By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

VASCULAR DEMENTIA CAUSES DISRUPTED THOUGHT AND MEMORY PROBLEMS

Question: Are there any interventions to help a post-stroke victim with cognitive deficits -- especially short- or long-term memory loss?

Answer: First let me talk a bit about strokes. A stroke occurs when the blood supply to the brain is cut off or slowed, thereby preventing a sufficient amount of oxygen from reaching brain tissue. The specific area of the brain that’s affected is determined by which blood vessels are involved. The brain cells in this area may be injured or die depending on the severity of the stroke.

About 80 percent of strokes are caused by a blocked artery in the neck (carotid artery) or in the brain. Less commonly, a stroke may be caused by a ruptured blood vessel in the brain. The injury to the brain and the resulting loss of function in the patient depends on the location of the decreased blood flow.

Prevention is the key to stroke management. Not smoking, lowering your cholesterol, managing your diabetes and keeping your blood pressure under control, all can help prevent a stroke. If a stroke occurs, several things can be done to help lessen the effects.

Early recognition of the signs of a stroke can get you to a hospital emergency department quicker. If your stroke is caused by a blood clot, using “clot-busting” drugs can help to reestablish the blood supply to the injured area and prevent permanent damage. If this is not possible, early rehabilitation can help a patient to improve lost functions.

Rehabilitation should begin in the acute care hospital with 24 to 48 hours of the stroke. Passive movement of an affected limb and frequent change of position in bed can keep the limbs strong and prevent bedsores. By moving the limbs, the brain is getting signals to help reestablish lost connections and help the patient learn how to do things in new ways.

Your specific question has to do with memory loss after a stroke. When a person becomes confused, has memory loss, difficulty planning and organizing, decreased attention span and/or other signs of intellectual decline after a stroke, this is classified as vascular dementia. It is the second leading cause of dementia after Alzheimer’s disease. About 20 percent of the people who have strokes will develop vascular dementia. Vascular dementia can also develop from chronically decreased blood supply to the brain. For instance, one type of vascular dementia -- called “multi infarct dementia” -- can develop after a person has had a series of small strokes. These 'mini-strokes' can cause symptoms such as light-headedness, temporary blindness and mild weakness in the arms or legs. Since the symptoms usually clear up quickly, many people don’t seek medical attention. That’s unfortunate, because if preventive measures aren’t taken, these mini-strokes, over time, may result in sufficient damage in the brain to produce dementia.

Unfortunately there is no treatment for vascular dementia at this time. If it is identified early and the vascular problems can be corrected, then the problem may not progress. A person with vascular dementia needs a strong support system and a concerned, loving caregiver. There are a few medications currently undergoing clinical trials that are showing some hope for medical treatment of vascular dementia.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.