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MIL was diagnosed with vascular dementia a few months ago. She has health issues such as diabetes, stroke history, and several cardiac issues, as well as kidney failure. She smokes and refuses to execise or eat healthy. Suffice to say, she’s in awful health. She was diagnosed incidentally after a CT scan happened to pick up dementia while scanning for something else. After a test confirmed it at her PCP, we realized she has probably had symptoms longer than we thought. My question is, does vascular dementia worsen in stages? It seems as if MIL will have a better(ish) day, then the next day she will worsen in behavior. A few days ago, she was trying to clean her kitchen. Today, she was unable to dress herself and basically laid in the bed with her pajamas half on, She could barely get out of bed, refused to walk, and wouldn’t even help me get her dressed, she just laid there. Then, she thought it was the morning of a different day and woke me up in the middle of the night, I was able to calm her down and get her back into bed. How does someone progress this quick? It’s almost scary to watch.

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Yes, is the simple answer. Vascular dementia is characterized by steps and plateaux - there is a sudden worsening of a function or symptoms, and then a period of no or very little change. This is often contrasted with Alzheimer's Disease, where there is more of a series of ups and downs (though still with an overall trend downwards).

I think the honest truth is probably that there is more than one thing going on with your mother, and you're doing the right thing by concentrating on what she needs on a particular day. You can drive yourself up the wall by trying to predict the unpredictable and explain the inexplicable. Hugs to you.
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I’ve observed over the last several years that attempting to rely on “stages” of dementia, no matter what “type” you’re dealing with, is probably not as useful as some new caregivers may think.

The most comfortable way for ME to continue as a caregiver is to live no more than one day at a time, not fixate on more than general expectations, and observe and make notes about behaviors and needs that do seem to become progressively more difficult to handle.

My grandmother suffered symptoms for almost10 years, probably because of vascular changes (no doctors involved, ever), and at the end could still walk up and down stairs, had no use of language, but was NEVER INCONTINENT.

Not too much predictable about her dementia, no matter what “stage” she was in.
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Yes to fluctuating ability, clarity & confusion, but not so sudden as you described.

Vascular dementia will mostly be a 'step-down' in functioning after another stroke. Then stay roughly there.

I would suspect the other health issues too. Fluid / toxin build up with kidney failure or heart, drop in O2, blood sugar level. Poor lady, got a lot happening.

Do you know her wishes? Eg If you find her unresponsive?
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Yes, in my experience. A very helpful thing will be for you to educate yourself about dementia but not expect it to fit in any time line or box. Learn how to better engage with your LO with each new change. Make sure you get enough breaks and vacations for yourself because you can burn out. On YouTube, Teepa Snow has some excellent videos.

One thing to watch for is UTIs. They are extremely common in elderly women and not only due to hygiene issues: our physiology body chemistry changes over time and our bladders don't void fully. Often the only symptoms of an infection is a "sudden" and sustained changed in behavior, like confusion, agitation and delusions. If this happens your LO needs medical attention right away as it can turn into sepsis, and she already has so many issues compromising her.

I wish you much wisdom and peace in your heart on this journey.
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You have described a typical case of vascular dementia and you can see how different it's from Alzheimer's. Vascular dementia progresses rapidly.
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Countrymouse May 2022
Vascular dementia doesn't always progress rapidly - average life expectancy after diagnosis is 4 years, but a lot depends on what the underlying cause(s) is/are, when the diagnosis is made, and what treatment/lifestyle adaptations are introduced. With luck and good management you can fend it off for years.
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