Can you get vascular dementia from stroke?
Does stroke cause vascular dementia? I'm presently caring for my grandparents, although this question is specifically regarding my grandfather. He's not particularly forthcoming when it comes to his medical problems, and with strict patient-doctor confidentiality laws in place here, the family really does feel left in the dark with him sometimes!
In 2007, Grandad had a minor stroke, although no one realized at the time, and only as an after-thought, he decided to seek help from medical professionals some days later. Recently, he inadvertently left a specialist's report lying around the house written by a gerontologist who oversaw his care following that stroke. In the letter, the doctor spoke of a "caudate nucleus infarct with significant small vessel/white matter diseases."
I have searched high and low around the net, trying to pull together info to help me understand, in layman's terms, what all this means. I do understand that the caudate nucleus infarct refers to the type and location of the stroke, although I am less clear as to how these "brain matter" diseases fit into the equation?
Following on from this, the main questions I have (which may cut across the stroke and dementia forums) are: (a) was the gerontologist's note a polite way of saying that my grandfather is in the early stages of (vascular?) dementia and (b) as a family, how do we know when his behaviors aren't owing to the effects of stroke, and instead start to become dementia?
Obviously, we have noticed hesitation with speech and memory and recall problems (e.g "What do I take my pills with? I've forgotten"). He can lack initiative, and can be rather more withdrawn than usual (although, even in his younger days, he only ever had a few close friends and has generally always preferred his own company).
If it helps, my grandfather turned 75 this year, has been a life-long smoker (hasn't even bothered to even cut back!!!) and takes Warfarin (1 mg) Cilazapril or "Inhibace" (2.5 mg) and Simvastatin (20 mg).
Best wishes, and many thanks in advance for any advice out there!
Expert Answer
These are great questions, let me try to tackle each one in turn:
First, "vascular dementia" is as much a clinical diagnosis as radiologic. In the case of your grandfather, it sounds like he has had a slow, but steady, build-up of very tiny strokes over the years deep in his brain - the "significant small vessel disease" that is referred to in the image. Over time, these tend to cause some mental slowing and memory loss, but there is not a perfect correlation between what is seen on the scan and the degree of symptoms. In order to make a diagnosis of "dementia", your grandfather should be seen by either a Neurologist or a Neuropsychologist. A Neuropsychologist would be particularly helpful here, because they can often put a great amount of detail into their analysis, even telling him whether his memory loss is from small strokes, or other diseases such as Alzheimers. It sounds like he should be seen by a specialist.
That ties into your other question about when is memory loss considered "dementia". This is somewhat hazy. I typically use a tool called a mini-mental status examination to make this determination. Most Neurologists use this as well. A Neuropsychologist would use additional, more detailed tests.
In general, I start to use the phrase "dementia" when someone is losing several points on this mental status scale, and is having clear inabilities taking care of themself. If you think he would be unfit or unsafe to take care of himself due to MENTAL reasons, he probably has dementia. I would confirm this with a consultation from a Neurologist or Neuropsychologist.
Finally, it sounds like he is on a good medication regimen to prevent strokes. He is taking a blood thinner, a blood pressure medicine, and a choleterol medicine. He should carefully watch his blood pressure and cholesterol with his internist. Smoking is absolutely horrible for the arteries and it is very much in his best interest to stop doing that immediately if he wants to avoid further strokes.
I hope that helps. I think the bottom line here is that he needs to stop smoking and he should be seen by either a Neurologist or Neuropsychologist to determine the degree of his memory problems. Good luck!