Dementia
Vascular

Next to Alzheimer's disease, vascular dementia is the most widespread reason for people developing dementia. Generally speaking, vascular dementia comprises around 20 per cent of all forms of dementias and is said to be a result of brain damage owing to cerebrovascular or cardiovascular troubles, especially strokes. Often vascular dementia may also be caused due to genetic ailments, amyloid angiopathy (a procedure wherein amyloid protein accumulates in the blood vessels of the brain occasionally resulting in 'bleeding' strokes called hemorrhagic) or endocarditis (contagion of a heart valve). It has been found that many patients often concurrently suffer from vascular dementia as well as Alzheimer's disease. This ailment is common in both men and women and usually occurs at an advanced age and worsens as the person ages.

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This form of dementia is a deteriorating cerebrovascular ailment that results in a continual degeneration in the intellectual and cognitive operations. Vascular dementia usually takes place when the flow of the blood transporting oxygen and nourishments from the heart to the brain is obstructed owing to a mass in the vascular system or when the vascular system is unhealthy. This disorder usually develops in people who are in the age group of 60 years and 75 years. In fact, vascular dementia distresses more men than women.

There are several types of vascular dementia and the most widespread among them is called multi-infarct dementia. Successions of mini or minor strokes that are usually ignored by people are responsible for this type of vascular dementia. Although the strokes may be trivial in nature, they result in the harm of the brain's cortex or outer stratum that is related to recollection, speech and knowledge. Often, such small strokes are denoted as transient ischemic attacks (briefly called TIAs) that cause intermittent and part obstruction to the blood supply to the brain as well as temporary damage in consciousness or vision. Nevertheless, eventually, the harm done to the brain tissues gets in the way of cerebral or cognitive performances of the patient and disturbs their routine operations.

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Precisely speaking, multi-infract dementia results in the lack of functioning in particular regions of the brain. The disease harms a number of cerebral and neurological functions, but not all the operations of the brain. On many occasions, vascular dementia develops along side other forms of dementia like Alzheimer's disease and in such cases the condition is called 'mixed dementia'.

The symptoms of vascular dementia differ in different patients. However, the impact of the disease is same in all the patients - it generally makes it more difficult for the patients to carry out their routine functions. As the disease advances causing more harm to the brain cells and tissues, the patients lose their ability to eat, dress, shop, walk and even talk properly. The different and widespread symptoms of vascular dementia are noted below.

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Physical symptoms

  • Dizziness or light-headedness
  • Forgetfulness or difficulty in remembrance
  • Debility of the limbs (arms and legs)
  • Lack of ability to focus on anything or inattentiveness
  • Loss of control over bowels and the functioning of the bladder
  • Fast movements with hobbling steps

Behavioural symptoms

  • Difficulty in verbal communication
  • Slurred speech
  • Anomalous behaviour patterns
  • Laughing or crying incongruously
  • Difficulty in handling money or checkbook
  • Drifting or getting lost in known surroundings
  • Problems in comprehending instructions
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It is important to note that the signs and symptoms of vascular dementia appear unexpectedly and usually following a stroke. People who develop vascular dementia may possibly have a history of vascular ailment, high blood pressure (hypertension), earlier strokes or heart attacks. Conditional on whether the patient suffers from previous strokes, vascular dementia may or may not deteriorate with the passage of time. Actually, in a number of cases, symptoms of vascular dementia may improve as time passes. However, when the ailment deteriorates, it actually advances gradually before the cerebral and physical capabilities of the patient changes abruptly. However, vascular dementia accompanied by brain injury in the middle regions of the brain may result in a steady and continuing cerebral damage that may resemble the symptoms of Alzheimer's disease. Nevertheless, there are some basic differences in the symptoms of vascular dementia and Alzheimer's disease. While people enduring Alzheimer's disease are robbed of their personal characteristics as well as the usual levels of emotional reactions, vascular dementia patients are free of these symptoms till the later phases of the ailment.

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It is significant to note that patients suffering from vascular dementia often roam about during night-time and also endure other problems that are common in people who have suffered a stroke. Such problems may include depression and incontinence (inability to hold back natural discharges of urine or feces).

Since the infarcts in Multi-infarct dementia (MID) have an effect on the cut off regions of the brain, the symptoms of vascular dementia are frequently restricted to one side of the body. Alternately, they may possibly have an effect on only one or a small number of particular functions like verbal communication or ability to speak properly. According to neurologists, such symptoms are 'local' or 'focal' signs, something opposite to the 'global' symptoms noticed in the case of patients suffering from Alzheimer's disease. In fact, Alzheimer's disease has an effect on several operations and is necessarily limited to only one side of the body.

It needs to be noted that all strokes do not result in the development of dementia. Nevertheless, in a number of instances even a solitary stroke has the ability to harm the brain sufficiently to lead to dementia. A medical condition like this is known as single-infarct dementia. In fact, it has been found that dementia occurs more often when the left side or hemisphere of the brain is affected by a stroke. It is also common to develop dementia when the stroke affects the hippocampus - the structure of the brain that is imperative for reminiscence or memory.

Binswanger's disease is a new variety of vascular dementia. This is a very exceptional type of dementia and distinguished by the damage done by the diseases to the smaller blood vessels in the brain's white matter - the substance present in the inside stratum of the brain and encloses numerous nerve fibers that are covered with a white colored fatty material known as myelin. Patients suffering from Binswanger's disease experience abrasions in the brain, memory loss, chaotic cerebral function as well as mood changes and depression. In addition, other symptoms of this rare type of dementia may include stroke, anomalous blood pressure, aberrations in blood, ailments of the large blood vessels in the region of the neck and/ or ailments of the heart valves.

People suffering from Binswanger's disease also face loss of control to retain urine, problems in walking, sluggishness, awkwardness, absence of any facial expression and difficulty in speaking or verbal communication. Normally, the symptoms first become noticeable when the patients are over 60 years old. Significantly enough, all these symptoms may not appear in all patients of Binswanger's disease and even if they do appear, sometimes they are only intermittent problems. Thus far, scientists are yet to develop a precise treatment of Binswanger's disease and presently the treatment of this rare disorder is basically based on the symptoms. In fact, physicians treating Binswanger's disease may also recommend medications that are used to cure depression, regulate high blood pressure or hypertension, low blood pressure and heart arrhythmias (irregular heart beat). People suffering from this rare cerebral disorder often experience incidents of limited recuperation.

CADASIL (cerebral autosomal dominant aeteriopathy with subcortical infarct and leukoencephalopathy) is yet another form of vascular dementia and this disorder is considered to be a highly uncommon hereditary disease. This form of vascular dementia is associated with aberrations of a particular gene  Notch3, present in chromosome 19. This condition can cause strokes along with multi-infarct dementia, mood swings and migraine with aura (a feeling, as of lights or a current of warm or cold air, prior to a migraine attack). The symptoms of this disease first appear when the patients are in their 20s, 30s or 40s and they usually succumb to the disorder by the time they are 65 years old. Scientists are of the view that most incidents of CADASIL actually go unnoticed as well as undiagnosed and, hence, the precise occurrence or frequency of the malady is yet to be ascertained.

Vascular dementia may occur owing to a number of reasons and some of the common causes for this disease may include inflammation of the blood vessels, vasculitis (inflammation of a blood or lymph vessel and is also called angiitis), profound hypotension or extremely low blood pressure as well as abrasions attributable to brain hemorrhage. In addition, the blood vessels may also be damaged resulting to dementia due to the inflammatory ailment temporal arteritis and the auto-immune disease called lupus erythematosus.

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