Vascular dementia

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Vascular dementia is a common type of dementia caused by reduced blood flow

to the brain. Vascular dementia, sometimes called vascular cognitive impairment,

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is the second most common cause of dementia after Alzheimer’s disease. It’s
estimated to affect around 150,000 people in the UK.Dementia is the name for

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problems with mental abilities caused by gradual changes and damage in the
brain. It's rare in people under 65.
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Causes
Vascular dementia is caused by reduced blood flow to the brain, which damages
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and eventually kills brain cells. This is usually due to:

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• narrowing of the small blood vessels deep inside the brain, known as
subcortical vascular dementia or small vessel disease
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• Stroke is a common cause of vascular dementia (where the blood supply to

part of the brain is suddenly cut off, usually because of a blood clot), called
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post-stroke dementia or single-infarct dementia

• lots of "mini strokes" (also called transient ischemic attacks or TIAs) that
cause tiny but widespread damage to the brain, known as multi-infarct
dementia. Some people with vascular dementia also have brain damage
caused by Alzheimer's disease. This is known as mixed dementia.

Who's most at risk?

Things that can increase your chances of getting vascular dementia in later life
include:

 high blood pressure (hypertension)

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  smoking
 an unhealthy diet
 high blood cholesterol
 lack of exercise
 being overweight or obese
 diabetes
 drinking too much alcohol
 atrial fibrillation – a type of irregular heartbeat (arrhythmia) – and other
types of heart disease

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These problems increase the risk of damage to the blood vessels in and around
your brain, or cause blood clots to develop inside them. There are some things

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you cannot change that can increase your risk of vascular dementia, such as:

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Age – the risk of vascular dementia increases as get older, with people over 65
most at risk
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Family history – The risk of problems such as strokes is higher if a close family
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member has had them.

Ethnicity – a south Asian, African or Caribbean background, the risk of vascular
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dementia is higher, as related problems such as diabetes and high 7blood

pressure are more common in these groups
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In rare cases, unavoidable genetic conditions can also increase the risk of vascular
dementia.
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Text B
Text B

Stages
Changes caused by vascular dementia occur in noticeable stages, the first stage is
called mild cognitive impairment. People with mild cognitive impairment are
aware that their memory and mental capabilities are not what they once were.
Mild impairment may occur after a minor stroke or after a series of mini strokes.
It may be hard to diagnose vascular dementia at this stage. More severe strokes
may cause advanced vascular dementia. A severe stroke that leaves the brain

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without oxygen and blood for an extended period of time can cause dramatic
changes in cognitive and physical capabilities.

Symptoms of vascular dementia

Vascular dementia can start suddenly or begin slowly over time. Early signs of
vascular dementia can include mild

 difficulty with planning and understanding

 slowness of thought
 problems with concentration
 changes to your mood, personality or behavior

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 feeling disoriented and confused


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difficulty walking and keeping balance

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At the beginning, these problems may be barely noticeable or mistaken for
something else, such as depression. But they indicate some brain damage has
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happened and that treatment is needed. Symptoms of Alzheimer's disease, such
as problems with memory and language (many people with vascular dementia
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also have Alzheimer's disease).These problems can make daily activities

increasingly difficult and someone with the condition may eventually be unable
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to look after themselves.

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Later symptoms
The symptoms often continue to get worse over time. This may happen slowly,
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or in sudden steps every few months or years. The symptoms depend on the part
of the brain that's affected, but can include:

 significant slowness of thought

 feeling disorientated and confused
 memory loss and difficulty concentrating
 difficulty finding the right words
 severe personality changes, such as becoming aggressive
 depression, mood swings and lack of interest or enthusiasm
 finding it difficult to walk and keep balance, with frequent falls
 loss of bladder control (incontinence)

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  increasing difficulty with daily activities

Text C Text C

Tests for vascular dementia

 There's no single test for vascular dementia. The tests that are needed to
make a diagnosis include:
 An assessment of symptoms – for example, whether these are typical
symptoms of vascular dementia
 A full medical history, including asking about a history of conditions related

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to vascular dementia, such as strokes or high blood pressure
 An assessment of mental abilities – this will usually involve several tasks

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and questions
 a brain scan, such as an MRI scan or CT scan, to look for any changes that
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have happened in your brain.

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Treatments for vascular dementia

There's currently no cure for vascular dementia and there's no way to reverse any
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loss of brain cells that happened before the condition was diagnosed. But
treatment can sometimes help slow down vascular dementia. Treatment aims to
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tackle the underlying cause, which may reduce the speed at which brain cells are
lost. This will often involve:

 eating a healthy, balanced diet

 losing weight if you're overweight
 stopping smoking
 getting fit
 cutting down on alcohol

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Medications
Medicines may also be offered to treat the underlying cause of vascular dementia
and help stop it getting worse. These include:

 medicines to treat high blood pressure

 medicines to treat high cholesterol, such as statins
 medicines such as aspirin or clopidogrel to reduce the risk of blood clots
and further strokes
 anticoagulant medicines, such as warfarin, which can also reduce the risk
of blood clots and further strokes

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 medicines to treat diabetes
 An antipsychotic medicine, such as haloperidol, may sometimes be given to

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people showing persistent aggression or extreme distress where there's a

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risk of harm to themselves or others. A consultant psychiatrist should be
involved in deciding whether to prescribe this medicine.
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 Alzheimer's disease medicines, such as donepezil (Aricept), galantine
(Reminyl), rivastigmine (Exelon) or memantine are not used to treat
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vascular dementia, but may be used in people who have a combination of

vascular dementia and Alzheimer's disease.
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Other treatments, including physiotherapy, occupational therapy, dementia

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activities (such as memory cafes) and psychological therapies, can help reduce
the impact of any existing problems.
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Prognosis
The brain is capable of repairing itself to a certain extent. It can regenerate blood
vessels to help heal damaged areas, according to the Alzheimer’s Association.
Still, vascular dementia shortens a person’s lifespan. Lifespan can be cut even
shorter if another stroke or heart attack causes additional brain damage. The
severity of vascular dementia affects a person’s prognosis. The greater the
damage to the brain, the more likely a person is to need assistance with everyday
task

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Time : 15 minutes
• Look at the four texts, A-D, in the separate Text Booklet
• For each question,1-20,look through the texts,A-D,to find
in this Question Paper
• Answer all the questions within the 15-minute time limit.
• Your answers should be correctly spelt.

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Vascular dementia: Questions

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Questions 1-7
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For each question 1-7 decide which text (A,B,C or D) the information comes from.
You may use any letter more than once.
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In which text can you find information about

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1) Life expectancy? ------------------

2) Progressive features? ------------------
3) Small vessel disease ? ------------------
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4) Symptoms of Alzheimer’s disease? ------------------

5) Lifestyle modification includes? ------------------
6) Measures to reduce the impact ? ------------------
7) Chances of getting it ? ------------------
Questions 8-14
Answer the questions,8-14,with a word or short phrase from one of the texts.
Each answer may include words ,numbers or both.

8) In rare cases--------------------------------can increase the risk of vascular

dementia ?

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 ---------------------------------------------------------------------------------------
9) It is seen more among the people with age of ------------------------?

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10) Group of dementia activities are ---------------------------------?

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11) The vascular dementia caused by Alzheimer’s disease is --------------?

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-------------------------------------------------------------------------------------------------
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12)Medications which are contra indicated to treat vascular dementia---------?
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13)Vascular dementia is other wise known as ---------------------------------?

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- -------------------------------------------------------
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14)-----------------------------is the common cause of vascular dementia?

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Questions 15-20
Complete each of the sentences ,15-20,with a word or short phrase from one of
the texts. Each answers may include words, numbers or both.

15)------------------------should be involved in deciding to prescribe medications for

extreme distress?

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16)Belongs to -----------------------------. group may also make a person more
susceptible to develop vascular dementia ?
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17) At the beginning these problems may be ----------------or mistaken for

something else?

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18)-------------------------------consists of several tasks and questions?

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19)The aim of vascular dementia management is to repair ----------------------?
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20)People with vascular dementia experience problems with ------------------?

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End of Part A
Proceed to Part B and C