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I’ve heard that vascular dementia is progressive and cannot be stopped. What makes it progress? Does vascular dementia progress by another stroke?


My main question is can you prevent the worsening of vascular dementia by treating the underlying disease? Also, what about vascular dementia caused by white matter disease? Just trying to find a glimmer of hope here.


My last question is what were you or your loved ones first signs of vascular dementia? And how long did it take to progress to a moderate form?

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Your mother is very young to have vascular dementia. It is caused by lack of bloodflow to the brain and consequently lack of oxygen. With no O2 the cells die off. Has her PCP ruled out all the treatable conditions for VaD? There are certain causes that can be treated: heavy smoking over a long time, high BP, high  cholesterol for example. In the case of a clogged artery, especially the carotid, an endarterectomy can be performed which would restore bloodflow but not repair any damage that has been done. If all of the treatable conditions have been exhausted, then VaD will continue to progress. There is no treatment although some AD meds may temporarily help. In this case, VaD IS the underlying disease. Like the other progressive dementias, there is no good way to anticipate its progress.

I would suggest that you learn more about it by going to YouTube and searching "Teepa Snow" and "Careblazers" and scrolling to find VaD. Also mayoclinic.org and webmd.com are good resources.
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Jessica56 Oct 3, 2020
From what I read she has mild dementia. She is slow with remembering words. Not necessarily forgetting them all together but it takes her a minute to remember. Will be talking and pause for a moment, usually with an “umm” and then she will remember the word. Every now and then she won’t pay attention to something someone is saying but it doesn’t happen often. She has heart disease and is diabetic. Her symptoms are very mild. I also wonder if it has something to do with her being tired. As she complains about this often. I hope if she gets the right treatment that her memory will improve. And maybe it wasn’t dementia after all. She works, drives and can take care of herself. She’s never had a stroke but I’m sure she has bad circulation
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Jessica, I would argue against the idea that any online cognitive tests are going to bring you peace of mind. I think they will only agitate you AND your parent.

Talk to the neurologist about getting a baseline neuropsych assessment done when that is possible.
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Jessica56 Oct 3, 2020
Could you give me some examples that mimic dementia? Her main issue is complications with diabetes, hypertension, peripheral artery disease and heart disease so I wouldn’t dismiss the fact that she probably has disease in her carotid artery. No heart failure. She’s in her late 50s.
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Thanks, can someone give me some online cognitive tests? I know it’s not a diagnoses but something to help ease of mind for the time being.
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My father's death certificate says he died of vascular dementia. He had a significant stroke at age 86 in 2012 after 10 years of occasional TIAs that his doctor said we could do nothing about. (No MRI becasue of pacemaker.) I knew of three of them in which he could not speak for about 20 minutes. He did not have high blood pressure or cholesterol. In fact he was the poster child for exercise and excellent diet. After the stroke hospitalization and rehab, he was put on a very small dosage of atorvastin plus a 325 mg daily aspirin and recovered about 90% of function (language, reasoning and mobility) with the help of rehab. Eventually he was able to drop the statin. I would say he declined in stages with age with the key problems being mobility, short-term memory, and confused thinking. His personality never changed. His doctor once mentioned Alzheimer's but it seemed like he plateaued a couple of times and he was able to live relatively independently - with supports - for another 4 years. Had a second stroke in 2019 after a hospital doctor took away the aspirin because he decided he was chewing it. He was in the hospital for a fall and minor UTI.

I had not heard the term "White Matter Disease" until you mentioned it now. I would have said it sounds like the chicken vs the egg discussion of which came first, but when I looked up White Matter Disease on Web/MD, they say this:

Can It Be Prevented?
Age-related white matter disease is progressive, meaning it can get worse. But you can take steps to stop it from spreading. Scientists think you might even be able to repair the damage, if you catch it early.
Keep your blood pressure and blood sugar in check. That can lead to white matter changes. To keep your heart healthy, follow a low-fat, low-salt diet, and get about 2 and a half hours of moderate-intensity exercise each week. Manage diabetes if you have it and keep your cholesterol in check. If you smoke, stop now.

This is pretty standard advice for all of us. Keep moving as long as you can.
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My mother had a lung issue in 2014 that was misdiagnosed, and once it was resolved she's never been the same. She was diagnosed with vascular dementia a couple of years later.

Her decline has been in big steps, not gradual decline. It's usually been marked by other health events, shocks to the system (my dad's death), and now the isolation due to Covid. She never recovers from a step down.

She's never had an actual stroke.
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These people are the experts:

https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia

The link is to a very good overview of vascular dementia, plus access to lots of other information.

The other point to mention is the common mantra in dementia care: "when you've met one person with dementia, you've met one person with dementia." You *cannot* predict what will happen to yourself or your loved one with any certainty at all based on other people's individual experiences.

With vascular dementia, where compromised blood supply can affect just about any function originating in the brain (i.e. most of them), it's even more like playing whack-a-mole. The best way to be prepared is to have a good support network.
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Hi Jessica,

Yes, vascular dementia is progressive yet everyone who has it progresses differently. It's not a one size fits all disease.

My 94 year old Mom started showing signs over 10 years ago (she never had a stroke) when she started getting lost driving. I don't remember the year but it was at least 10 years ago. Today she is doing fine with normal confusion and forgetfulness (she does remember her childhood), it's the short term memory that's affected.

Again, everyone progresses differently. I do knock on wood that my Mom has not had any strokes.

Best to you!
Jenna
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Jessica56 Oct 3, 2020
hi Jenna, does your mom have white matter disease?
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My husband had had a massive stroke in 1996, and at that time his neurologist did make me aware that his odds of developing dementia down the road were greatly increased because of his stroke. Well in 2017 my husband starting falling more, and shortly after the incontinence started (both signs of vascular dementia). It wasn't until July of 2018 that my husband was diagnosed with vascular dementia, and in his case the confusion came after the other physical symptoms first started showing up. He never had another stroke after the initial massive one, and just died on Sept. 14th. Vascular dementia is the most aggressive of all the dementias, and the life expectancy is now 5 years. Hope this info helps.
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My dad had vascular dementia as a result of very poor cardiac function and poor circulation. For many reasons he neglected maintaining his health and so his brain suffered greatly. No blood flow, no oxygen to brain. After general anesthesia a few times he only worsened and eventually passed. After several heart caths he did not recover.
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Jessica56 Oct 3, 2020
If you don’t mind me asking, did he have heart failure? Did he have a stroke with the heart cath?
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Hi Jessica,

You have already gotten links to some good articles, I just wanted to add my mom's experience since she has vascular dementia, however I also agree with Martz that everyone's journey is different. My understanding is that with vascular dementia it can present very differently depending on what area of the brain is affected.

My mom was diagnosed with vascular dementia about 3 years after she had a stroke. The brain damage from the stroke was near the language center in the brain so she had significant aphasia and trouble finding her words but she recovered from that and got back to about 80% functioning. In those first 3 years she seemed okay to me as far as dementia, I never suspected it, as she was able to hide her increasing struggles pretty well.

Now she is 2 years into her diagnosis, and during that time she has progressed from mild to moderate stage.... so about 5 years from that initial stroke so far.

My mom's stroke was caused by high cholesterol that she was lazy controlling for years. Now she takes her meds religiously as to prevent another stoke. She also takes BP meds. So even though vascular dementia is progressive it can be slowed down with meds that prevent future strokes and TIAs.

My mom's mobility isn't great but all of her doctors have said exercise is helpful. Basically a healthy lifestyle.

If this is the start of your caregiver journey you might be feeling overwhelmed. I know I did, and it can be scary. This forum is very helpful, not just for getting info but for when you need to vent, cry, laugh, and talk to others who understand what you are going through. So, welcome!
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Vascular dementia is another umbrella term that includes several subtypes, including multi infarct dementia and white matter disease (Binswager's Disease)

https://www.medicinenet.com/binswangers_disease/article.htm#what_is_binswangers_disease

Treatment and progression depend on the the success in treating the underlying disease and on the area of the brain effected - complicating matters is that it may coexist with other forms of dementia like Alzheimer's or Parkinson's.

My mom never had a diagnosis, all I had to go on was her history of TIAs and a report that her MRI "lit up like a Christmas tree", in fact I had never heard of vascular dementia until I was desperately searching on line trying to figure out what the heck was happening. Mom lived with dementia for 7 or 8 years.
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I believe everyone’s dementia is different. With my father it all started about 8 years ago. He started off having trouble balancing his checkbook now and then. Then he started having trouble finding the right words. However he was still living on his own but I could tell something was wrong. About 4 years ago he started having trouble finishing sentences so we moved him into our guest house and I finally convinced him to go to a neurologist. He was given an mri, the Dr. said he had a lot of white matter . He was given a cognitive test but he failed. The dr said there was definitely some memory issues. However at that time the dr did not diagnose anything but white matter. He’s been getting progressively worse. Last year he started doing some scary things out of the ordinary. We saw a different neurologist (I snuck out of the room and explained to the Dr. something is going on. We had workers come over and the next day he forgot they were coming and went out asking if they were stealing from us. The following day he didn’t remember they were there the day before and accused them of stealing again. The dr said she would give him a thorough exam). He couldn’t pass the cognitive tests and based on that, his mri, and what I was telling her she said he most likely has vascular dementia. She recommended pills to help slow it down and with memory but he declined. She said make sure you keep your blood pressure in control. I’m not sure exactly what stage of dementia he is in but I’m guessing he’s approaching moderate. (He can still bathe dress and feed himself however at times he gets very confused). I also can’t get over how much of the time he has good days and bad days. Some days he seems so confused and is not even understanding what I’m saying. Other days he seems so sharp and you can’t tell anything is wrong. Best wishes to you.
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Welcome, Jessica!

https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia

This is a pretty comprehensive article.
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