Hypertensive
New research made public by the Alzheimer’s society during the Dementia Awareness Week held from the 6th to 12th of July 2008 states that people with high blood pressure are an amazing 600 percent likely to develop dementia. High blood pressure led to a six fold increase in vascular dementia, the second most common form of dementia in the United States and Europe, ranking behind Alzheimer’s disease.
However, it is important to note that apart from high blood pressure, other risk factors are associated with vascular dementia. These include diabetes, family history of heart problems, obesity, atherosclerosis, arteriosclerosis, heart rhythm abnormalities and rare causes such as Lupus and Temporal arthritis.
Vascular dementia is caused by interruption of the blood supply to the brain. Blockage of the blood supply at some point results in stagnation of blood prior to the point of obstruction. The blockage may be caused by large clots which have been transported to the brain from some other site in the body, or by the accumulation of fatty substances (plaque) in the wall of the blood vessel (cerebral arteries or any of their tributaries).
The most common type of vascular dementia is called multi-infarct dementia (MID). It is caused by mini-strokes, also known as Transient Ischemic Attacks (TIAs) which occur suddenly and may go unnoticed because it resolves spontaneously. It is brought about by temporal, partial blockages of blood supply that cause damage to the brain resulting in brief impairments in consciousness and sight. Over time, affected patients have progressive impairment of the higher functions of the brain, such as memory, new learning, recognition, fine motor movements and planning.
Other types of dementia are Vascular dementia of acute onset (occurs usually following a stroke) or post-stroke dementia and Sub cortical vascular dementia characterized by a history of high blood pressure and loss of the covering sheath of nerve fibers in the brain (demyelination).
Vascular dementia should be suspected in the elderly with memory problems, loss of concentration, weakness or numbness of an arm or leg, slurred speech, language problems, abnormal behavior, loss of awareness of surroundings, inappropriate crying or laughter, difficulty following instructions, hallucinations, delusions, physical or verbal aggression restlessness and incontinence.
Although the brain damage caused by dementia cannot be reversed, the focus of management is to prevent further brain damage by improving circulation. Prescription medication used to treat Alzheimer’s disease may also be beneficial for patients with vascular dementia but these medications are licensed only for that disorder. Aspirin (75-150mg) helps to thin the blood, prevent the reoccurrence of strokes and improve the circulation. However, prolonged use may worsen established cases of stomach or duodenal ulcers. Compliance with prescribed antihypertensive medication and other medication for diabetes and high cholesterol and improvements in lifestyle i.e. cessation of smoking, reduced intake of fatty foods, eating a balanced diet and regular aerobic exercise may potentially control the vascular risk factors. Rehabilitative support such as physiotherapy, occupational therapy and speech therapy may be required for certain individuals to help maximize their opportunities to regain their lost functions.
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