Vascular Dementia

This is not medical advice or expertise… this is my research and attempt to explain how Vascular Dementia is manifesting in my mother.  It will not be perfect.  It is very hard to explain and understand her dementia and behaviour.  Unless you have spent time with her, I don’t think anyone can fully understand.

“Vascular dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes caused by brain damage from impaired blood flow to your brain.”

 

July 7, 2016 – my mother was found on the ground, semi-conscious.   It was determined at the hospital that she had a spontaneous brain bleed due to the blood thinner medicine she is on for her A-fib.   Yes, that kinda sounds like a stroke, but that isn’t what they called it.   The blood filled up a whole 1/2 of her brain.   After spending most of that summer in the hospital and then 2 months in rehab, she was able to come home, but could no longer be left alone.

 

Yes, she had all the risk factors for stroke/vascular dementia with the a-fib, diabetes, high blood pressure, etc.  Though she was sort of controlling those herself.  However, in reality, she was ignoring her health.

 

At first when she came home, she had more physical issues to overcome from being immobile for so long.  Mentally, she was present 75-90% of the time.  She could carry on appropriate conversations.  She knew who everyone was.  She had her humor and seemed to be doing well.

 

I remember the day vividly, when she told the visiting occupational therapist that I was her sister Dora.   That woman tried and tried to convince her otherwise.  She had me find a photo.  But nothing would change my mother’s mind.  From that point on, the slide away from reality continued a slow and steady decline.  At the same time, her physical health improved dramatically because I was keeping her diabetes under control and she was getting exercise regularly.

 

Some of the listed symptoms are:

“Vascular dementia symptoms vary, depending on the part of your brain where blood flow is impaired.

Vascular dementia signs and symptoms include:

• Confusion
• Trouble paying attention and concentrating
• Reduced ability to organize thoughts or actions
• Decline in ability to analyze a situation, develop an effective plan and communicate that plan to others
• Difficulty deciding what to do next
• Problems with memory
• Restlessness and agitation
• Unsteady gait
• Sudden or frequent urge to urinate or inability to control passing urine
• Depression or apathy”

 

Confusion:  That has increased over the years.  However, it isn’t confusion like you traditionally think about dementia.  She isn’t confused on what a bowl is.  She also doesn’t think she is confused, she believes that she is correct and everyone else is confused.   Her confusion centers around where and when she imagines she is:  primarily her childhood home.  She will not believe you when you try to bring her back to reality.  She gets belligerent about it.  She believes she can take your car and drive to her mother’s house.  That she can walk through the bushes to get home.  That her mother is upstairs.  Even when we go upstairs 3 times to look for “mother,”  she still insists that she is up there and needs to go to check on her.  

Trouble paying attention and concentrating: YES!  This goes hand in hand with the confusion.  The only thing that marginally holds her attention is a book to read.  AND really, that only holds it if it is morning or she has had a decent nap so her brain is fresh.  She cannot get outside of her swirling brain and imagination.  

 

Reduced Ability to organize thoughts and actions:  Actually, she really has no issues with this. The problem is, that what she organizes and the actions she proposes are out of her confusion and imagination of where and when she is.

 

Decline in ability to analyze a situation, develop an effective plan and communicate that plan to others:  Oh she can communicate just fine.   The other day she gave me a whole plan of how she was going to drive to her mother’s and it was fine if mother wasn’t there, she would just wait for her or go to the neighbor’s to wait for  her.  One of the biggest issues we have with her is that she can communicate so clearly and, unless you know better, you would believe everything she says.   She speaks with clarity and authority.   Even when we have a granny-sitter, and tell them that she cannot have certain snacks, my mom will tell them it is alright she is allowed a small bit.   She says it in such a way, that you really wouldn’t question it…unless you know that she no longer understands her health (did she ever?)

Difficulty deciding what to do next:   I don’t really think she has an issue with this.  She doesn’t do much.  She understands full well when something is given to her as busy work.   She will refuse to do it.  I could easily give her beads or buttons to sort, but she knows there is no reason for that, so she won’t do it.   She will read.  On occasion, she will write a letter if we tell her to.   For this reason, one of those fidget blanket/muffs wouldn’t entertain her, she would think it was dumb and would see no purpose for it for her.  

 

Problems with memory:  not really, more confusion because she is lost in her mind and imagination.   Honestly, she recognizes people she hasn’t seen in ages and knows their names.  She does have some short term memory issues, but I think it is more because she doesn’t pay attention and because she doesn’t like the reality around her.   Living in reality is much harder than living in imagination.

Restlessness and agitation:  OH YES!!!  Her anxiety is through the roof.  However, as my cousin has often said, she probably would have been diagnosed with ADHD, if that was a thing in the 40-50’s.  Before this, she could channel her energy and knew how to control it when she needed to.  Now, she cannot control it.  All impulse control is lost.   She cannot stop her brain from swirling.  Unless she gets an afternoon nap to reset her brain,  it gets worse and worse through the day.  

 

Unsteady gait:  NAH!  Her physical health is actually pretty good.  On occasion she might have an issue, but that is very rare.

 

Urinary issues:   maybe… but some of that is diabetes related.  She wears depends now, and should have been doing so for decades.   She hasn’t had a diarrhea episode in over a year… maybe longer… because her diet is strictly controlled. 

 

Depression or Apathy:  That has always been an issue.  She has been on anti-depressants for decades.   Is it worse?  Probably.  But most of it stems from her lack of touch with reality.   

A lot of her issues stem from the fact that she doesn’t like being told no.   Apparently no one ever told her no as a child (or adult) and now she doesn’t know what to do when she is corrected.   It is almost humorous when you catch her doing something she has been told not to and, on the fly, she makes up a lie to cover what she is doing.   I’m entirely certain that this is something she has done all her life.   She was always the one who KNEW everything.  My opinion now is, she made most of it up.   People have told me that she could remember great details from events that they couldn’t remember.  Yeah?  Probably because she made them up!!   

 

Her imagination has always been amazing!!  That is a great thing, until that is where she lives.   It is great when she is reading “Mr. Cookie Baker” to her grandchildren.  Not so great when she is trying to find her father’s car to drive to Uncle George’s house.  

 

The way my mother is displaying her dementia, is not like anything I’ve ever heard or seen before.  She does NOT lose her words.  She knows them all and doesn’t struggle to communicate.   She is not in touch with reality.  She lives inside her head.   She has moved further and further inside over the years.

 

Remember when I said she was mentally present most of the time when she first came home in 2016?  I would say that now she is present, if I’m lucky, about 10% of the time.   However, as long as you realize that everything out of her mouth is made up, you could carry on a great conversation with her.