Submissions from Readers

Cognitive impairment

by Alison Robins
(Woodford Green)

Question: My mother had a couple of mini strokes about 35 years ago and recently has had at least two strokes. The consultant thinks probably more that weren't so noticeable. She has now got a very poor memory and is confused and sometimes thinks things have happened when they haven't at all. I can't seem to find any help with this? Many thanks and kind regards.

Answer: Vascular or multi-infarct dementia is a type of dementia that is caused by multiple small (or large) strokes in the brain. I would begin researching this type of dementia and treatment. First and foremost, if your mother does have this, it is best to control any lifestyle factors that contribute to it. This means controlling blood pressure (I would have her or someone else if she is not able to monitor her blood pressure daily), controlling diabetes if she has it, not smoking, keeping cholesterol down, and I would add getting some type of cardiovascular exercise if approved by her doctor. Also, I would check with her doctors about the blood pressure range they would like her to say within. Some studies have shown detriment with lower blood pressures in those with vascular dementia as well, so I would check with her doctor to know the exact range recommended for her rather than relying on norms recommended for the healthy population. High blood pressure is definitely a big risk factor, but what is
considered high for her may be different depending on her health conditions.

There are several medicines being used in clinical trials to help with vascular dementia, and though I'm not sure that any have been approved for use, I would definitely do some research on it and talk to her doctor about possible medications that might help.

Lastly, if she is at home, I would recommend having home health occupational and speech therapy. They can evaluate her safety in the home and recommend adaptations, determine what activities of daily living she is having trouble with and how much help she should have, issue a home exercise program, and help her with memory aids or notebooks and other suggestions. IF she also has physical limitations, then physical therapy may be needed as well. I once had a patient with multi infarct dementia who stayed at home by herself during the day. Her family did not realize how impaired she truly had become. Her vision and cognition had been affected, and she truly had trouble with even the simplest of tasks. It was very deceiving, however, that she had no physical deficits and could walk and move without issue. I think a thorough cognitive (and visual) examination should always be done so families have a better idea of their loved one's limitations.

Here are some articles that might help you learn more about multi-infarct dementia (the second one has good resources for those in the UK):

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