Vascular dementia
It is not a single clinical entity as it is caused by multiple causes, including both haemorrhagic (rupture of an aneurysm) and ischaemic (interruption of blood circulation) brain lesions, which give rise to different symptomatologies depending on the location of the lesion. It is considered the second most common cause of dementia after Alzheimer’s disease. Although, as mentioned above, the symptomatology is very heterogeneous depending on the damaged area of the brain, some of the most common symptoms in vascular dementia are described below.
Cognitive impairment in the course of vascular dementia
Inability to maintain attention on a task for a prolonged period of time (sustained attention), to direct attention to the relevant stimulus (selective attention) or to perform two tasks simultaneously (divided attention). In everyday life, this causes people with this type of dementia to leave tasks unfinished, to be easily distracted, to find it difficult to follow the thread of a conversation, etc.
The person with vascular dementia does not remain stable; the intensity of symptoms varies relatively sharply from one moment to the next, with days when cognitive impairment seems greater than others.
Executive functions are those that integrate the orderly and effective functioning of the rest of the cognitive functions. As Elkhonon Goldberg explains it, they act as an orchestra conductor, making the different cognitive processes intervene in an orderly and appropriate manner to the extent that they are required for the correct execution of an activity. This leads to problems in planning (a family meeting, the organisation of the day, a trip…), logical reasoning, understanding of figurative meanings, irony…
Disorder of the effective execution of voluntary and well-learned motor acts, with a purpose or intentionality, in the absence of physical impairments that prevent or hinder movement. Actions such as the proper use of cutlery, tools, toilet utensils, buttoning buttons, tying shoelaces, drawing, making communicative gestures with the hands… would be among the examples of everyday activities that require adequate praxical ability.
Visuospatial functions allow us to identify and locate visual stimuli in space. Their impairment can manifest itself in the form of difficulty in orienting oneself in space, difficulty in recognising and locating objects in space, or errors in calculating distances that can lead to falls or accidents when driving vehicles.
Psychological and behavioural symptomatology that can occur in vascular dementia
Depression may be evident by symptoms such as crying, sadness or hopelessness, as well as loss of appetite, severe weight loss or insomnia.
A marked loss of motivation and initiative in carrying out activities. Although, in itself, it is a common symptom of depression, in dementia it can appear (and often does) independently. Sometimes there is a marked introversion and a tendency to isolation as a result of the confusion that the patient experiences in certain situations, which leads him or her to withdraw and show no interest. Apathy usually appears at the onset of the symptomatic process and persists, although it may fluctuate, throughout the different phases.
This trace is the expression of an anticipatory fear of experiencing unpleasant situations, harm or misfortune. The particular difficulty that people with dementia have in foreseeing what will happen in the future, even if it is immediate, often leads to manifestations of anxiety.
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