Vascular Dementia

1. Vascular Dementia Presented By Liz Graham Brightwater Care Group Training to care for people with dementia

2. Objectives • To increase knowledge and understanding of Vascular Dementia • To demonstrate the progression of Vascular Dementia • To discuss the importance of team management of the person with Vascular Dementia Training to care for people with dementia

3. Types of Dementia • Creutzfelt-Jacob Disease (CJD) • Progressive Supranuclear Palsy • Downs Syndrome • AIDS related • Encephalitis • Head Injury • And Others (over 80 causes) • Alzheimer’s Disease • Vascular Dementia • Dementia with Lewy bodies • Frontal lobe Dementia • Korsakoff’s Syndrome • Huntington’s Disease • Substance abuse Training to care for people with dementia

4. What is Vascular Dementia? • Second most common form of dementia after Alzheimer’s disease. • Occurs when the blood supply to the brain is interrupted by a blocked or diseased vascular system. Training to care for people with dementia

5. A Little Bit of History • Arteriosclerosis and senile dementia described as different syndromes as early as 1899. • Mayer-Gross et al in 1969 reported hypertension to be the cause in 50% of patients. • Hachinski in 1974 used the term multi-infarct dementia. • In 1985 the term vascular dementia was used by Loeb. Training to care for people with dementia

6. Different Types 0f Vascular Dementia • Mild vascular cognitive impairment • Multi-infarct dementia • Vascular dementia due to a strategic single infarct. • Vascular dementia due to lacunar lesions • Vascular dementia due to haemorrhagic lesions • Binswanger disease • Subcortical vascular dementia • Mixed dementia (combination of AD and Vascular) Article by Kannayiram Alagiakrishnam Training to care for people with dementia

7. Multi-infarct dementia • Most common form • Caused by a series of small strokes or TIA. • Damage caused to the cortex of the brain • Area associated with learning, memory and language. • Can be temporary but over time with repeated incidents become permanent • Symptoms include severe depression, mood swings and epilepsy Training to care for people with dementia

8. Binswanger’s Disease(or Subcortical vascular dementia) • Associated with stroke-related changes. • Damage to tiny blood vessels of the white matter, deep within the brain. • Symptoms develop more gradually and include • Slowness, lethargy, difficulty walking, emotional ups and downs, lack of bladder control. Training to care for people with dementia

9. Physical signs/symptoms Memory problems, forgetfulness Dizziness Leg or arm weakness Lack of concentration Moving with rapid, shuffling steps Loss of bladder or bowel control Signs and Symptoms of Vascular Dementia Training to care for people with dementia

10. Behavioural signs/symptoms • Depression • Slurred speech • Language problems • Abnormal behaviour • Wandering/getting lost • Laughing/crying inappropriately • Difficulty following instructions • Problems handling money Training to care for people with dementia

11. Risk Factors that increase risk of developing Vascular Dementia Training to care for people with dementia

12. Risk Factors • High blood pressure • Smoking • Diabetes • High Cholesterol • History of mild warning strokes • Evidence of arterial disease elsewhere • Heart rhythm abnormalities • Lack of physical activity • Fatty diet • Gender – Men are at a slightly higher risk. • Age – Usually between 60 and 75, incidence increases with age. Training to care for people with dementia

13. GOOD NEWSUnlike Alzheimer’s Disease, there are ways to prevent and reduce the severity of vascular dementia. Training to care for people with dementia

14. Medical management of: • High blood pressure • High Cholesterol • Heart disease • Diabetes • Administering medication to prevent clots forming eg Aspirin • Drugs to relieve restlessness or depression • Recent research indicates that cholinesterase inhibitor medications which are helpful with Alzheimer’s disease may be of benefit in Vascular Dementia eg Aricept, Reminyl. • In some cases surgery such as carotid endarterectomy may be indicated. Training to care for people with dementia

15. Receiving Rehabilitative Support: Physiotherapy Occupational Therapy Speech Therapy To help the person regain lost functions. Unlike Alzheimer’s Disease, there are ways to prevent and reduce the severity of vascular dementia. • A Healthier Lifestyle: • A healthy diet • Regular Exercise • Stop smoking • Moderate intake of alcohol Training to care for people with dementia

16. Progression of Vascular Dementia Onset gradual or dramatic Stabilise TIA/Stroke Stabilise TIA/Stroke Typically Vascular Dementia progresses gradually in a stepwise fashion in which a person’s abilities deteriorate after a stroke, then stabilise until the next stroke. Training to care for people with dementia

17. Mortality/Morbidity • In community-based studies in Australia, the prevalence rate for vascular and mixed dementia is 13% and 28%, respectively. • In patients with dementia who have had a stroke, the increase in mortality is significant. The 5 year survival rate is 39% for patients with vascular dementia compares with 75% age matched controls. • Vascular dementia is associated with higher mortality rate than AD, presumably because of the coexistence of other atherosclerotic diseases. (Alagiakrishnan) Training to care for people with dementia

18. Case Study • 74 year old male admitted to High Care from CAP unit • Diagnosis – Dementia • History of Hypertension, TIAs. • Supportive family, wife and 2 daughters • Transfer information - Communication poor. - Mobility: Non-ambulant, hoist transfer. • ADLs: Full assistance, resistive in showering/dressing. • Doubly incontinent. - Full assistance with meals. Training to care for people with dementia

19. Personhood • “A standing or status that is bestowed upon one human being, by others, in the context of relationship and social being. It implies recognition, respect and trust” • (Kitwood 1997) Training to care for people with dementia

20. Philosophy and Principles of Person Centred Care • Attend to the whole person • See each person as unique and special • Give respect to the past • Focus on the positives • Stay in communication • Nourish attachments • Create community • Maximise freedom – minimise controls • Maintain environment of trust and value Training to care for people with dementia

21. Team assessment and planning of care GP OCCUPATIONAL THERAPIST CARER JIM FAMILY RN SPEECH PATHOLOGIST PHYSIOTHERAPIST Training to care for people with dementia

22. From Assessment • GP – Reviews and monitors medication for hypertension and administers aspirin. • RN – Monitors health status and specifically blood pressure. Works with team to implement care strategies. • Occupational Therapist – Establishes grabbing and gripping is behavioural. Implements strategies to assist during washing/dressing including good communication, time, use of smiling, careful handling. • Carer– Works with Jim implementing strategies and feeding back responses. • Family– Guided by all staff in understanding and supporting Jim’s needs. Involved during mealtimes, activities to support Jim. Training to care for people with dementia

23. From assessment Contd. • Physio – Works to promote effective transfers and walking with assistance of 2, 20 metres. Works with OT to ensure active upper limb range present for washing /dressing. Works with team to implement care strategies. • Speech Pathologist – Establishes dysphagia status and assistance for meals (along with OT). Soft diet, promoting assistance to initiate ability to feed himself especially with finger foods. Communication requires one stage commands, time to respond and friendly smiling face. Works with team to implement care strategies Training to care for people with dementia

24. Example of Jim’s Progress Walks 20m with 2, Feeds himself with help, Strategies assist during washing. Gross motor activity, Entertainment TIA Non-Ambulant, Smiles, Whistles, Resistive, Assisted with meals Stand transfers, non-ambulant, Distracter to hold during washing Smiles, Whistles, Gross motor TIA Standing Hoist transfers, Active-Assisted exercises. Assistance with vitamised meals. Continue Distractor use. Smiles but no whistling. Assess Implement Evaluate Review Training to care for people with dementia

25. Take Home Message The take home message is simple: By reducing your risk for stroke, you also reduce your risk for vascular dementia. Training to care for people with dementia

26. References • www.brad.ac.uk/acad/health/dementia • www.helpguide.org/elder/vascular_dementia.htm • www.alzheimers.org.uk • www.nia.nih.gov/Alzheimers/Publication/dementia.htm • www.memorylossonline.com/pastissues/summer2000/ vasculardementia.html • www.alzheimers.org.au • www.emedicine.com/MED/topic3150.htm Training to care for people with dementia