Finally witnessed an obvious TIA - Vascular Dementia

jmlarue

I think I'm finally catching on to the subtle signs that my DH is suffering another micro-vascular stroke, which always precedes an abrupt change in behavior or cognition. 

Before bedtime on Tuesday, DH was watching TV, which is often accompanied by some sort of stream of-consciousness mumblings, long conversations with the cat on his lap, or rhetorical wonderings about the comings and goings of neighbors. I've learned to tune out that static so that I can watch TV, too, but when the constant ramblings cease, I sit up and take notice. What I saw was a vacant stare, unblinking, like a person lost in a daydream. There were no other outward signs of distress - slow, regular breathing; no tremor; no sign of pain; no facial droopiness. When I said, "Are you okay,? he didn't respond. The second time I asked, he turned his head slightly and nodded. I waited and watched for about 10 min. Just as I was about to call 911, he shifted his body and started to speak almost in a whisper. I couldn't make sense of what he might have said. Over the following 15 min. or so, I could see him coming back. He began to look around, shifted in his chair, and turned his head to look at me with seeing eyes this time. 

I aborted the idea of calling 911. I was pretty sure what I was witnessing was a TIA (Transient Ischemic Attack) that his doctors have said was a chronic thing damaging his brain one small piece at a time. Experience has taught me that there is nothing to prevent them and nothing to be done for him in emergency care to treat him. For the most part, these mini-strokes clear fairly quickly without intervention. Even so, I stay alert for symptoms of a major stroke. DH pretty much came back to his baseline behavior over the next hour or so. I encouraged him to go to bed and he was able to walk and change out of his clothes with minimal assistance. He fell asleep quickly and slept peacefully through the night. No incontinence. On awakening, it was obvious that more damage had been done to the part of the brain that controls speech. 

Later in the day, I became aware that his short-term memory was also effected - to the extent that, if interrupted, he had no memory of what he was saying or doing just moments before. Clearly, his executive function suffered further damage that will now require me to change my behavior as a caregiver to help him do tasks. Directions will need to be a single small step at a time. No more "Go brush your teeth." Instead, the process needs to be broken down - "Find your toothbrush...find your toothpaste...take off the cap...squeeze toothpaste on the toothbrush...etc, etc. It's going to be tedious and take more patience and direct assistance from me for every one of his ADLs going forward. On the plus side, distracting him from unwanted behavior might be easier now, where it was fairly difficult before.

I apologize for the long post, but I thought someone else on this journey might find these details helpful in the future with their LO. DH has had many tiny stokes that have caused his dementia (the "flares" can be seen with an MRI), but this was the first time I saw a TIA in real time.

Ed1937

Jm, I'm sorry. I wish I had words to help, but there are none.

Joydean

Jim, I am sorry. But impressed that you were able to observe your dh at the same time he was having TIA and described it with great details. I would probably have freaked out! Prayers for you and your DH.

Dio

I don't have words of comfort, but this journey is so lonely for us all. No matter how everyone wants to or offers help, it's still a very lonely road that we bear.

Gig Harbor

I think you did the right thing by not calling 911. He would have been stressed and confused by everything going on around him and very likely they would have not initiated any treatment. To relieve some of the stress on you put the toothpaste on his brush. I started doing that when I realized it was harder and harder to get him to follow my directions. I definitely use as few words as possible. Has his short term memory improved at all today? I hope it has.

jmlarue

Gig - Short term memory not utterly gone, but any interruption causes a short circuit. He wanted to soak in the tub yesterday, but angrily insisted he could take care of it all himself and I was to go away. When I didn't hear the water running in the tub after a few minutes, I went to check on him and found him madly searching the bedroom. He'd lost his wedding ring - again. Helped him search (as I always do), but couldn't find it. I said we'd look for it after he had his bath, whereupon he insists he's already had his bath, then proceeds to get dressed. Ring forgotten. I'm beginning to doubt my own sanity, so I check the bathroom. Tub is bone dry, as is the bathmat. No wet towel to take to the laundry. I notice the toilet paper roll needs to be replaced. When I pull the paper core off the hook, his ring hits the floor. Near as I can figure, he sat on the toilet, put his ring on the toilet paper hook - his idea of a "safe place." While getting undressed, he notices his ring missing from his hand so he starts the frantic search. Taking a bath instantly forgotten, though he insists he did bathe. This whole situation couldn't have taken more than 15 minutes start to finish. Wish my DH was a computer so I could take him in for a new hard drive.

Gig Harbor

It does make you question your sanity. My husband will insist that he has had a shower when the shower is dry. He uses a washcloth or hand towel to dry off and not his bath towel. He has completely forgotten about bath towels. He tries to put on 2 or 3 pair of underwear and tshirts. He simply has no idea of what he used to do and is so easily sidetracked. You are so lucky you found the ring and that it didn’t end up getting flushed down the toilet. Do you think if you told him you were taking it in to get sized smaller he would forget about it?

jmlarue

I might try that ring re-sizing idea. This is the one thing that he pushes back the hardest on putting away in a safe place. I've given up the battle and resigned myself to the idea that one day it will disappear forever. The ring re-sizing idea just might work. Thanks for suggesting it.