I have seen deeply demented patients weep or shiver as they listen to music they have never heard before, and I think they can experience the entire range of feelings the rest of us can, and that dementia, at least at these times, is no bar to emotional depth. Once one has seen such responses, one knows that there is still a self to be called upon, even if music, and only music, can do the calling—Oliver Sacks (2007) Musicophilia: Tales of Music and the Brain New York: Knopf (p.346)
Some people with Alzheimer’s-like symptoms are diagnosed with a condition called Vascular dementia. It presents itself very similarly to Alzheimer’s, and caregiving techniques are typically the same for both ailments.
Alzheimer’s disease is caused by plaques and tangles in the brain that cause brain cell degeneration. It’s a progressive condition that damages areas of the brain involved in memory, intelligence, judgment, language, and behavior. It is the most common form of mental decline, or dementia, in older adults.
Alzheimer’s disease always gets worse over time, but the course of the disease varies from person to person. While some people lose the ability to do daily activities very early on, others may still be able to function relatively well.
Over time, Alzheimer’s disease causes severe mental and functional problems and eventually results in death. There is no cure for Alzheimer’s disease. But occasionally things can be done, including medicines and behavioral modifications, to maintain the person’s quality of life and to help the person stay active. Many people with Alzheimer’s disease can be cared for at home.
Vascular Dementia is a combination of circulatory issues, primarily referenced as strokes. You can find more specific information on both of these subjects on www.WebMD.com.
Vascular Dementia is often said to follow a stairstep pattern of decline, as compared to Alzheimer’s disease, which follows a gradual slope. The biggest difference between Vascular Dementia and Alzheimer’s is what is causing the symptoms for which the diagnosis is given. That being said, regardless of what is causing the symptoms, what the person has is a regressive, degenerative brain disease.
A person with Vascular Dementia will stay essentially the same until they have some form of a vascular incident and then they can deteriorate quite rapidly
How quickly dementia progresses depends on what is causing it and the area of the brain that is affected. Some types of dementia progress slowly over several years. Other types may progress more rapidly. If vascular dementia is caused by a series of small strokes, the loss of mental skills may be gradual. If it is caused by a single stroke in a large vessel, loss of function may occur suddenly.
The course of dementia varies greatly from one person to another. Early diagnosis and treatment with medicines used for Alzheimer’s (cholinesterase inhibitors such as donepezil (Aricept) may help preserve mental functioning for a while in people with vascular dementia, dementia with Lewy bodies, or Parkinson’s disease. Even without these medicines, some people remain stable for months or years, while others decline rapidly.
Many people with dementia are not aware of their mental decline. They may deny their condition and blame others for the problems they experience. Those who are aware may mourn their loss of abilities and become hopeless and depressed.
Depending on the type of dementia, the person’s behavior may eventually become out of control. The person may become angry, agitated, and combative or clingy and childlike. He or she may wander and become lost. These problems can make it difficult for family members or others to continue providing care at home.
Even with the best care, people with dementia tend to have a shorter life span than the average person their age. Death usually results from lung or kidney infections caused by being bedridden.
Many older people have a slight loss of mental skills (usually recent memory) that doesn’t affect their daily functioning. This is called mild cognitive impairment by some. People who have mild cognitive impairment may be in the early stage of dementia, or they may stay at their present level of ability for a long time.
So, how do you know which one your loved one with memory problems has, if they have not yet been diagnosed? A complete exam should be used, which may require a neurological scan. The diagnosis is made by “ruling out” conditions, and is considered to be in the 90th percentile for accuracy. The only totally accurate test for Alzheimer’s is during an autopsy.
“Dementia” is the term we use to describe the symptoms of brain cell corruption. Alzheimer’s is the most common cause of the symptoms of dementia, and vascular dementia is the second most common cause. It is possible for a person to have both. Usually the course of Alzheimer’s disease is slow and one must look back over a period of time to see evidence of significant change.
Support groups, many medications, and just about all of the caregiver strategies and tools we talk about work for everyone with dementia. And, regardless of what we call the symptoms, they are heart-breaking, as we have lost our loved ones who have the disease even though they haven’t actually died. As Nancy Reagan famously said “It is the long goodbye.” Thank you for reading. Stay well. See you next week.