Order 1039606: Subdural Haematoma

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Vascular Dementia

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14 May 2018

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Background

Vascular dementia is among the major causes of dementia in Western Europe and in the United States. Medical studies also indicate that it is the leading cause of dementia in Russia, Japan, and other Eastern countries (Alzheimer's Society 2005). Vascular dementia is an etiological category of dementia that is recognized by the severe cognitive impairment that results from a hemorrhagic or ischemic stroke that affects the brain regions that are responsible for cognition, behavior, and memory. It is also described as a clinical-pathological condition where the cerebral lesions of vascular origin cause diverse cognitive symptoms (Alzheimer's Society 2005). These lesions may include diffuse leukoencephalothapy, hemorrhages, and infarcts (Alzheimer's Society 2013).

The most recognized vascular pathologies include cerebral amyloid angiopathy, lipohyalinosis, atherosclerosis, and arteriolosclerosis (Alzheimer's Society 2013). It is worth noting that the cortical involvement usually translates into executive dysfunctions which have been experimented and discovered in animal models of vascular dementia. Medical studies, however, have established that a pure form of vascular dementia is a rare condition. Therefore, most studies usually focus on vascular contributions to cognitive dementia and impairment. The mechanisms that underlie the effects of vascular diseases on the medical manifestations of dementia have not been fully established, however, it is well known that conditions such as hypertension, obesity, and diabetes are some risk factors for dementia (Alzheimer's Society 2013). Medical researchers are currently facing the challenge of establishing effective interventions for patients at high risk of developing vascular dementia which will delay, prevent and ameliorate the progression of cognitive impairment (Alzheimer's Society 2013). This paper, therefore, focuses on describing vascular dementia by assessing its causes, symptoms, diagnosis, and treatment. It further discusses the role of Computed Tomography (CT) in treating vascular dementia.

Causes and Risk Factors for Vascular Dementia

Race, gender, and age have been identified as risk factors for vascular dementia. When compared to Alzheimer’s disease, the rate of vascular dementia increases exponentially with age, however, the rate of increase appears to be steeper for vascular dementia (Meyer 2001). In the case of gender, medical studies indicate that males are more at risk of getting vascular dementia than the females (Meyer 2001). Racially, the Blacks seem to be at higher risk of getting vascular dementia more than people from other races (Meyer 2001). Medical studies have also identified a close relationship of stroke risk factors to vascular dementia risk factor, however, the two conditions and not identical. Other risk factors for vascular dementia include diabetes mellitus, low HDL cholesterol levels and arterial hypertension (Meyer 2001).

Vascular dementia occurs when blood vessels supplying the brain get blocked or narrowed (Wahlund et al. 2009). This condition has similar risk factors and symptoms as the stroke that occurs when the supply of blood rich in oxygen to the brain is suddenly cut off. Medical studies have established that vascular dementia is created over a long time due to cumulative vascular damage to the brain (Wahlund et al. 2009). However, there is no known specific type, size or location of stroke that predicts the damage to the brain and intellectual decline. Studies also indicate that observable vascular brain damage usually occurs in almost half of the population of people who are above 65 years or the elderly persons (Budson and Solomon 2015). The five key types of vascular brain damage include hypotensive brain damage, hypertensive changes, ischemic white matter damage, anoxic brain damage and stroke produced by atherosclerosis (Budson and Solomon 2015).

Stroke, which is a risk factor for vascular dementia, is produced by atherosclerosis. This is a disorder that is common in large diameter blood vessels. Atherosclerosis leads to the hardening of the arteries and this condition is a common disorder in the elderly persons above 65 years old (Grotta 2016). The risk factors for atherosclerosis include diabetes, elevated lipids, and hypertension. This condition damages the inner layer of large diameter blood vessels and also causes cholesterol debris to be deposited in the inner layer of large diameter blood vessels (Grotta 2016). The resulting bulging effect that is commonly known as atherosclerosis plagues has adverse health effect like causing blood clotting that in turn occludes the blood vessels. Likewise, the fragmented debris resulting from these deposits can break loose and produce stroke through occluding smaller diameter blood vessels (Grotta 2016).

Severe heart diseases are also risk factors for vascular dementia. This is because they produce blood clotting and poor blood flow within heart chambers like ventricles. Fragments from these clots such as emboli and thrombus can be transported to the brain and this also produces stroke (Sharre 2016). Irregular pumping of heart like arrhythmias also sometimes causes embolic strokes. Long-term suffering from hypertension produces arteriolosclerosis which is the damage to small diameter blood vessels. Hypertension usually destroys the middle layer of small blood vessels (Sharre 2016). The result is the disintegration of blood vessels and bleeding into the blood tissues. Arteriolosclerosis also leads to the blockage of the blood vessels and this creates a small slit-like stroke that is known as lacunar infarct (Sharre 2016). This condition together with hemorrhages is common features in patients with untreated hypertension. Uncontrolled hemorrhage, on the other hand, usually leads to death.

Vascular dementia is also understood to be caused by the damage of fragile blood vessels that connect neurons I to the spinal cord. These fragile blood vessels are easily damaged by high blood pressure causing white matter abnormalities. Some of these abnormalities have been given names like leukoaraiosis, Binswanger’s disease and subcortical arteriolar sclerotic leukoencephalopathy (Bowler and Hachinski 2003). Last but not least, low blood flow or low oxygen flow to the brain produces anoxic brain damage. Neurons usually can only survive for three minutes without an adequate oxygen supply. Without enough oxygen and blood flow through the neurons, the affected person will experience respiratory or cardiac arrest (Bowler and Hachinski 2003). Damage to brains regions like hippocampus that cannot survive without oxygen supply usually produces amnesia which is also a risk factor for vascular dementia.

Symptoms of Vascular Dementia

Clinical studies indicate that vascular dementia has similar symptoms as those of Alzheimer’s disease. These symptoms do get more similar as vascular dementia progresses. Important to note is that the early signs of vascular dementia are not forgetfulness but they include reduced speed of thought, concentration problems characterized by short periods of confusion, and difficulties with organizing or planning like making consistent decisions (Holtz 2011). A patient with early symptoms of vascular dementia is usually prone to mood swings, apathy and being unusually emotional (Holtz 2011). Sometimes they do develop depression and anxiety since they become worried about what the vascular dementia is doing to them. Vascular dementia that follows a serious stroke is usually characterized by physical symptoms that include problems with speech or vision, and weakness of the limbs (Holtz 2011). The early signs of vascular dementia are a result of the damage to the brain caused by stroke. The symptoms of vascular dementia begin resembling those of middle and acute stage Alzheimer’s disease.

The early symptoms get worse as vascular dementia propagates and problems such as confusion, communication, reasoning, memory loss, and disorientation become worse. Behavioral changes such as agitation and irritability that are similar to Alzheimer’s disease are also witnessed as vascular dementia propagates. Hallucination and delusions also characterize vascular dementia in its late stages (Leatherdale 2013). These symptoms can be summarized as challenges with short-term memory, getting lost in familiar areas, crying or laughing at inappropriate times, challenges in following instructions, a problem in managing money, problems with planning and concentrating, delusions, hallucinations, and loss of bowel control or loss of bladder (Leatherdale 2013). Balancing and walking can also be problems in the early stages of vascular dementia.

Diagnosis of Vascular Dementia

Health experts have established that the early occurrence of vascular dementia is difficult to notice. Therefore, they recommend that professional screening with brief tests to access thinking, reasoning, and memory should be conducted for patients especially the elderly persons who are over 65 years old who are considered to be at higher risk of developing this disorder (Mendez et al. 2003). Screening should also be performed on people who have had stroke or mini-stroke, people with high HDL cholesterol, diabetes mellitus, high blood pressure and other risk factors for blood vessel and heart diseases (Mendez et al. 2003). The health experts also recommend professional screening for depression since people with depression are also at higher risks of developing vascular dementia disorder. This is because depression has been found to coexist with other brain vascular diseases that usually reduce intelligence and also contributes to other cognitive symptoms (Mendez et al. 2003). Whenever a brief screening provides hints on changes in a patient’s reasoning or thinking, a more detailed screening will be required to perform a thorough diagnosis.

The primary elements in the assessment of vascular dementia include a proper follow up of a patient’s medical history, including his or her family history of dementia, assessment of the patient’s daily activities and independent functions, input from a trusted friend or family member, tests in the laboratory that includes brain imaging and blood tests, and in-office examination evaluating functions of reflexes and nerves, coordination, sense, balance and movements (Leatherdale 2013). The three key likelihood that dementia or mild cognitive impairment are as a result of vascular changes includes; if neurocognitive testing confirms mild cognitive impairment and diagnosis of dementia (Leatherdale 2013). This is usually performed for several hours of computerized and written tests that provide a detailed assessment of certain thinking skills which include problem-solving, memory, reasoning, planning and judgment (Leatherdale 2013). Secondly, if the brain imaging performed by magnetic resonance imaging shows evidence for a recent case of stroke or changes in the structure of other blood vessels whose network interfere with the tissues and they relate to documented types of impairment in neurocognitive testing (Leatherdale 2013). And lastly, if there is no proof that the other factors, other than vascular changes, are causing the decline in a person’s cognitive ability (Leatherdale 2013).

Treatment and Outcome of Vascular Dementia

Until to date, there is no medical research that has come with drugs to treat the symptoms of vascular dementia. However, clinical tests have somehow approved that certain drugs that treat Alzheimer's disease may also help patients who are diagnosed with vascular dementia. Without curative drugs, interventions such as managing the risk factors which may improve the chances of increased damage to the brain’s blood vessels are important strategies for treating vascular dementia (Moretti 2006). Clinical tests have proven that treating risk factors is a sure treatment method that improves the outcome and prevents further damage to blood vessels in the brain and reduced intelligence. Every vascular dementia patient has his or her own way of managing her condition. Therefore, the patients need to engage and work together with physicians to create the best treatment plans that best suits a patient for their circumstances and symptoms (Moretti 2006). Treatment also involves managing high blood pressure through medication, diet, and exercise (Moretti 2006). For patients suffering from diabetes, they should stop drinking alcohol and smoking. Behavioral interventions such as reminders and cues can also assist in improving the quality of health for vascular dementia patients. Communication with the vascular dementia patients should also be improved and made effective like reminding the patients on dates and the tasks they should be performing at a given time. Identifying early symptoms of vascular dementia helps in preventing further damage to the brain and this is the best treatment method for this condition. Untreated vascular dementia usually ends up in heart diseases or infections and in worst conditions like stroke it leads to death.

Computed Tomography Scan for Vascular Dementia

This is a non-invasive diagnostic imaging procedure that works with the same technology as X-ray; however, it produces more details of the body internal organs more than X-ray. This technology is a combination of high computer technology and special X-ray equipment. CT scan produces cross-sectional images of the body both vertically and horizontally (Haaga 2009). The images produced can then be displayed and analyzed through a computer monitor or printed for analysis. CT scan is important in the diagnosis of vascular dementia because it produces comprehensive images of all bones, body organs, including the brain, bones, and muscles (Haaga 2009). The images for blood vessels, internal organs, soft tissues and bones that are produced by this technology also have high clarity and provide more details than X-ray can provide. Unlike X-ray, CT scan is not a risk factor for health and it can be conducted repeatedly because it minimizes exposure to radiations (Barkhof 2011). Medical experts sometimes inject a dye in a person’s veins to let the tissues and organs show up more clearly. In CT scan, the X-ray beam moves all around a patient’s body (Alzheimer's Society 2011). This is important in the diagnosis of vascular dementia because it allows a specific organ to be viewed from different angles. The obtained information is then transmitted into a computer that interprets the information and displays the results in a two-dimensional monitor (Alzheimer's Society 2011). The information obtained from CT scan is easily interpreted by radiologists who can then easily diagnose problems such as vascular dementia, musculoskeletal disorders, trauma and cardiovascular diseases. Diagnosis of the chest using CT scan is important in discovering the early symptoms of vascular dementia and other chronic diseases. Chest scan can also be used to visualize the placement of needles during aspiration of fluids from the chest or during biopsies of thoracic tumors and organs. This is important for the monitoring of tumor as it is one of the risk factors for brain damage that also causes vascular dementia.

Conclusion

Vascular dementia is a condition that is caused when blood vessels supplying the brain are blocked, narrowed or damaged. The symptoms of this condition are similar to those of stroke and Alzheimer’s disease from its onset to late stages. One of the notable symptoms of this condition is the impairment of thinking and reasoning capability. These symptoms are as results of the mild or severe damage of some regions of the brain. Clinical studies have identified that age, gender, and race are risk factors and causes of vascular dementia. Other risk factors are obesity, diabetes mellitus, and hypertension. Diagnosis of vascular dementia in patients suffering from obesity, hypertension, and diabetes is important in discovering its early signs since the disorders take too long to show its related symptoms. Brain imaging through CT scan and MRI are some of the best diagnosis methods for vascular dementia. Treatment of the condition involves managing risk factors and health conditions that produce vascular dementia. Managing high blood pressure, hypertension, and diabetes can effectively prevent and slow down the propagation of vascular dementia.

References

Alzheimer's Society 2005, Understanding vascular dementia. London, Alzheimer's Society.

Alzheimer's Society 2011, Alzheimers society factsheet 402: what is vascular dementia? New York, Alzheimer'S Society. 

Alzheimer's Society 2013, The Dementia Guide. UK, NHS.

Barkhof, F. 2011, Neuroimaging in dementia. Berlin, Springer.

Bowler, J. V., & Hachinski, V. C. 2003, Vascular cognitive impairment: preventable dementia. Oxford, Oxford University Press.

Budson, A. E., & Solomon, P. R. 2015, Memory Loss, Alzheimer's Disease, and Dementia. New York, Elsevier.

Grotta, J. C. 2016, Stroke: pathophysiology, diagnosis, and management. Philadelphia, Elsevier Saunders.

Haaga, J. R. 2009, CT and MRI of the whole body. Volume 1 Volume 1. Philadelphia, PA, Mosby/Elsevier. 

Holtz, J. L. 2011, Applied clinical neuropsychology: an introduction. New York, Springer Pub. Co.

Leatherdale, L. 2013, Sundown dementia, vascular dementia and Lewy body dementia: stages, symptoms, signs, prognosis, diagnosis, treatments, progression, care and mood changes all covered. New York, IMB Publishing.

Mendez, M. F., Cummings, J. L., & Cummings, J. L. 2003, Dementia: a clinical approach. Amsterdam, Butterworth-Heinemann.

Meyer, J. S. 2001, Vascular dementia. Armonk, NY, Futura Pub. Co.

Moretti, R. 2006, Subcortical vascular dementia. New York, Nova Science Publishers.

Sharre, D. 2016, Long-Term Management of Dementia. New York, CRC.

Wahlund, L.-O., Erkinjuntti, T., & Gauthier, S. 2009, Vascular cognitive impairment in clinical practice. Cambridge, UK, Cambridge University Press.