Vascular Dementia and Alzheimer’s Disease: Symptoms, Stages, and Care
Vascular Dementia and Alzheimer’s Disease
Understanding Vascular Dementia
Vascular dementia is an anatomoclinical syndrome resulting from cerebral arterial lesions with different pathophysiological mechanisms, such as ischemia, hypertension, cardiac disorders, hematologic disorders, and bleeding. Symptoms typically have a sudden onset and a fluctuating course. Patients often present with extensive neurological deficits, but their personality may be partially or totally conserved.
Alzheimer’s Disease: Prevalence and Stages
The incidence of Alzheimer’s disease is 1.9% to 5.8% in individuals over 65 years old, increasing to over 20% in those over 85 years old. The disease progresses through several phases:
- Early Phase (2-4 years):
- Partial and progressive loss of recent memory
- Sudden mood changes
- Social isolation
- Irritability
- Decreased language fluency and flexibility
- Intermediate Phase (3 years):
- Total alteration of recent memory
- Apathy and fatigue
- Exaggerated and unjustified reactions
- Hallucinations and paranoia
- Decreased language skills
- Echolalia: consistently repeating what is heard
- Visual agnosia: difficulty recognizing objects
- Difficulty driving
- Slowed motor skills and balance
- Difficulty leaving home alone
- Disability in activities of daily living (ADL)
- Third Phase:
- Total memory loss
- Apathy and passivity
- Dysphagia (difficulty swallowing)
- Agnosia and aphasia
- Episodes of restlessness
- Inability to coordinate movements
- Incontinence
- Bedridden state
- Terminal mutism
- Complications: pressure ulcers, respiratory infections
Specific scales are used to assess pain in patients with dementia, as they may not be able to express it verbally.
Care Planning for Dementia Patients
Caring for a person with dementia is a challenge due to difficult behaviors such as aggression, insomnia, and verbal repetitions. Patient agitation, abnormal behavior, lack of social support, and ineffective coping strategies are factors that predict caregiver stress and depression. Patient behavior disturbances are also predictors of stress in caregivers.
Addressing Challenging Behaviors
- Take security measures to prevent the person from getting lost or wandering.
- Communicate clearly, slowly, simply, and repetitively.
- Avoid trying to convince the person or contradicting them; it’s best to distract them.
- Be sympathetic to their frustration and aggression.
- Show affection through eye contact, touch, etc.
- Help the person do all they can for themselves.
- Refer the patient to a doctor if they experience hallucinations or excessive aggression.
Family Caregiver vs. Professional Caregiver
There are considerable differences between family caregivers and professional caregivers:
- Time: Family caregivers often provide 24-hour care, while professional caregivers have set hours.
- Support: Family caregivers may have limited support, while professional caregivers often work in teams.
- Value: Family caregivers have greater personal motivation but may develop an overly dependent relationship.
- Training: Family caregivers often lack formal training in dementia care and may need to learn on the job.
Recommendations for Potential Caregivers
- Reflect on your commitment before taking on the role of caregiver.
- Inform yourself about the disease and potential support systems.
- Avoid unnecessary changes in the patient’s routine.
- Establish priorities and use common sense.
- Seek information and guidance on existing social resources.
- Connect with other affected families and professional associations.
Nursing Care in Dementia
In general, patients affected by dementia do not present diagnoses, since, except in the initial phase of the disease, they cannot voluntarily change their behavior. Nursing care and caregiver support will focus on substitution activities, taking into account how the family lives with and manages the presence of the patient.