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What Does Vascular Dementia Mean?
Question:
Good evening doctor,
Does the classification 1 b in vascular dementia have any particular medical meaning for you?
Thank you
Good evening doctor,
Does the classification 1 b in vascular dementia have any particular medical meaning for you?
Thank you
Brief Answer:
Vascular dementia and its causes
Detailed Answer:
Hello, Thanks for coming to HealthCareMagic.
Let me see if I can give you a quick primer on Dementia and move on to discussing the two type of Vascular Dementia. I hope that will give you the information you seek.
So, "Dementia" is a general term for a decline in mental ability, we don't give people that diagnosis until the impairment is severe enough to interfere with daily life. Alzheimer's is the most common type of dementia.
Now what do I mean by 'decline in mental ability'.. it's not simply memory loss. Most of the time we try to take into account problem solving ability.. activities in daily life are full of little problems that need solving. Most normal people can react quickly enough to solve these little problems on the fly. But those with clinical dementia get to a point where they have difficulty reacting in real time or within a reasonable time.
So enough about that. Now lets talk about vascular dementia. Long story short.. vascular dementia is named after what causes it. A problem with the blood vessels to the brain.. for some reason... blood flow to the brain has been altered and stopped and is causing symptoms of dementia.. bear with me am getting to type 1b.
There are TWO types of vascular dementia (VaD). They are classified based on WHAT CAUSED the vascular issue in the first place.
They are
VaD 1a ) AKA Post Stroke Syndrome / Clinical Stroke Syndrome: This is a situation where the person has had a stroke which is a catastrophic interruption of bloodflow to the brain. This causes a die off of neurons and leaves the patient in a state of dementia. Depending on which arteries are involved you can have an entire hemisphere of the brain involved.. or a much smaller portion... Goes without saying that when less of the brain is involved.. the prognosis is better. But the important thing that make 1a.. "1a" is that the stroke was CLINICAL.. that means it could be detected by clinical examination by a professional. It wasn't so small as to not be noticed or not even have symptoms.
To your query
VaD 1b) Subclinical "silent" brain infarctions leading to dementia. Here there are problems in the tiny blood vessels that normally supply blood to core parts of the center of the brain. Over the year the poor blood flow will starve off many of the neurons in this region... but the process is so slow and on such a tiny scale that the brain overall doesn't really notice the die off until the patient begins having symptoms.
To summarize: When someone talks about 1b vascular dementia (and rarely do I subject my patients to classifications and such, it is of no use to THEM in my opinion), i imagine a patient who is advanced in age, has cholesterol issues or hypertension or both and has symptoms of memory loss and problem solving issues interfering with their normal activities of daily living.
When a Cerebral Angiogram is done (a fancy scan where they check the blood flow in the brain), the pictures show tiny tiny areas in the core of the brain that have died off over time.. they look like tiny little scratches on the film when you think about it..
But it all comes together then.. the patient has been having ministrokes.. and the dementia is a result of this...
Treatment is very limited in these cases. What i try to make sure of is that the underlying vascular problems... cholesterol plaques, hypertension etc are being managed and that the patient is on blood thinners to try and prevent more strokes. But after that.. the treatment involves Occupational and physical therapy to try and shore up existing neuronal pathways and allow the brain to try and remap damaged areas to healthy areas. in an aged brain there is very little regenerative capability.. but it is still there and my goal is to do everything that can be done without hurting the patient.
I hope this has helped. Feel free to follow-up regarding this. If you have any specific queries regarding this condition in relation to a patient.. yourself or someone else.. let me know their background, clinical info and upload their scans.. That way we can have a richer and more detailed discussion.
Take care.
Vinay
Vascular dementia and its causes
Detailed Answer:
Hello, Thanks for coming to HealthCareMagic.
Let me see if I can give you a quick primer on Dementia and move on to discussing the two type of Vascular Dementia. I hope that will give you the information you seek.
So, "Dementia" is a general term for a decline in mental ability, we don't give people that diagnosis until the impairment is severe enough to interfere with daily life. Alzheimer's is the most common type of dementia.
Now what do I mean by 'decline in mental ability'.. it's not simply memory loss. Most of the time we try to take into account problem solving ability.. activities in daily life are full of little problems that need solving. Most normal people can react quickly enough to solve these little problems on the fly. But those with clinical dementia get to a point where they have difficulty reacting in real time or within a reasonable time.
So enough about that. Now lets talk about vascular dementia. Long story short.. vascular dementia is named after what causes it. A problem with the blood vessels to the brain.. for some reason... blood flow to the brain has been altered and stopped and is causing symptoms of dementia.. bear with me am getting to type 1b.
There are TWO types of vascular dementia (VaD). They are classified based on WHAT CAUSED the vascular issue in the first place.
They are
VaD 1a ) AKA Post Stroke Syndrome / Clinical Stroke Syndrome: This is a situation where the person has had a stroke which is a catastrophic interruption of bloodflow to the brain. This causes a die off of neurons and leaves the patient in a state of dementia. Depending on which arteries are involved you can have an entire hemisphere of the brain involved.. or a much smaller portion... Goes without saying that when less of the brain is involved.. the prognosis is better. But the important thing that make 1a.. "1a" is that the stroke was CLINICAL.. that means it could be detected by clinical examination by a professional. It wasn't so small as to not be noticed or not even have symptoms.
To your query
VaD 1b) Subclinical "silent" brain infarctions leading to dementia. Here there are problems in the tiny blood vessels that normally supply blood to core parts of the center of the brain. Over the year the poor blood flow will starve off many of the neurons in this region... but the process is so slow and on such a tiny scale that the brain overall doesn't really notice the die off until the patient begins having symptoms.
To summarize: When someone talks about 1b vascular dementia (and rarely do I subject my patients to classifications and such, it is of no use to THEM in my opinion), i imagine a patient who is advanced in age, has cholesterol issues or hypertension or both and has symptoms of memory loss and problem solving issues interfering with their normal activities of daily living.
When a Cerebral Angiogram is done (a fancy scan where they check the blood flow in the brain), the pictures show tiny tiny areas in the core of the brain that have died off over time.. they look like tiny little scratches on the film when you think about it..
But it all comes together then.. the patient has been having ministrokes.. and the dementia is a result of this...
Treatment is very limited in these cases. What i try to make sure of is that the underlying vascular problems... cholesterol plaques, hypertension etc are being managed and that the patient is on blood thinners to try and prevent more strokes. But after that.. the treatment involves Occupational and physical therapy to try and shore up existing neuronal pathways and allow the brain to try and remap damaged areas to healthy areas. in an aged brain there is very little regenerative capability.. but it is still there and my goal is to do everything that can be done without hurting the patient.
I hope this has helped. Feel free to follow-up regarding this. If you have any specific queries regarding this condition in relation to a patient.. yourself or someone else.. let me know their background, clinical info and upload their scans.. That way we can have a richer and more detailed discussion.
Take care.
Vinay
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Good morning Dr XXXXXXX
Thank you very much for your detailed information.
So it seems that at least for vascular dementia 1 b there might be a noting of the subject's changed behaviour such as difficulty in everyday situations etc and the doctor may then do a Cerebral Angiogram or MRI scan and the clinical causes can then be identified.
My request for information is on behalf of my mother who deceased 19 January.
The Post Mortem report gave bronchopneumonia and vascular dementia as primary causes of death- the secondary cause was a cardiac arrest.
There seem to be various problems to explore and clarify.
Regarding "vascular dementia"
1) My mother for a person in her nineties was very independent and prided herself on her independence- she cooked, did light cleaning, shopping etc and managed simple everyday affairs and was very articulate. Two years ago she fell and broke her hip and though having it replaced she did not walk again. Three weeks after the fall she was diagnosed as having vascular "dementia" a diagnosis which I found curious as no such qualitative change had occurred. I asked about a scan but no scan had been done to scientifically evidence this.
2) The PM report though stating vascular dementia as a cause of death reveals no scan having been made either. I had asked the Coroner for a scan to be used before the autopsy and he agreed to this but this it seems wasn't effected at the autopsy.
The PM report does report vascular plaques to an extent but in the circumstances and in relation to the information given should a angiogram/ MRI scan in your opinion be insisted on to confirm the diagnosis now made twice?
XXXX
Thank you very much for your detailed information.
So it seems that at least for vascular dementia 1 b there might be a noting of the subject's changed behaviour such as difficulty in everyday situations etc and the doctor may then do a Cerebral Angiogram or MRI scan and the clinical causes can then be identified.
My request for information is on behalf of my mother who deceased 19 January.
The Post Mortem report gave bronchopneumonia and vascular dementia as primary causes of death- the secondary cause was a cardiac arrest.
There seem to be various problems to explore and clarify.
Regarding "vascular dementia"
1) My mother for a person in her nineties was very independent and prided herself on her independence- she cooked, did light cleaning, shopping etc and managed simple everyday affairs and was very articulate. Two years ago she fell and broke her hip and though having it replaced she did not walk again. Three weeks after the fall she was diagnosed as having vascular "dementia" a diagnosis which I found curious as no such qualitative change had occurred. I asked about a scan but no scan had been done to scientifically evidence this.
2) The PM report though stating vascular dementia as a cause of death reveals no scan having been made either. I had asked the Coroner for a scan to be used before the autopsy and he agreed to this but this it seems wasn't effected at the autopsy.
The PM report does report vascular plaques to an extent but in the circumstances and in relation to the information given should a angiogram/ MRI scan in your opinion be insisted on to confirm the diagnosis now made twice?
XXXX
Brief Answer:
No, MRI would be ineffective
Detailed Answer:
Dementia is a clinical diagnosis. It cannot be arrived at at this point. If the coroner saw lots of plaques and evidence of stroke. He can make a diagnosis like ulti infarct syndrome.. But to diagnose a person with dementia post mortem is non-sequitir.
I am so sorry to hear about your mother and my condolences to you, but at this point, more testing would be purely academic.
Instead I would talk to the coroner about how he/she arrived at the diagnosis of dementia.
I hope this helps.
Vinay
No, MRI would be ineffective
Detailed Answer:
Dementia is a clinical diagnosis. It cannot be arrived at at this point. If the coroner saw lots of plaques and evidence of stroke. He can make a diagnosis like ulti infarct syndrome.. But to diagnose a person with dementia post mortem is non-sequitir.
I am so sorry to hear about your mother and my condolences to you, but at this point, more testing would be purely academic.
Instead I would talk to the coroner about how he/she arrived at the diagnosis of dementia.
I hope this helps.
Vinay
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Good afternoon Dr Bhardwaj,
Thank you very much for your reply, information and condolances for the passing of my mother.
The problem is also that my mother was diagnosed as having vascular dementia when alive but without testing and which a I found rather curious to be honest.
If there was a person who didn't have dementia it was her from an everyday practical point of view and a person in his or her early nineties as she was at that time of first diagnosis. The diagnosis was done by a psychiatrist after she had fallen and was doing convalescence in a Care Home. No doubt at first she would have been disorientated in some way and to some extent in the Convalescence Home (though I didn't notice that) but just three weeks before she had been independent, and with normal cognitive functioning applied to everyday practical situations.
There is no reporting of a clinical history of significant or noted infarction in the past. The clinical report in a) below doesn't seem to evidence any major stroke which would have been noticed?
After decease, brain relevant statements in the PM report are that a) the cerebral arteries show extensive atheroma and have a markedly tortuous outline with several sites of stenosis.
b) Some shrinkage of the right temporal lobe.
c) Very minor narrowing of the gyri consistent with generalised cerebral atrophy.
If there had been a major stroke then there would be other signs to identify I suppose?
The extract report above was given to the Coroner by the Pathologist a few months ago and repeated the diagnosis of dementia of two years earlier.
If a scanning test would be purely academic as you say then perhaps there might be as an alternative method an analysis of brain tissue regarding the typical signs of vascular dementia?
Thanks.
XXXX
Thank you very much for your reply, information and condolances for the passing of my mother.
The problem is also that my mother was diagnosed as having vascular dementia when alive but without testing and which a I found rather curious to be honest.
If there was a person who didn't have dementia it was her from an everyday practical point of view and a person in his or her early nineties as she was at that time of first diagnosis. The diagnosis was done by a psychiatrist after she had fallen and was doing convalescence in a Care Home. No doubt at first she would have been disorientated in some way and to some extent in the Convalescence Home (though I didn't notice that) but just three weeks before she had been independent, and with normal cognitive functioning applied to everyday practical situations.
There is no reporting of a clinical history of significant or noted infarction in the past. The clinical report in a) below doesn't seem to evidence any major stroke which would have been noticed?
After decease, brain relevant statements in the PM report are that a) the cerebral arteries show extensive atheroma and have a markedly tortuous outline with several sites of stenosis.
b) Some shrinkage of the right temporal lobe.
c) Very minor narrowing of the gyri consistent with generalised cerebral atrophy.
If there had been a major stroke then there would be other signs to identify I suppose?
The extract report above was given to the Coroner by the Pathologist a few months ago and repeated the diagnosis of dementia of two years earlier.
If a scanning test would be purely academic as you say then perhaps there might be as an alternative method an analysis of brain tissue regarding the typical signs of vascular dementia?
Thanks.
XXXX
Brief Answer:
A biopsy of the Brain would diagnose it
Detailed Answer:
A biopsy of the brain (particularly the blood vessels in the brain would be the best way to look for vascular issues of any sort. Now I dunno if we will ever be able to prove or disprove that she had 'Dementia' as no scan or biopsy can tell us about FUNCTIONING of the brain. But the biopsy will get us as close as we can get.
Indeed, given the history that you have painted for me i do not believe that she would have been diagnosed dementia as she was pretty independent. The diagnosis seems to have arisen from the fact that she had some mental status changes after her injury. You have to remember, doctors are human to and we get heavily swayed by what we EXPECT. So, imagine you are a neurologist and you get called to examine a woman just a few years shy of being a centenarian. She is showing signs of Altered mentation and she has fallen and injured herself. Given this set up, I think it's pretty easy for the doctor to get carried away and peg everything on a diagnosis of dementia. It's not right. but it's what happens from time to time.
Seek out the coroner and see if you can get the wording changed if that is what you want.
Viinay
A biopsy of the Brain would diagnose it
Detailed Answer:
A biopsy of the brain (particularly the blood vessels in the brain would be the best way to look for vascular issues of any sort. Now I dunno if we will ever be able to prove or disprove that she had 'Dementia' as no scan or biopsy can tell us about FUNCTIONING of the brain. But the biopsy will get us as close as we can get.
Indeed, given the history that you have painted for me i do not believe that she would have been diagnosed dementia as she was pretty independent. The diagnosis seems to have arisen from the fact that she had some mental status changes after her injury. You have to remember, doctors are human to and we get heavily swayed by what we EXPECT. So, imagine you are a neurologist and you get called to examine a woman just a few years shy of being a centenarian. She is showing signs of Altered mentation and she has fallen and injured herself. Given this set up, I think it's pretty easy for the doctor to get carried away and peg everything on a diagnosis of dementia. It's not right. but it's what happens from time to time.
Seek out the coroner and see if you can get the wording changed if that is what you want.
Viinay
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Good morning Dr XXXXXXX
Thanks for the quick reply and information.
My mother did have some personality changes, that's true. I thought that they would put it down to living next to electric pylons, the magnetic resonance issue is quite a growing issue in the UK. The decease was completely unexpected and unwanted.
So it seems that behavioural aspects and cognitive aspects are taken into consideration for a diagnosis by what you say.
However, medicine is a precise and scientific applied discipline so the biopsy should be done on decease before a definitive cause of death conclusion is reached, and pre-decease the MRI scan should have been done? Vascular dementia is about clinical changed aspects of the brain that effect cognitive ability, but may also cause a change of behaviour and personality? Is that correct to say exactly in that way?
Thanking you.
XXXX
Thanks for the quick reply and information.
My mother did have some personality changes, that's true. I thought that they would put it down to living next to electric pylons, the magnetic resonance issue is quite a growing issue in the UK. The decease was completely unexpected and unwanted.
So it seems that behavioural aspects and cognitive aspects are taken into consideration for a diagnosis by what you say.
However, medicine is a precise and scientific applied discipline so the biopsy should be done on decease before a definitive cause of death conclusion is reached, and pre-decease the MRI scan should have been done? Vascular dementia is about clinical changed aspects of the brain that effect cognitive ability, but may also cause a change of behaviour and personality? Is that correct to say exactly in that way?
Thanking you.
XXXX
Brief Answer:
Magnetic pylons do not cause changes
Detailed Answer:
Hi again, thanks for following up. First things first. There is no evidence that Magnetic pylons cause any mental changes. If she was having changes in personality, then i would chalk it up to the vascular dementia.
The rest of what you have described is ok.
Thanks for following up, keep in touch
Vin
Magnetic pylons do not cause changes
Detailed Answer:
Hi again, thanks for following up. First things first. There is no evidence that Magnetic pylons cause any mental changes. If she was having changes in personality, then i would chalk it up to the vascular dementia.
The rest of what you have described is ok.
Thanks for following up, keep in touch
Vin
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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