Vascular and Mixed Dementias

held March 17, 2014, 1:30-2:30 PM Eastern Time

SERIES BACKGROUND

Arriving at an accurate diagnosis for both the presence of dementia and then the type of dementia takes time and requires clinicians to look at a variety of factors (Alzheimer’s Disease International, 2009). Recent research reflects a growing understanding of non-Alzheimer’s dementias. While Alzheimer’s disease continues to make up a majority of the dementia diagnoses, studies estimate the prevalence of vascular dementia to be 10-30%, making it the second most common dementia (WHO, 2012, Alzheimer’s Disease International, 2009; Stephan & Brayne, 2008; Alzheimer’s Society, 2007).

Estimates for the prevalence of Lewy Body dementia tend to be harder to pinpoint, with some studies estimating prevalence at less than five percent and others estimating it at ten percent or even as high as vascular dementia (Stephan & Brayne, 2008, WHO, 2012, Alzheimer’s Disease International, 2009). It is estimated that Parkinson’s disease dementia, a type of Lewy Body dementia, affects up to two percent of those over 65 and that of the nearly one million Americans with Parkinson’s, 50-80% will experience the dementia associated with it (Alzheimer’s Association, 2013). Additionally, there is increasing evidence to suggest that mixed dementia, a combination of two or more types of dementia, is more prevalent than previously thought and that it under diagnosed (Stephan and Brayne, dementia public policy; world report).

For these reasons it is important to provide sound, evidence-based training on the different types of dementias, including the origins, symptoms and best practice treatments. Therefore, this series, through virtual training and active learning, seeks to advance the training and workforce development goals of the Virginia Dementia State Plan.

The webinar series will include a pre-recorded 30-minute free lecture that briefly reviews types of dementia and three, live 60-minute free webinars on different types of dementia (Lewy body dementia, vascular and mixed dementias, and Parkinson’s disease dementia) and with a special emphasis on ethnic and racial minorities.

This was the first live webinar in the series which focused on vascular and mixed dementias, the second most common cause of dementia (WHO, 2012; Alzheimer’s Disease International, 2009; Stephan & Brayne, 2008; Alzheimer’s Society, 2007).

WHAT WILL YOU LEARN (big picture)?

  1. Vascular dementia is the most common dementia after Alzheimer’s disease.
  2. Vascular dementia and Alzheimer’s disease commonly co-occur and are referred to as “mixed dementia.”
  3. Controlling vascular risk factors is critical to minimize the occurrence of vascular dementia.

SESSION OBJECTIVES

  • The webinar will review the causes, signs and symptoms, disease trajectory, treatment options, and best practices for caring for the individual with Vascular dementia as well as their caregivers.
  • The webinar will pay particular attention to ethnic and racial minorities as well as available supports for individuals.
  • The presenter will provide a case scenario to the webinar attendees and participants will be encouraged to answer questions and provide suggestions for how to handle the case.
  • Flashcards will be available to allow participants to test their knowledge before and after the webinar.

PRESENTER

ManningCCarol Manning, PhD, ABPP-CN, is Director of the Memory Disorders Clinic, Director of the Neurobehavioral Assessment Laboratory, Associate Professor of Neurology and Vice Chair for Faculty Development in the Department of Neurology at the University of Virginia.  She has additional appointments in the Departments of Psychology, Neuroscience, and School of Nursing.  In addition to being Director of the Memory Disorders Clinic, Dr. Manning is also an active member of the Parkinson’s Disease and Huntington’s Disease Treatment Teams at the University of Virginia.   Dr. Manning is the Vice Chair of the Central and Western Virginia Alzheimer’s Association and was recently appointed to the Virginia Alzheimer’s Disease and Related Disorders Commission.

Dr. Manning received her PhD in clinical psychology from the University of Texas at Austin in 1990.  Her post-doctoral training in neuropsychology and neurosciences was funded by the National Institutes of Health. 

Her clinical interests include diagnostic issues in dementia, cognitive and behavioral changes associated with neurodegenerative disease including Alzheimer’s disease,  Parkinson’s disease, and Huntington’s disease as well as depression and anxiety.  Her research involves the effects of neurodegenerative disease on memory, apathy and decision making processes.

MODERATOR

Ayn WellefordE. Ayn Welleford, PhDreceived her B.A. in Management/Psychology from Averett College, M.S. in Gerontology and Ph.D. in Developmental Psychology from Virginia Commonwealth University. She has taught extensively in the areas of Lifespan Development, and Adult Development and Aging, Geropsychology, and Aging & Human Values. As an educator, researcher, and previously as a practitioner she has worked with a broad spectrum of individuals across the caregiving and long term care continuum.

As Associate Professor and Chair of VCU’s Department of Gerontology, she currently works to “Improve Elder Care through Education” through her Teaching, Scholarship, and Community Engagement. Outside of the classroom, Dr. Welleford provides community education and serves on several boards and committees.

Dr. Welleford is former Chair of the Governor’s Commonwealth of Virginia Alzheimer’s and Related Disorders Commission, as well as a recipient of the AGHE Distinguished Teacher Award. In 2011, Dr. Welleford was honored by the Alzheimer’s Association at their annual Recognition Reception for her statewide advocacy. Dr. Welleford is the author of numerous publications and presentations given at national, state and local conferences, community engagement and continuing education forums. In 2012, Dr. Welleford was appointed to the Advisory Board for VCU’s West Grace Village project. She is also the recipient of the 2012 Mary Creath Payne Leadership Award from Senior Connections, the Capital Area Agency on Aging.

THE WEBINAR

The recording was open to all and free for all.
The webinar is a combination of video (showing slides) and audio (available through the computer’s speakers or a telephone dial-in). PC and Mac platforms are available. iPADs, iPhones and Android platforms are supported as well. Instructions on accessing the event will be provided after the registration.

The webinar was recorded and slides are posted below.

Q&A

Q: Are lower socioeconomic classes at higher risk of vascular dementia?
Yes, more likely to have vascular risks due to diet, smoking and exercise.

Q: Are there vitamins we can begin taking in our 50’s to help prevent vascular dementia?
No.

Q: Will the risk factors for vascular dementia also cause kidney or liver failure if they are not controlled?
More likely to cause cardiac difficulties.

Q: Are there better tests than the Mini Mental State Exam (MMSE) for identifying vascular dementia?
Yes, the MMSE is a screening instrument only and can miss dementia. A neuopsychological test battery is more appropriate.

Q. What is included in the neuropsychological evaluation of suspected vascular dementia?
This was discussed in the actual presentation. The test examine areas of cognition including memory, language, attention, executive functioning.

Q:I am concerned about a loved one’s dementia symptoms but they deny they are having any problems.  How can I encourage them to attend an appointment with the doctor to get a full work up and assessment?
Talk directly to your doctor about such strategies.

Q: I know that the primary care physician is often a starting point, but what are the other resources specific to the work up and assessment/evaluation of vascular dementia?
The other resources are memory disorder clinics, neuropsychologists, and neurologists.

Q: What does stepwise progression tend to look like in vascular dementia?
A decline that levels off for some time followed by ongoing decline.

Q: Does vascular dementia spare the memory?
Usually early on.

Q:  How do you assess and manage sleep hygiene and problems in persons with vascular dementia?
Conduct an assessment by a sleep specialist

Q: Do people with vascular dementia tend to recognize any decline in their own cognition?
Sometimes, depending on what the decline is.

Q: Why is gait affected with vascular dementia?
It can be if areas of the brain that involve motor abilities are affected.

Q: Do tremors indicate an incipient event?
Not necessarily.

Q: Is there a correlation between alcohol abuse and vascular dementia?
Alcohol abuse generally involves korsokoff or wenicke’s dementias

Q: Can people with dementia improve if they have an underlying B12 deficiency or depression which is successfully treated?
Yes

Q: What types of cognitive tasks are most helpful for people with vascular vs. Alzheimer’s dementia?  For instance, does it make sense to reduce abstract demands and focus on concrete ones?
Yes, rely on cognitive strengths not weaknesses.

Q: Are there nutritional interventions that could manage symptoms?
Not that could manage symptoms but the Mediterranean diet is associated with better cognition.

Q: What potential does rehab offer people with vascular dementia who have experienced a decline?
That depends on the kind of decline.

Q: Given all the potential side effects of Aricept, Exelon and Namenda, why do doctors prescribe them for vascular dementia? Are there benefits?
These drugs are associated with a slower rate of decline.

Q: The research identifies African Americans as having a higher risk. Are there any community outreach programs as a result of the research?
Please contact the Alzheimer’s Association in your area/region.

Q: What are some of the support systems and education provided or available for families of those with vascular dementia?
The Alzheimer’s Association has ample resources and information on providing this type of education and support systems for the family caregivers.

 

The Other Dementias: Virtual Training and Active Learning on Non-Alzheimer’s Dementias series is made possible through a grant from the Virginia Center on Aging’s Geriatric Training and Education Initiative.

 

Slides

To download the slides, click here.

LEARN/TEST/PLAY

The window below will provide a variety of options for learning, testing oneself and playing (while learning!).  From the bottom right corner, you can select your options (for learning purposes, we suggest using only the Flashcards and the Test).  Note that a mobile version of this platform is available on Quizlet (for both, iOS as well as androids).