I'm looking for caregivers who have been through/or are going through caregiving of someone who developed vascular dementia after a large stroke. My mother at 59 had a major stroke in March. She has since been moved to a nursing home because she couldn't care for herself. She walks very little, has fairly sever aphasia, slight movement in her arm, basically no movement in her hand. The stroke was caused by unmanaged type 2 diabetes and high blood pressure. Her BP has since gone down and but her diabetes is very sensitive. She still is incontinent as well. The past four months I held out on extreme hope that she would move past this. I had hoped that her stay in the nursing home would be short and she would move to assisted living. But that hope is fading. Her mind is of a 10-12 year old with aphasia. She sleeps a lot of the day and night. She has no desire to move outside the nursing home on to assisted living. Give it to me straight folks...could she be on the path for vascular dementia? Or is this stroke recovery?

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I agree - losing grip of routines you used to handle easily would be one alarm bell if you were looking for dementia. It isn't just the cognitive function, either: it's mood, energy, everything that keeps you ticking over normally. Your mother has probably been struggling for a good long while - but DON'T whatever you do beat yourself up for not noticing. For one thing, it's really not easy to spot while it's happening, because it's so gradual; and for another there probably wasn't anything specific your mother could have told you about, so she wouldn't have said anything to prompt you.

The NH sounds like a good one, that must be a weight off your mind. It is terribly sad to think of her not even wanting to get better, or that there isn't really anything she'd want to fight for. I don't know what to suggest. She's so young!

Do you have anybody to talk all this through with?
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we cross posted. Yes she could have had vascular dementia before the stroke. My father had type 2 diabetes, not well controlled and diagnosed in his 50s. By age 60 he was showing signs of VaD and after that had a number of TIA's before larger strokes later in life. I would make that her meds for manic depression are meeting her needs now. It sounds like she was poorly motivated to do things before the stroke, and that condition continues. Manic depression is not easy to treat at the best of times. 

It is sad and part of what you are dealing with is your own emotions at seeing your mother decline. (((((((hugs)))))))
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Hi - my mother has vascular dementia, but never had a stroke. She has accumulated damage over the years from high blood pressure.

With " unmanaged type 2 diabetes and high blood pressure" your mother already had blood vessel problems in her brain that led up to the stroke. It is quite possible that she has additional damage amounting to at least early vascular dementia. A large stroke is a huge insult to the body and can take a long time from which to recover.

From the American Heart/Stroke Association: Gains can happen quickly or over time. The most rapid recovery usually occurs during the first three to four months after a stroke, but some stroke survivors continue to recover well into the first and second year post-stroke.

I, too, wonder about what rehab she is getting and if post-stroke depression is being addressed. It may be part of the reason for her sleeping so much and having little motivation.
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Her diabetes: I thought that she was carefully managing it all these years. It seemed to be the center part of her life...checking her sugars daily, watching what she ate, going to the doctor and paying for prescriptions. Turns out, I was dooped. Long story short she made it appear that she was working to control it , but behind closed doors she had washed her hands of it more than five years ago. In November she even got diabetic ketoacidosis; which is extremely rare for type two diabetes. And it's a huge warning sign that it's not being managed. BUT she told me she had a stomach bug and her lingering nausea was a hiatal hernia. All along it was extremely high blood sugar.

Could it possibly be that she had dementia BEFORE the stroke????? I had never thought of that. But she was diagnosed with diabetes at 32, which is pretty young and I imagine that would take it's toll on the human body.

The past few weeks her PT/OT/Speech therapy has gone from daily to weekly and I can see her declining rapidly. The NH has given her exercises and has a host of activities to keep her active. But she says, "they are always when I'm napping."

Motivation is a challenge!! Before the stroke she was on SSI for manic depression. So she already wasn't working. She lived alone in a 55+ apartment complex and lived a very inactive lifestyle. Her car broke down over a year ago and she became very secluded after that. Quite frankly she's completely out of touch with what a normal person of 59 years is able to accomplish in a day.

I don't have any carrots to dangle in front of her for motivation. It's not like she has a job to go back to, or even a car to drive. She even lost her apartment when she moved into the nursing home. It's all very sad!
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Holding my hand up to reply, I'm a caregiver whose mother had vascular dementia and then a large stroke - not the same sequence, of course; although it's possible that your mother's brain blood supply was already compromised before the stroke - was she always poor at managing her diabetes, or did she do well and then stop bothering, for example?

As far as I remember from my wider reading, four months post-stroke is still comparatively early days. The points on your side are that your mother is only 59, she has professionals taking care of her, and there is potential for her to recover further.

The trouble is, if she does nothing and stays as is, she will decline. If her BP is under control and she's presumably being given anti-coagulants? then that will help to avoid strokes, TIAs, the blood supply issues that cause vascular dementia; but immobility is bad news all round. Also, miserable for her as well as you.

It's motivating her that is going to be the challenge. What does she get in the way of rehab support, if any? Does the NH work with any of the therapies - physical, occupational, speech and language?
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