Visiting a relative or friend in the later stages of dementia can be a bewildering, and even frightening prospect. Not knowing what to do or say, feeling self-conscious in front of other relatives or care home staff, and even fear of unsettling the person you’ve come to visit, can all add pressure to the situation, particularly if the person you are going to see fails to recognise you, or presents strange and unfathomable behaviour.

Magdalena Schamberger, from the Scottish charity Hearts and Minds advocates a gentle, reactive approach to take away the pressure. Don’t go in with an agenda or expectations as this is likely to cause frustration and upset if these are not fulfilled. As she puts it, “Take time and just be”. Take the lead from the person you are visiting and allow them to be the person they are right now.

Here are 5 simple suggestions to help you do just that:Holding hands stock photo

  1. Allow for Silence

Spend some time without feeling the need to do or say anything- however alien this may at first feel.  Make eye contact, be still, and just enjoy being together without judgement or expectation. Even everyday tasks such as washing, dressing and eating can be fraught with difficulties, so leaving tasks to one side for a moment and just being still, holding hands and breathing together can be relaxing and provide a meaningful moment for both of you.

  1. Follow – don’t lead

Holding a one-sided conversation, asking questions and contradicting what someone is saying (even if you are right!) puts pressure on both of you and can quickly become distressing. Instead listen carefully and respond positively to any interaction. Go with their flow, even if it is nonsensical . Rhythm and repetition can be a useful strategy to try if the person you are visiting is unresponsive. Repeating the name of your relative or friend to a familiar melody may make a connection, and help them realise you are there for them.

  1. Focus on the immediate

Try to do a physical activity if the person is still capable to doing so. This removes the need for verbal responses which can be so difficult in the later stages of dementia. Activities that you used to do together (such as baking, DIY or gardening ) can provide a positive experience in the moment, even if the person won’t remember it afterwards. Activities could be something as simple as a hand massage with a scented oil or cream, or perhaps a rummage box (containing familiar things that they used to enjoy doing, or pleasantly tactile objects to hold) for the person to hold on to and fiddle with.

  1. Show kindness and compassion

Physical contact is important. Although the person you are visiting may be distant, confused or unsettled, they still have feelings and emotions. Hold their hand and give them a hug. Remember agitated behaviour may be a sign that they are hungry, thirsty or in pain, so check their basic needs are being met and they are not uncomfortable.

  1. Create a shared moment

Listen to some favourite music, sing, smile, laugh and dance together. Get out of the daily routine for a little way and enjoy  a shared moment together.

Hearts and Minds is a Scottish charity which aims to improve the experience of people in hospital and in hospice, residential and respite care by using the performing arts to encourage communication, interaction and laughter.

Alzheimer’s is now a widely known term in the English language and has, for many, become the “catch-all” phrase for dementia. Yet Vascular Dementia  is the second biggest cause of dementia in the UK and while the two diseases may share similarities, there are also important differences which people should be aware of.

What is Vascular Dementia?

Vascular dementia is the outcome of blocked or minimized flow of blood to the brain, denying the brain cells of crucial oxygen and nutrients.
Unlike Alzheimer’s, where the cause continues to be unclear, vascular dementia is triggered by a specific, intense occasion (or series of events) such as stroke or TIAs (mini strokes) where the flow of blood to the brain is disrupted, OR, small vessel disease which develops slowly with time from narrowing or blocked  blood vessels deep inside the brain.
The beginning of signs can be abrupt or gradual depending upon the degree of damage to the blood vessels and the particular part of the brain impacted. After a major stroke, the symptoms of dementia might become obvious very promptly, however when it comes to small vessel illness or a series of mini-strokes (where the decrease of blood flow to the brain is much more steady), the signs may go completely undetected to start with and develop only with time.

The signs of Vascular Dementia

After a significant stroke, the symptoms of dementia are likely to take place at the same time as the physical effects of stroke such as paralysis on one side of the body, trouble walking and headache. Symptoms may consist of:

  • Confusion
  • Disorientation
  • Communication problems –  problems speaking or understanding speech
  • Loss of vision

In the case of Multi-infarct dementia (the type of dementia triggered by a series of mini-strokes) or Subcortical Vascular dementia (small vessel illness) the signs are likely to be  more progressive modifications in thinking and habits as the damage to the brain builds up in time. Early indicators might include:

  •  Difficulty finding the right words
  • Declining attention span
  • Difficulty addressing issues
  • Impaired planning and judgement
  • Visual mistakes and misperceptions
  • Hallucinations or misconceptions
  • Loss of bladder control
  • Uncontrolled feelings- chuckling and/or crying inappropriately.

Depression and anxiety commonly go hand in hand with vascular dementia as the person with the symptoms understands the troubles they are dealing with. This anxiety can in itself make the intellectual symptoms worse.

Holding hands

It is important to ALWAYS consult your GP if you experience any signs and symptoms, even if they appear to go away after a time, because the symptoms could be triggered by short-lived disruptions in the blood flow to the brain, which left without treatment, could trigger long-term damage.

How does Vascular Dementia differ from Alzheimer’s illness?

The primary difference between these 2 types of dementia is in the way the symptoms begin, and then develop.
In Alzheimer’s illness, the symptoms have the tendency to appear gradually, then get worse in a stable downward path. The rate of decrease is typically consistent throughout all intellectual capabilities.
With Vascular Dementia, the signs may appear gradually or all of a sudden, but will certainly then stabilize for a time period, till another stroke triggers a more sharp decrease. In many cases, cognitive changes may even enhance briefly during recuperation from the intense stage of a stroke as the brain generates new blood vessels, and brain cells outside the broken area take on brand-new roles. This unequal pattern through the disease is often described as a stepped pattern of decrease, wheras the decrease in Alzheimer’s generally follows a straight constant downward course.

Another important distinction lies in the fact that individuals with vascular dementia tend to have fewer personality changes, and maintain particular capabilities up until much later phases of the condition. This is due to the fact that Vascular Dementia influences unique parts of the brain, while Alzheimer’s has the tendency to impact the entire brain. For this reason, memory loss might not be a substantial symptom in Vascular dementia if that is not the region of the brain where blood flow is decreased.

Mixed Dementias

Recognising the symptoms, and trying to anticipate the course of the disease is made more complicated by the fact that many people with Alzheimer’s likewise have vascular dementia. The Alzheimer’s Society estimate that about 10 % of people with dementia have a mixed type of the disease where Alzheimer’s disease plus stroke or small vessel disease have together caused damage to the brain. Other sources place the figure even greater, making predicting the course of the dementia more problematic.

Family with nurse

Treatment for Vascular Dementia

1. Lifestyle modifications to lower the risk factors.
There is substantial proof that successful treatment of the risk factors for dementia may postpone or even  prevent additional decline. Improving diet, taking routine exercise, avoiding weight problems and cutting out tobacco can all play a part in an effective therapy programme.

2. Drug treatment to deal with any underlying conditions such as hypertension, diabetes, stroke, heart problems or high cholesterol.
These may consist of anticoagulants such as warfarin, antiplatelet representatives such as aspirin, medications to decrease viscosity (blood density), and even possible surgical treatment for extreme cases.

3. Rehabilitation support.
Multi-agency support (Occupational Therapy, Speech and Language Therapy, and Physiotherapy) can help people to  regain lost function and hold off further decline.

At the time of writing this post, no drug treatments are approved to treat Vascular Dementia directly in either the UK or United States. There is some clinical trial evidence that certain medicines authorized for Alzheimer’s disease might provide a modest benefits for the therapy of mixed dementia, and in certain cases these could be prescribed, specifically when Alzheimer’s is the primary condition.