training to care for people with dementia vascular dementia presented by liz graham brightwater care...

Training to care for people with dementia

Vascular Dementia

Presented By Liz Graham

Brightwater Care Group


Objectives

• To increase knowledge and understanding of Vascular Dementia• To demonstrate the progression of Vascular Dementia• To discuss the importance of team management of the person with Vascular Dementia


Types of Dementia

• Alzheimer’s Disease• Vascular Dementia• Dementia with Lewy

bodies• Frontal lobe Dementia• Korsakoff’s Syndrome• Huntington’s Disease• Substance abuse

• Creutzfelt-Jacob Disease (CJD)• Progressive Supranuclear Palsy• Downs Syndrome• AIDS related• Encephalitis• Head Injury• And Others (over 80 causes)


What is Vascular Dementia?

• Second most common form of dementia after Alzheimer’s disease.

• Occurs when the blood supply to the brain is interrupted by a blocked or diseased vascular system.


A Little Bit of History

• Arteriosclerosis and senile dementia described as different syndromes as early as 1899.

• Mayer-Gross et al in 1969 reported hypertension to be the cause in 50% of patients.

• Hachinski in 1974 used the term multi-infarct dementia.

• In 1985 the term vascular dementia was used by Loeb.


Different Types 0f Vascular Dementia1. Mild vascular cognitive impairment2. Multi-infarct dementia3. Vascular dementia due to a strategic single infarct.4. Vascular dementia due to lacunar lesions5. Vascular dementia due to haemorrhagic lesions6. Binswanger disease7. Subcortical vascular dementia8. Mixed dementia (combination of AD and Vascular)

Article by Kannayiram Alagiakrishnam


Multi-infarct dementia

• Most common form• Caused by a series of small strokes or TIA.• Damage caused to the cortex of the brain• Area associated with learning, memory and language.• Can be temporary but over time with repeated incidents

become permanent• Symptoms include severe depression, mood swings and

epilepsy


Binswanger’s Disease(or Subcortical vascular dementia)

• Associated with stroke-related changes.• Damage to tiny blood vessels of the white matter,

deep within the brain.• Symptoms develop more gradually and include• Slowness, lethargy, difficulty walking, emotional ups

and downs, lack of bladder control.


Signs and Symptoms of Vascular Dementia

Physical signs/symptoms• Memory problems, forgetfulness• Dizziness• Leg or arm weakness• Lack of concentration• Moving with rapid, shuffling steps• Loss of bladder or bowel control


Behavioural signs/symptoms

• Depression• Slurred speech• Language problems• Abnormal behaviour• Wandering/getting lost• Laughing/crying inappropriately• Difficulty following instructions• Problems handling money


Risk Factors that increase risk of developing Vascular Dementia


Risk Factors

• High blood pressure• Smoking• Diabetes• High Cholesterol• History of mild warning strokes• Evidence of arterial disease elsewhere• Heart rhythm abnormalities• Lack of physical activity• Fatty diet• Gender – Men are at a slightly higher risk.• Age – Usually between 60 and 75, incidence increases with age.


GOOD NEWS

Unlike Alzheimer’s Disease, there are ways to prevent and reduce the severity of vascular dementia.


Medical management of:

• High blood pressure• High Cholesterol• Heart disease• Diabetes• Administering medication to prevent clots forming eg Aspirin• Drugs to relieve restlessness or depression• Recent research indicates that cholinesterase inhibitor

medications which are helpful with Alzheimer’s disease may be of benefit in Vascular Dementia eg Aricept, Reminyl.

• In some cases surgery such as carotid endarterectomy may be indicated.


Unlike Alzheimer’s Disease, there are ways to prevent and reduce the severity of vascular dementia.

Receiving Rehabilitative Support:

• Physiotherapy• Occupational Therapy• Speech Therapy

To help the person regain lost functions.

A Healthier Lifestyle:

•A healthy diet•Regular Exercise•Stop smoking•Moderate intake of alcohol


Progression of Vascular Dementia

Onset gradual or dramatic

Stabilise

TIA/Stroke

Stabilise

TIA/Stroke

Typically Vascular Dementia progresses gradually in a stepwise fashion in which

a person’s abilities deteriorate after a stroke, then stabilise until the next stroke.


Mortality/Morbidity• In community-based studies in Australia, the

prevalence rate for vascular and mixed dementia is 13% and 28%, respectively.

• In patients with dementia who have had a stroke, the increase in mortality is significant. The 5 year survival rate is 39% for patients with vascular dementia compares with 75% age matched controls.

• Vascular dementia is associated with higher mortality rate than AD, presumably because of the coexistence of other atherosclerotic diseases. (Alagiakrishnan)


Case Study• 74 year old male admitted to High Care from CAP unit• Diagnosis – Dementia• History of Hypertension, TIAs.• Supportive family, wife and 2 daughters

• Transfer information- Communication poor.- Mobility: Non-ambulant, hoist transfer.- ADLs: Full assistance, resistive in showering/dressing.- Doubly incontinent.- Full assistance with meals.


Personhood

• “A standing or status that is bestowed upon one human being, by others, in the context of relationship and social being. It implies recognition, respect and trust”

• (Kitwood 1997)


Philosophy and Principles of Person Centred Care

• Attend to the whole person• See each person as unique and special• Give respect to the past• Focus on the positives• Stay in communication• Nourish attachments• Create community• Maximise freedom – minimise controls• Maintain environment of trust and value


Team assessment and planning of care

JIM

GP

RN

PHYSIOTHERAPIST

FAMILY

OCCUPATIONALTHERAPIST

CARER

SPEECHPATHOLOGIST


From Assessment• GP – Reviews and monitors medication for hypertension and administers

aspirin.• RN – Monitors health status and specifically blood pressure. Works with

team to implement care strategies.• Occupational Therapist – Establishes grabbing and gripping is

behavioural. Implements strategies to assist during washing/dressing including good communication, time, use of smiling, careful handling.

• Carer – Works with Jim implementing strategies and feeding back responses.

• Family – Guided by all staff in understanding and supporting Jim’s needs. Involved during mealtimes, activities to support Jim.


From assessment Contd.

• Physio – Works to promote effective transfers and walking with assistance of 2, 20 metres. Works with OT to ensure active upper limb range present for washing /dressing. Works with team to implement care strategies.

• Speech Pathologist – Establishes dysphagia status and assistance for meals (along with OT). Soft diet, promoting assistance to initiate ability to feed himself especially with finger foods.

Communication requires one stage commands, time to respond and friendly smiling face. Works with team to implement care strategies


Example of Jim’s Progress

TIA

Stand transfers, non-ambulant,Distracter to hold during washingSmiles, Whistles, Gross motor

TIAStanding Hoist transfers, Active-Assisted exercises.Assistance with vitamised meals.Continue Distractor use.Smiles but no whistling.Assess

Implement

Review

Evaluate

Non-Ambulant, Smiles, Whistles,Resistive, Assisted with meals

Walks 20m with 2, Feeds himself with help, Strategies assist during washing. Gross motor activity, Entertainment


Take Home Message

The take home message is simple:

By reducing your risk for stroke, you also

reduce your risk for vascular dementia.


References

• www.brad.ac.uk/acad/health/dementia• www.helpguide.org/elder/vascular_dementia.htm• www.alzheimers.org.uk• www.nia.nih.gov/Alzheimers/Publication/dementia.htm• www.memorylossonline.com/pastissues/summer2000/ vasculardementia.html• www.alzheimers.org.au• www.emedicine.com/MED/topic3150.htm

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