Vascular Dementia??

Care4Mom2

People say that defining what type of dementia doesn’t matter, but it does to me. It doesn’t change what they have, but, for me, it just makes it easier to understand what the future may hold. The life expectancy for someone with vascular dementia is less than someone with AD.  

Though our neurologist cannot diagnosis dementia herself, without extensive testing that my husband refuses to get, I am still leaning toward my DH having vascular mild cognitive impairment or vascular dementia. I have posted some of this before, but I don’t know if people actually remember what others post….

In May, 2020, my DH had an MRI that showed “scattered white matter consistent with ischemic small vessel disease,” according to the radiologist. His internist said it was “normal.” 

I had expressed concern to my doctor (also my DH’s) three years prior about my DH’s memory issues, which I noticed a few years before that. Nothing was done until 2020, when my DH started to notice issues. We were finally referred to a neurologist and he was diagnosed with MCI. 

He has high blood pressure, which went untreated for years. He was on BP meds at one time, but for some reason, was taken off of them. About 6 months ago, his doctor put him on Losartan. His BP seems all over the place, though. Also, recently the BP machine and his fitness tracker indicated a irregular heartbeat. If it has happened again, he is hiding it from me.

He has mostly short-term memory issues. He can’t seem to keep things organized. He can’t make decisions. His hygiene is not that good — taking a shower every 3 or 4 days, brushing his teeth about as often. I tried addressing the shower issue, even at the last neurologist appointment, but it doesn’t seem to matter. I mentioned something to him recently and he told me he did take a shower after I left to go to the store. He said he “rinsed off” because he was sweaty. There were a few times (this morning, one) where he took a shower at night and again in the morning. I will take that over not showering at all! But, I wonder if he forgot that he already took ones?! 

This past September, I noticed his short-term memory seems worse. He is repeating himself in the same conversation, or within less than 5 minutes. The other thing that seems to coincide with this is that he started with erectile dysfunction. He also seems very emotional — crying while watching movies that I don’t even cry over! He does try to hide it. But taking his glasses off and wiping his eyes is a dead giveaway. 

He is getting exercise — walking quite a bit. He recently complained about back pain (had back surgery last year). I told him that he rocks when he walks, which could cause an issue (I’m thinking). It seems it is how he plants his feet. But, I have also notice that he is listing to the right when he walks. He was never much of a walker, so I don’t know if this is his “normal” gait. You would think after 33 years of marriage, though, I would have noticed it before!

Any project I give him that I think he can handle takes him literally hours to do. I hate not giving him things to do because I don’t want him to think he can’t do anything. He always put up the outside Christmas decorations. We have 6 outdoor lighted decorations. This year, he stood there and said, “I know what needs to be done (what needs to be plugged in), but I can’t figure out how to do it.”

These symptoms all seem to point to something vascular. What do you think?

What makes things worse is that my husband has gallows humor. He seems to blow things off, which makes it hard for me to care. He has always been one to think he knows everything, so he doesn’t listen to me. So, I just shut up and wonder what the future holds….

Thanks for listening.

Rick4407

Hello Care, my DW was diagnosed with VD in 2016.  Just about 5 years ago, she has progressed from MCI to stage 6 and is approaching stage 7.  The average life expectancies are really only a general guide.  An exact diagnosis can be done at an autopsy when the brain can be looked at in detail.  Before that its just eliminating other potential issues.  

In my DW initial diagnosis the psychologist explained that high blood pressure can contribute to VD, at least that was his theory.   After a few years the neurologist added alz to my wife's diagnosis, just covering all the bases I suspect.  

Not much help, but there really is not much help any place you look.  One day at a time, Rick

Ed1937

Rick4407 wrote:

The average life expectancies are really only a general guide.  An exact diagnosis can be done at an autopsy when the brain can be looked at in detail.  Before that its just eliminating other potential issues.  

I think Rick has it right. Everyone says early onset means a much shorter life left to live, but someone here said they've dealt with it for 17 years, if I remember correctly. One day at a time.

Emily 123

Hello,

This thread has members sharing what they've seen:

https://www.alzconnected.org/discussion.aspx?g=posts&t=2147559080

My understanding is that there can often be mixed AD/VD.   Vascular dementia will present with some changes occurring abruptly and be specific to the functions of one area of the brain, and that AD will usually follw the declining 'stages' of AD with initially short term memory loss showing up early and consistently.   It is not unusual to see an MRI or CT note 'diffuse changes'  that are considered as normal as we age.  Still, to me there seems like so much overlap it can be hard to tease out.

''Vascular dementia tends to almost come and go with different variations of severity. One minute your loved one could be “the old them” and the next could see episodes of dementia the likes of which you have never seen. They call the fashion in which vascular dementia displays itself as a step-like progression. In other words, it comes and goes.

On the other hand, we have Alzheimer’s. Though the outcome is generally the same, the progression of Alzheimer’s is more of a downward slope. There aren’t really any moments of bouncing in and out of symptoms. Instead, it tends to simply get worse as the months go on. Although this process tends to be more gradual, you won’t see the bounce backs like you would with vascular dementia.''

You can downlad an extensive AD checklist from this site (bottom of the page) if you supply an email--they don't spam:

https://tamcummings.com/stages-of-dementia/

I was able to get my mom to the neuropsych by telling her that it was part of her yearly Medicare wellness check. Her short term memory was such that I told her about it the day of the visit and off we went. The multiple tests can show a pattern of cognition losses vs. the norm by age/education that may help identify probable etiologies, so given that my mom's 'holes' were with her short term memory, she has a diagnosis of 'probable' AD.  Maybe there's a mix, or perhaps she has some white matter disease, but at 92 with a probable diagnosis there doesn't seem much point in doing the MRI or CT.

I think one of the key things is that you and your husband are doing the things that help in either case--exercise, involvement, control of other factors like hypertension.