My father’s dementia took my siblings and me by surprise. Although forgetful, at age 88, my dad, Ed Schneider, still worked part-time as a self-employed business owner. Then, in September 2018, he fell and broke his shoulder; just a few short weeks later, he didn’t remember where he was. And when he did, he didn’t know why he was there. Three months after the dementia symptoms appeared, my father passed away (on the same day as his 89th birthday).
For those months before his death, my father, once a strong, independent man, had been helpless. We couldn’t leave him alone for even a minute because at times, he didn’t remember that he needed a walker and would get up from his chair and try to walk. When that happened, someone needed to run to his side before he ended up on the floor.
Sometimes he didn’t remember where his bedroom was and we needed to gently guide him in the right direction.
Life had come full circle. We remembered the days when our father had lovingly cared for us and now it was our turn to care for him. My father was a kind, caring man, and we returned that love with round-the-clock vigils and our time.
What Did He Have?
Our dad’s symptoms didn’t fit Alzheimer’s disease. When someone has Alzheimer’s, symptoms often appear gradually, but my father’s occurred almost overnight.
The neurologist diagnosed him with vascular dementia, also called vascular cognitive impairment (VCI), and explained it as damaged blood vessels in the brain. When this damage happens, the brain doesn’t receive the blood flow necessary to function properly. It can slowly develop or the symptoms can suddenly appear.
Jeannine Forrest, Ph.D., R.N., a dementia education and support provider, explained in an email interview that when symptoms are sudden and swift, like with my dad, they could be caused by blockage or damage to a major blood vessel in the brain.
“The person may have rather sudden confusion, difficulty understanding a conversation, or speaking,” she says. “Symptoms can come on gradually over time because of damage done to numerous small blood vessels throughout the brain or an accumulation of smaller strokes. In this case, the person may have difficulty with making plans, problems with judgement and attention, and perhaps fluctuations with emotions.”
What Causes Vascular Dementia?
Vascular dementia (VCI) is caused by decreased blood flow to the brain. It is the second most prevalent form of dementia and explains about 5% to 10% of dementia cases, according to Dr. Forrest.
However, there is “debate in the literature about the accuracy of the number because it can exist alone or be mixed with other dementias.”
Blood vessels leading to the brain can become damaged because of blood clots, stroke, atherosclerosis, infection, high blood pressure, or autoimmune disorders, according to Cedars-Sinai Medical Center. It can occur in people over the age of 65, but is most common in those who are in their 80s and 90s.
What are the Risk Factors for Vascular Dementia?
When we looked at the risk factors for VCI, as listed on Cedars-Sinai Medical Center website, my father fit several. He had heart disease for many years; continued to smoke; didn’t exercise; and about eight months prior to the onset of dementia, he was diagnosed with atrial fibrillation. There was also a family history of dementia; both his father and his brother had dementia prior to their deaths.
There are additional risk factors. Those include hypertension, high cholesterol, and diabetes. Still others include advancing age, poor diet, obesity, sleep apnea, depression, and lack of exercise, according to Dr. Forrest. But the risk factor that most struck me and my siblings was family history. Were we at risk for developing VCI? My father’s disease took us by surprise, leaving us to wonder, is this something we now need to prepare our children for as we ourselves age?
Not necessarily, Dr. Forrest explains.
“In our current understanding, genetic risk is a very low risk factor for vascular related dementia,” she says. “There is one known very rare gene mutation known as NOTCH3.”
Dr. Forrest says that people with a strong family history of diabetes and hypertension puts them at risk for developing VCI.
"However, the risks can be significantly decreased by adhering to healthier lifestyle choices – heart heathy diets, adequate exercise, no smoking, limited use of alcohol, stress reduction,” she says.
The Bottom Line?
“Just because a person has many close family members with vascular cognitive impairment, it is not inevitable that one would also end up with VCI.”
As difficult as it was to witness our dad’s decline, my siblings and I did find relief in knowing that we can potentially mitigate our own risk of developing this devastating form of dementia.