This study is
meant to bring awareness to the members of the
public around the globe about the dangers of dementia
disease, importance of caring and team work to
help the affected people in the locality. Types
of dementia forms are clearly outlined but Vascular
Dementia form is the basic form that is discussed
in this study. The study includes a brief outline
of the disease, its types, symptoms, causes, effects,
diagnosis treatment and the affected people ratio
in the globe. It also provides advice on the risk
factors of affected individuals, to help deal
with the disease. A case study on the disease,
diagnosis and effects are provided to help understand
Key words: Vascular Dementia, Management,
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The term dementia refers to a set of symptoms that occur
after the brain is damaged by a specific disease. This
includes memory impairment, loss of communications skills
and gradual deterioration in the person's ability to
carry out daily tasks and activities(1). Frequent signs
of ailment include troubles with verbal communication
and enthusiasm. There are some small cases of the disease
running in families. The view of ailment normally depends
on the rigorousness and the history of individuals'
health. It is anticipated that about 40 million populace
of the planet are affected by the illness, that is,
about 20% of the populace develop ailment at one point
in their existence(1).
The disease is more common with age the group 66-75;
3% of this group are suffering from dementia. In the
age group of 73-85, it is estimated that 19% of them
have Dementia. It is also estimated that about half
of the people aged 87 and above have Dementia. Dementia
for this reason is the most common cause of disability
among aged people in the world and it is suggested that
it accumulates economic costs(2). Social stigma greatly
impacts on affected people. Therefore, there is need
to raise more awareness of the disease to avoid such
impacts on patients and stigma.
1.2 Forms of Dementia
There are numerous forms of dementia. Some of the most
prevalent forms are conferred below.
Figure 1: A pie chart to show the percentage spread
of Dementia forms
1.3 Alzheimer's Disease
This is the most widespread form of Dementia. It affects
about 80% of individuals in most Dementia cases. The
part of the brain that is mostly affected by this disease
is the hippocampus. Other parts that develop atrophy
are the temporal and the parietal lobes as researched
by Cipriani et al.(3)
1.4 Vascular Dementia
This sort of Dementia affects about 20% of Dementia
sufferers. It is the second most widespread type and
is caused by incompetent blood streams in the brain.
Lack of oxygen and supplementary nutrient supplies to
the brain lead to individuals collapsing. Some of the
common symptoms include impaired judgments on decision
making and organization(4). Brain imaging can be utilised
to view the blood vessels affected by the disease.
1.5 Dementia with Lewy Bodies
Referred also to as Lewy body disease, also has common
symptoms. These symptoms include hallucinations, rigid
muscles and a lack of concentration. This form is distinguished
by irregular protein drops on brain stem nerve cells.
This causes a disruption
in the brain's regular functioning(4).
1.6 Parkinson's disease dementia
Parkinson's disease is a progressive neurological disease.
In its advanced stages, the disease can affect cognitive
functioning(5). It is very important to note that not
all individuals who have Parkinson's disease develop
dementia but a significant number does. The most common
symptoms of Parkinson's disease include tremors, muscle
stiffness, slow and delayed comprehension and decision
1.7 Frontotemporal Dementia (FTD)
This form of dementia is exemplified by drastic personality
changes and speech difficulties in the sufferer. There
are three types of FTD, they include Behavioral Variant
FTD (bv-FTD), Temporal Variant Dementia (TV-FTD) and
Progressive Non Fluent Aphasia (PNFA)(10).
1.8 Creutzfeldt-Jacob Dementia
The occurrence of this disease is very rare. It is caused
by some viruses that affect the brain's normal functioning.
This form of dementia has no treatment and advances
rapidly over a period of few months. The common symptoms
of the disease include, muscle stiffness, lack of coordination
causing falls in geriatric individuals, and speech impairment(6).
1.9 Normal Pressure Hydrocephalus
This sort of dementia engrosses the accretion of cerebrospinal
fluid in the head cavities. This solution then leads
to the upsurge of added force on the brain hindering
the brain's ability to function normally(3). Symptoms
that are associated with this disease include, problems
in balance, bladder control, speech impairment and reduced
problem solving abilities.
1.10 Huntington's Disease
This is an innate type of Dementia. It affects individuals'
cognition, routine and relationships. The behavioral
symptoms associated with this type of Dementia include
memory problems, impaired judgments, mood swings and
depression(5). Symptoms such as involuntary jerking
movements of the face, body and sometimes hallucinations
may also be observed in affected individuals.
1.11 Wernicke Korsakoff Syndrome
This type of Dementia is caused by a deficiency of vitamin
B1 (Thiamine). When Thiamine ranks are condensed, brain
cells are unable to regenerate sufficient vigor to help
accurate functioning. Deficiency in B6, B12, vitamin
E, Folate and Omega 3 are associated with increased
Homocysteine level which lead or contribute to the occurrence
of a stroke. This form of dementia is most common in
alcoholics, but can also be caused by cancer, malnutrition,
high levels of thyroid hormone and long term dialysis(3).
The most widespread signs of the disease are lasting
gaps of memory loss and affected short term memory.
1.12 Mild Cognitive Impairment
As suggested by Rabins et al.(5) this type of Dementia
may be caused by a medical illness, medications or environmental
factors. Individuals with MCI are always aware and feel
like they are in an unpleasant or dangerous state or
situation. A number of the indications linked with this
form of dementia include memory failure, prejudiced
judgment and poor speech. Depression, anxiety, aggression
and emotional apathy may also be experienced. This is
mostly because of the patients' unawareness of the disease
and its symptoms, causing frustration.
2. Vascular dementia
2.1 A brief summary
of Vascular Dementia Disease
Vascular Dementia is a group of ailments that cause
a decline in cognitive skills. The disease is characterised
by condensed blood flow to the brain as a result of
blockage problems with blood vessels supplying blood
flow to the head(7). As a result, the brain eventually
becomes damaged in a very short time and can even die
due to lack of oxygen. Vascular dementia is a progressive
disease that has significant effects on the life style
of the affected person, friends and family members.
There are many forms of Dementia. After Alzheimer's
Disease, Vascular Dementia is the second most widespread
The first discovery and diagnosis of Vascular Dementia
was in 1899; it was named Senile Dementia. In 1969 Mayer
Gross and his partners discovered that there are many
different syndromes relating to different vascular mechanisms.
They reported that hypertension contributes to the development
of the disease in about 50% of patients(8). In this
form of dementia, changes in thinking skills may sometimes
occur very quickly due to cases of strokes, causing
blockage in the main blood vessels leading to the brain.
Thinking problems may either be mild or severe. Brain
experts refer to this as Vascular Cognitive Impairments
3. Varieties of Vascular
There are many diverse forms of Vascular Dementia. They
include; Mild Vascular Cognitive Impairment and Multi-Infarct
Dementia, that are due to strategic single infarct.
Vascular Dementia is also caused by hemorrhagic lesions,
the Binswanger Disease, Sub Cortical Vascular Dementia
and Mixed Dementia which is a combination of Alzheimer
Dementia and Vascular Dementia diseases(7). Two main
universal forms of Vascular Dementia Disease are the
Multi-Infarct and the Binswanger's Disease.
3.1 Multi-Infarct Dementia
This is the most widespread type of Vascular Dementia
Disease. It originates from numerous mini strokes or
Transient Ischemic Attacks (TIA). The strokes source
harm to the cortex of the brain in the area that is
generally associated with erudition, reminiscence and
verbal communication. A person suffering from this type
of Vascular Dementia has better insight in its early
stages than people suffering from Alzheimer's Disease
because parts of their personality remain intact for
a longer time. Signs of the disease include severe hopelessness,
temper swings and Epilepsy(7).
3.2 Binswanger's Disease
In the past years, this disease has been assumed to
be rare but the disease is relatively common. It is
connected with stroke interrelated modification where
the white matter deep in the brain is generally affected.
As suggested by Etherton-Beer(7) it is caused by high
blood pressure, solidification of the arteries and deficient
blood flow. Common symptoms associated with the disease
include sluggishness, complexity in walking, expressive
ups and downs and lack of bladder management.
of Vascular Dementia Disease
Vascular Dementia can from time to time have very equivalent
forewarning signs to Alzheimer's Dementia. The signs
are dissimilar depending on the part of the brain affected
as suggested by Sharp et al.(9) The symptoms in most
cases are always clear when occurring suddenly after
a stroke. When changes in ones intellect and reasoning
are clearly linked to a stroke, the condition is called
Post Stroke Dementia. Additional distinctiveness of
Vascular Dementia symptoms outline includes a sequence
of mini strokes. The disease's warning signs can be
divided into three categories; behavioural, mental and
4.1 Behavioural Symptoms
These symptoms affect the way a person behaves naturally
in their day to day activities. They include confusion,
trouble paying attention, speech problems, reduced ability
to organize thoughts, agitation and irritation, laughing
or crying for no particular reasons and basically reduced
ability to function in daily life activities. This includes
experiencing difficulty doing things that used to come
easily such as handling money or paying bills(10).
4.2 Mental Symptoms
These include indications linked with individuals' mental
power skills. They consist of illusion and fantasy,
confusions, slow judgment, common inattentiveness, personal
alterations and odd mood swings, hallucinations, delusions
and dizziness. People suffering from the disease also
get lost frequently, even in familiar settings(10).
4.3 Physical Symptoms
These are indications that can be seen on the physical
physique of the affected person. They include movement
problems especially when it comes to balancing, hands
and legs weakness, urinary and bowel incontinence, slowed
movement tremors, moving with rapid and shuffling steps(10).
4.4 Co-existence of Symptoms
It should be considered that behavioral, mental and
physical symptoms of Vascular Dementia can co-exist
across the different categorised symptoms.
5. The risk factors of Vascular
According to Stephan et al.(8), the risk aspects of
Vascular Dementia Disease are identical to the risk
aspects of heart disease and stroke. They include;
Figure 2: A diagram showing the risk factors of Vascular
5.1 Age Factor
As individuals become older, the danger of acquiring
Vascular Dementia Disease amplifies. This is
the reason most elderly people have the disease by the
age of 85 and above(2).
5.2 A History of Heart Attack
The chances of developing Vascular Dementia Disease
are higher in individuals who have suffered a heart
attack. This is because brain blood vessels develop
complications which may increase the risk of developing
5.3 High Cholesterol
High levels of cholesterol are allied with the danger
and intensification of Vascular Dementia. This is because
cholesterol decreases the flow of blood that nurtures
5.4 High Blood Pressure
When blood strain is high there is excessive stress
on the body and the brains' blood vessels. This intensifies
the likelihood of having vascular complications in the
head as proposed by Sharp et al.(9)
Increased glucose intensity can cause injury to blood
vessels in the body including those in the head. This
damage in blood vessels, particularly in the brain can
pilot to contagion of Vascular Dementia and a stroke(8).
Overweight individuals are at a higher risk of developing
Vascular Dementia than average weight individuals. This
is because of their increased Cholesterol, Diabetes,
Atrial Sclerosis, Thrombosis and Embolism and Aneurysm(8).
5.7 Atrial Fibrillation
This is an irregular heart beat where the higher chambers
of the heart begin to pound hastily and erratically
out of harmonization with the upper cavity of the heart.
The threatening of a stroke is caused by the poor blood
current in the brain along with body components(8).
5.8 Smoking and Alcoholism
Martin-Ruiz et al(11) assert that smoking and alcohol
are common risk factors contributing to the development
of Dementia. This is because smoking damages blood vessels,
causing respiratory diseases including Vascular Dementia.
Considering the signs and symptoms of Vascular Dementia,
individuals experience signs and symptoms as the disease
progresses as shown in the below graph.
Figure 3: Progression of Vascular Dementia
of Vascular Dementia Disease
Vascular Dementia disease is normally diagnosed with
the use of several techniques. These techniques include
neurological examinations, brain scans which include
the computerized tomography and magnetic resonance imaging
(MRI) tests. The verdict of Vascular Dementia is pedestal
on the presence of cognitive mutilation and cerebrovascular
disease being the chief source of the signs(8). If ailment
is assumed, numerous tests have to be executed to make
sure accurate analysis takes place. Neuropsychological
checks are carried out to evaluate the sub cortical
brain utility. To assess and establish the location
of brain damage, a brain examination is conducted using
MRI and computerized tomography(1).
Vascular Dementia Disease
There is no precise cure for ailment causing Vascular
Dementia. The only available prescriptions are those
that can assist in managing the intensification of the
disease. Controlling the conditions affect the underlying
health of the heart according to Stephan et al.(8) Pentoxifylline
and ergolid mesylates (Hydergine) can be beneficial
for increasing cerebral blood flow; significant improvement
will be noticed in assessing intellectual and cognitive
function and helpful in slowing down the rates at which
Vascular Cognitive Impairment (VCI) progresses to further
pathology. Medications to help control high blood pressure,
high cholesterol, atrial fibrillation and diabetes can
be prescribed(9). Aspirins or other anti-coagulant drugs
can also be prescribed to reduce clotting in blood vessels
in the appropriate timely manner. A healthy diet, exercise
and avoidance of smoking and excessive alcohol intake
play a great role in the reduction of strokes and Vascular
Drugs can be approved to alleviate agitation or gloominess
to help Dementia patients. A carotid endarterectomy
surgery can be performed to treat obstruction in the
carotid arteries, the main blood vessel leading to the
brain(8). Recent studies indicated that some medications
used by Alzheimer's patients can be used for patients
suffering from Vascular Dementia Disease in some circumstances.
The medications include cholinesterase inhibitor medications
such as Donepezil and Galantamine.
Team assessment and planning of care for patients is
crucial. This includes Physiotherapy to help in movement
and balance. Speech Therapy is also necessary to assist
patients' speech impairment. Educating family members
can also play a big role in helping patients at home.
They can develop strategies to help in memory enhancement
by writing and placing notes and reminders. The purpose
of the below diagram and above explanation is to remind
the public and treating doctor to follow team assessment
and planning of care. This should be encouraged as it
is not effective if only one doctor treats a Vascular
Dementia patient whose symptoms and treatments vary
across various medical fields. Therefore, having team
assessment and planning allows the achievement of a
successful treatment plan. Constantly reminding the
patients of common details about themselves would also
be helpful as suggested by Stephan et al. (8)
Figure 4: Team assessment and planning of care
changes that can be used to manage and prevent Vascular
Diagnosis of the disease can be challenging, especially
because there is no cure for the disease. But with the
correct guidelines on how to live healthy, there are
several things that can be planned to maintain a sufficient
lifestyle and manage the disease.
Regular exercise is one of the most important things
in managing the effects of ailment. It is very important
to at least take a 20 minute walk every day to help
slow the progression of Vascular Dementia and help control
weight, boost overall happiness and also relieve stress(11).
Seeking help, encouragement from friends, family and
health experts are also very important whilst managing
the disease. This is because such people are a very
important part of affected individuals' lives(11).
A healthy diet is another important way of controlling
the effects of Vascular Dementia disease. It helps to
manage the cholesterol levels which will, in turn improve
and slow the progression of Vascular Dementia symptoms.
Boosting individuals' memory, learning how to relax
and manage stress is also another strategy to help control
ailment. Meditation and yoga can also help in relaxation
and reduce stress(11). Challenging the brain can be
applied in the management of ailment. Training the brain
to retain and retrieve memories, setting up a special
routine plan sometime in the evening to try and recall
all the day's activities help build memory capacity
such as an eating plan, exercise plan, remembering medication
and emergency numbers. Other activities such as painting
and learning to complete puzzles can also help in building
brain capacity(8). Keeping a routine can also assist
in managing the effects of Vascular Dementia. Certain
routines of the day can help in the avoidance of forgetting
9. Case study
A 77 year old female visiting her sister from overseas
(Middle Eastern Country) to Australia attended the clinic
with her younger sister who is 67 years old for an assessment
for her reduced cognitive abilities. Her sister who
is residing in Australia is concerned about the older
visiting sister and her short term memory loss for the
past 2 years as stated by the family overseas. The patient
had a stroke 5 years ago. Following the stoke she started
to ask the same questions repeatedly. The patient recently
had another minor stroke which was misdiagnosed as hypoglycemia
by a family member, not a medical practitioner 12 months
prior to visiting Australia. She had an episode of dizziness
within one month of her arrival. Her sister noticed
further decline in her cognition; she recently noticed
that she is becoming more suspicious of her nephews
and has been holding onto things. She has also lost
interest in her daily activities and forgets to include
the right ingredients and components in her cooking.
Whilst taking her daily medications, her sister needs
to remind her of the correct medication and dosage.
As well as this, her second eldest son and his wife
in her home country are helping her manage her finances
and living arrangements as she hallucinates of mice
travelling in the florescent tubes in the ceiling.
The patient has Hypertension, Diabetes, Cholesterol,
Osteoarthritis and Osteoporosis. On the Mini-Mental
Status Examination (MMSE), the patient scored 21/30
with abnormal clock drawing. On the Geriatric Depression
Scale (GDS), the patient scored 2/15. A CT scan of the
head was performed in Sydney, Australia revealing multiple
lacuna infarcts in the right basal ganglion and left
The diagram below is used to establish the principles
of the ongoing management of Vascular Dementia patients.
Figure 5: Management guide
Vascular Dementia Disease is an ailment that affects
the brain and the ability to think properly. There are
several types of the disease and there is great importance
to establish a correct diagnosis of Vascular Dementia
from the treating doctor. Family is very important to
patients who are affected as they require a lot of support
from their families and friends to avoid cases of stigma.
Although the disease has no known cure, its symptoms
can be controlled by use of some medication, surgery,
Occupational Therapy, a Registered Nurse, Physiotherapy,
Speech Therapy, a Geriatric Specialist, Carer and the
General Practitioner / Family Doctor working as a team.
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