in the house with him without briefs handy. And the first clue I had that he had a urinary tract infection was that he got thirsty and tried to use the soap dish (with soap in it) as a glass.

His capability for semi-independent living is very much determined by his health, hydration, and just plain old luck. For example, he likes to walk around the block a lot and a vocational therapist checked on him and said he's OK to do that alone, but someone has to remind him to drink up after a walk in the summer to keep him hydrated. He does fine with taking his meds by himself because he only takes them once a day, as long as it's the ones he's used to taking. He requires watching when his meds change. When the doctor adds a drug to treat an infection or something, my husband is confused and will either forget it (or remove it from his pill case because it's unfamiliar) or take too many of it.

He can do lots of things for himself as long as everything goes well. If our paid caregiver buys a different brand of a food he likes, he might skip lunch because he doesn't recognize it. If the phone rings when he's in the middle of something, he might forget where he is and usually skips steps or stops early. Lucky for us, he never leaves the oven on or microwaves things for too long, so he can safely make a snack for himself if I'm out.

Edema might not be connected as directly to dementia or endanger life, unless it's related to heart failure. You can have it just due to vein valve problems, and the compression stockings really will help that, but yeah, a lot of people don't like them. You could try to compromise and get a lighter compression that looks more like regular stockings or socks...that will work better for venous stasis then TED hose or similar that stay in the drawer. It may seem odd to put compression on an open area, but if it is a venous stasis ulcer as I think your mom may have had, it will actually work. Infection in the swollen leg will make it worse too. My mom would get cellulitis and need a run of antibiotics now and then. Her arterial circulation was not great either, so it was hard to get anything healed. She had edema from just not being able to walk and sitting all day mainly. If your calf muscles don't pump, blood tends to stay in the lower leg veins and make them look cool and purple even if the arterial circulation is OK. Well, it's hard, either way...hope you can help her avoid another skin graft.

Yep, Countrymouse. And the longer it 'dimple' stays indicates just how bad it is.

As a side not: To check for 'dehydration' you would pinch the skin. If it doesn't 'snap back' then the person needs liquids immediately. Dehydration happens at all time of year, regardless of temperature. Which mean, YES, even in dead of winter. I was trained as First Response Combat Medic during time spend in military.

Sure-fire test for oedema/edema: stick your finger in it. [But mind you don't press with a nail! - the skin becomes incredibly fragile.] The dimple will stay put.

vstefans had ask the question, "What's "leg adenoma" and what's that got to...."

blannie, thank you for the correction. That is what was meant ..."bet he means leg edema..."

Edema is the 'abnormal infiltration and excess accumulation of serous fluid in connective tissue'

The veins valves, in Mothers legs, are not fully functional, if at all. If not watched and tended to the edema will travel and at some point cause a shut-down of organs (liver, spleen, kidneys and heart) eventually ending in death. That is the tie in to the subject "Vascular Dementia". At least the way it was presented to me.

Mother's left leg was the first; last year she was hospitalized for two weeks and required a skin graft in upper calf area. After 'favoring' the left and not following instruction, the right now has the same problem -minus graft. Since May of this year (2013), five more hospital stays have occurred. Each time for the problem of swelling. When I say 'swelling', believe me, they have the appearance of an elephant leg....there is NO definition from mid calf to end of toes....NONE.

Anyway, as correct blood circulation is vital to all organs it is unlikely the brain will function 'normally' with this edema and disorders, such as Dementia set in.

Mother will not follow advise (aka DIRECTIONS) from anyone. When told to put prescribed compression stocking on before getting active for the day, or take a rest (half hour up-and-about, followed by at least an hour in recliner w/feet up, above heart level), there is, more times then not, resentment. Don't matter how it's presented, caring tone or stern, the tone is an order in Mother's mind; that is perceived as 'I'm your mother. Why are you (talking, treating, etc.) me this way? I didn't raise you to be like this.' And so, the battle rages on to do what. It is heart-breaking to see someone like this, especially our parents. So we do what we can, and pray to the Deity for strong.

Today is Thanksgiving Day and I give thanks to Him for the blessings bestowed on us, and ask for guidance through our troubling times. Amen.

Mantis? Mentis! That wasn't me, that was automatic spelling corrector, I promise…

Conjures up a cute new animal species, though! Any cartoonists around?

On the "sharp as a tack" v. "very confused" point: how can you explain to people that mental function doesn't have an On/Off switch? That you don't go from compos mantis to completely gaga just like that?

I'm struggling with getting family to engage normally with my mother: it's as though, because sometimes she doesn't remember some things, or muddles events when she talks about them, or appears not to know what day it is, they think she understands nothing at all. And we've barely started out with this thing!

My grandfather had vascular dementia. He suffered a stroke and it was maybe a year later when he was diagnosed with vascular dementia. He wasn't much of a talker to begin with but he became more of a recluse afterwards. Or at least in the first few years. We often wouldn't even notice him sitting on his favorite rocking chair in the den. He was just so quiet and so still. Later on, perhaps a year or so later, his behavior did an about face. He would wander around the house at all hours. Not really doing anything just walking and walking and generally driving grandma crazy. He became a "screamer" too. He would keep shout at grandma to get her to do whatever it was that he needed (food, getting up, getting dressed, the works.) He also used a cane and he would continuously bash it on the furniture to accentuate his shouts. We wanted to take it away except he uses it as a walking aide. On the last year of his life, he also suffered from incontinence.

It was definitely a stressing and trying time for our entire family.

kazaa, that's the way this kind of dementia is...brain function varies from day to day and some things that are more automatic come out more appropriately, other times things are from left field... Its not you, you are just letting the uneveness of it all get to you and thorw you for a loop. And, she will recognize familiar people perfectly well even pretty far along in the course of it, to me that was the one thing very different from Alzheimer type. Many casual observers will think because they are recognized and conversed with, the peson is "sharp as a tack" but when it comes to judgement and critical thinking skills, and most short term memory things, they really need full time help. They will grasp what they can and they wil often not realize what you'd think should be obvious. Never take it personally. I have to admit when a former nursing school mate came to visit mom and chatted a while, and then told me privately, "she's very confused" it was helpful to me, because so many peole gave me the "sharp as a tack" stuff, which made me feel guilty about thinking she could never go home alone again the way she wanted to so badly, and yet, because she physically needed so much help, it turned out they did not actually think she could go back home either. It had to et to where any little infection or inflammation she had would send her off the deep end, hallucinating and hitting people with her purse, before I was finally ready to do what needed to be done...hardest thing I ever had to do was to sell that house to have funds for long term care for her, then move her to my city after my dad passed on.

And now I feel like a dingbat for not guessing leg edema from adenoma!

Mom had leg edema also. Doctors tried treating her for congestive heart failure, but her edema was due to her arthritis. It is pseudogout. Her rheumatologist is treating her with a long duration, low dose & diminishing prednisone. No more edema!
She suffers from vascular dementia also, and is in assisted living. I wrote a note to the doctor so she knew mom is waiting to hear she is well enough to go home. The doctor was great! She told mom that her health has improved and she is in a safe caring place. She has activities and interacts with peers. She is just where she needs to be! It has been 3 months, and mom doesn't ask when she's going "home."

Blannie, CHF seems to lead inevitably to vascular dementia if you survive with it long enough - the poor pumping action means the brain doesn't get a good enough blood supply; plus blood can pool in the left ventricle and throw off small clots that get to the brain, and goodness knows where else.

My mother's never smoked, never been overweight, always stayed fit and active - her diet wasn't great, but cholesterol always ok - and was bustling home from work back in 1996 when she collapsed in public and was admitted to hospital. First diuretics, then beta-blockers and ACE inhibitors, then the angiotensin wotsit instead of the ACE, then they tried her on spironolactone but pulled it, then the special pacemaker, then a change of diuretic, then finally this year the cardiologist snapped her file shut and said: well, that's your lot, I'm afraid.

Two strokes, two weeks apart, and here we are waiting for our appointment at the Memory Clinic. 17 extra years of good quality of life, I've no complaints about the medical profession. I just wish they could tell me what's coming next and when.

My mums geriatrician was honest with her but shes not registering I jsut dont know anymore shes refusing to see doc and still wont sign POA? I dont think a doc telling them makes a difference they are in denial OR forget?
Thanks guys im feeling so tired lately and sometimes I wonder how long can I continue living like this I feel like im waiting for a bomb to go off its awful not really knowing what stage my mums at shes sharp then can say something that completly throws you then shes so damn lucid then she wobbles when walking dosnt register what im saying sometimes but witty and sharp when on the phone to family? this is like someone messing with your head constantly I tell you theres times I really wonder am I "nuts" God forgive me but there are times I wish shed just say "who the hell are you?" then I can say ok heres where we are at? so frustrating to watch.
Sister coming this weekend so palpatations have kicked in? Do you know she rang to ask me to find a top belong to her and wash it????????? I didnt answer and gave phone to mum. Tell me is it me? Oh and I forogt to mention that im going into hospital tom for an angiogram and she never even asked me how I was HELLO WASH HER TOP?
Beam me up scotty and soon!

LifeRyder I know what you mean. My mom keeps telling me she's ready to go but what can either of us do about it? I've seriously thought about the countries and states that allow physician-assisted suicide for that time when it's my turn. I don't think my mom would actively want to commit suicide, but it's tough.

I wish doctors would ask patient's family members if the patient should be told the truth or not. Some people can't handle and don't want the truth. But when it comes to whether someone needs 24/7 care, docs should definitely tell the patient that it is required.

And VStefans, I bet he means leg edema...which might indicate congestive heart failure. Not sure how that would relate to vascular dementia though...

I mean DO WITH IT of course...

Man, that's rough...a little tactful truth telling so she does not have to sit around wondering what she (or anyone else) are doing wrong that she can't get better would have helped. She probably realizes she's not getting better but she's not supposed to say so.

What's "leg adenoma" and what's that got to domain hit though?

Mother has leg adenoma that her PCP at times has referred to her having vascular dementia. I have no clue what his talking about. First it's 'She has the onset of Dementia', then 'She has Dementia', then it's 'Vascular Dementia'. Add that to the referred neurologist that tells her, 'You're doing fine. Keep taking your medications, socialize outside the home, watch TV, do puzzles or play games. You will get better.' ARE YOU SERIOUS? They have both told me, in private, 'She can not live independently, she need 24/7 care. And no, she will not get better with time ... only worse.' I have told them both that "You need to level with my Mother and stop blowing smoke in her (not the exact words, you understand) nether region. Being the optimist that Mother is, she needs to hear the reality from those she trusts. Hearing it from me that the 'reality' is other then her optimist view, especially when not stated by the doctors, causes a disheartening chain of events.

Mother has stated, 'I don't want to live like this. Your Grandmother (her Mother) didn't have this; why do I?' Then there are the statements Mother makes about going 'walk in traffic', 'just take me out for a ride in the country and drop me off somewhere, I can make it back.' The one that really, really upsets me is, 'just shoot me, so I can be in peace. I never wanted or expected to live (past seventy-five anyway) this long.'

Though Dr. Jack Kevorkian - aka. Dr Death- famously said, "dying is not a crime" Maybe he was onto something; letting a person choose to leave this level of the journey for the next level on their own terms. I've stated the following before, 'Boys! If I get to this point in life, just make sure I have a full tank of gas, some pocket cash, clothes and sleeping bag strapped to my motorcycle & tell me "go west ole-man.' That's the way I feel, my terms. It may seem rash, crude or whatever, but that's me.

I'm sorry for going way off topic here. It's just been one of those days. Please enjoy Thanksgiving with family and friends. Ours problems will still be here tomorrow.

My mom had this type and we did the best we could to prevent fruther strokes and extension of old ones, but in the long term thngs progressed anyways. She was not real sensitive to the usual anti-platelet meds for this, and they deemed it too risky to use Coumadin. You do the best you can; if you are like I was, sometimes you only wish you could prevent any more progression, and keep what quaity of life you have, and sometimes you have to wonder how long it will go on. I worried about what if it went to where she could not swallow but still wanted to eat...her heart disease (coronary artery predominant) did take her away from us finally before that really happened; we had maxed out meds, including a few I had never heard of, it was inoperable, and her PAD and general tolerance made the counterpulsation pump therapy thing seemed like too much so we did not go that far. As far as diet, we did go sugarfree, but she was not ready to try seriously changing to a Mediterranean or save-your-heart fruit and vegetable diet, and the general consensus was no use shutting the barn door when that horse was out of the barn a long time ago. So we ate pizza. (Hey, at least it has tomatoes.) She gradually became unable to do activities that needed any kind of sequencing or planning, but was alert and recognized everyone til the last day. She was physically completely disabled by the last few months with arthritis and deconditioning both, really even needed help to turn in bed. Her vision was poor due to the strokes - we tried very hard to see if any of it was diabetic-related and treatable, but it was all cortical (due to the brain). Her hearing was bad and hearing aid use rarely worked out, so we just yelled.

It is not a good situation and I desperately try to live healthier and maybe avoid all of that for myself...what can I say, you do the best you can, you try to make lemonade out of those lemons for yoru loved one, but they get pretty dry after a while.

My mom was diagnosed over 10 years ago with vascular dementia. I was told at the beginning that she could stay the same for 20 years or not. There is no set time frame. She started to become a hermit and more of a hoarder. With one on one careing from an outside aide. We put our heads together and started to break the traditional ways dementia people behave. Now after time. My mother is getting more confused but she goes out to family functions, she goes and gets her hair done along with her nails. Keeping involved in daily living activities and strict structure but allowance foe bad days. She can live a fulfilled life as long as she is here. Pleae look into community based programs such as CDPAP( Consumer directive personal assistance program paid by Medicaid, if she doesn't qualify for community medicaid ask them that you will open a Supplement needs pool trust account for the surplus income. And get outside help to deal with the needs she will be requiring.

My husband has vascular dementia but he is not diabetic maybe because he's on a feeding tube as a result of the tongue and tonsil cancer. He developed symptoms when he had his open heart surgery in 2002 and went downhill quickly from there. I took his drivers license away un 2009, because his driving was risky. Now he's in a nursing home and knows who and what I am to him and he knows people who come to visit if I tell them they are coming. He can't tell me what he did yesterday

If your mother is diabetic this is also a part of of vascular dementia, you are correct about the diet and exercise, but I understand that she may be reluctant to you being the source of what exercise and what food. My mother was not receptive to my help,I took her to a day care center for the elderly for the exercise program and lunch three days a week. Maybe it was the peer pressure or not wanting to appear ill behaved with an audience but it was helpful and she participated after a few visits with enthusiasm. She eventually passed as the result of a stroke but in my opinion and that of other family members this intervention improved the quality of her life.

So… My mother has a pacemaker, she's on Clopidogrel, we've reached the end of the branch for heart meds… Where next? It's so hard to know if poor concentration/recall/processing/balance on bad days comes from fatigue or dementia (or boredom or annoyance or hearing loss or cataracts or…). What wouldn't I give for a crystal ball.