Complications
The prevalence of major depression in people with vascular dementia has been reported to vary from 20% to 45%.[110] It may be hard to establish whether these symptoms are a primary depressive disorder or a manifestation of stroke-related disruption of frontal cortical function. Patient is treated for depression.
The available evidence does not provide strong support for the efficacy of antidepressants for treating depression in dementia.[111] However, clinical consensus supports undertaking a trial of an antidepressant to treat clinically significant depression in people with dementia.[112]
Symptoms of apathy or depression may be improved by encouraging social gatherings and activities (such as gardening, cleaning, and setting the table) to provide the person with routine and foster a sense of utility.
Nondrug interventions such as massage therapy, and cognitive stimulation combined with exercise and social interaction can be more effective than medication to treat depression in dementia patients.[107]
Symptoms associated with psychosis (such as agitation and aggression) may be seen in up to 20% of people with vascular dementia, although the biologic basis of psychoses is still unclear.[128]
One Cochrane review found that the selective serotonin-reuptake inhibitors citalopram and sertraline were associated with a reduction in symptoms of agitation compared with placebo in people with dementia, although there was no separate evidence for people with vascular dementia.[113]
Actions that can be useful in reducing agitation include explaining caregiver actions in advance, giving written instructions, and using calendars, clocks, and charts to help patients stay oriented to the time and place.
Nursing home placement may be necessary.
There are no good data describing the prevalence of wandering behavior in people with vascular dementia. Nursing home placement may be necessary.
There are no data on the risk of falls in people with vascular dementia. However, there is a significant association between non-Alzheimer dementia and gait disturbance, potentially increasing risk for falls.[129]
Preventive measures toward reducing falls risk are advised, such as environmental modification, muscle strengthening, and supervised or assisted mobility.
Patients with vascular dementia are at high risk of further cerebrovascular events. There is an absence of definitive evidence on the efficacy of thrombolysis and endovascular therapy for treating ischemic stroke in patients with premorbid dementia because such patients have generally been excluded from randomized controlled trials. A pragmatic case-by-case approach is recommended in these patients.[130]
Although the frequency of aspiration pneumonia is unknown in unselected samples of patients with vascular dementia, this is most commonly seen in the presence of stroke-related swallowing deficits.
Appropriate swallowing assessments, dietary modification, and positioning are important preventive measures.
The patient is treated for pneumonia.
This is probably most commonly seen in patients with end-stage dementia who are immobile. Standard nursing methods such as appropriate mattresses and positioning should be used. When necessary, ulcers should be debrided with topical or systemic antimicrobials.
Nursing home placement may be necessary.
In the first 6 months of the pandemic in 2020, there was a threefold increased risk of contracting COVID-19 for patients with vascular dementia, against a twofold increased risk for patients with all-cause dementia.
Similarly, 6-month hospitalization and mortality risk was 59% and 21% respectively for dementia patients with COVID-19, compared to 23% and 5% for COVID-19 patients without dementia. The risk was significantly higher again for black patients compared to white patients. This underlines the importance of protecting these vulnerable patients from infection through vaccination and shielding.[131]
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