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What are the 7 Stages of Vascular Dementia?
Vascular dementia is progressive. This means the condition causes deterioration over time through seven different stages. So, what are the 7 stages of vascular dementia? In exploring this, we look at the support that is needed at the different stages.
Image courtesy of Science Direct
What is vascular dementia?
Before coming onto what are the 7 stages of vascular dementia, it’s necessary to understand what vascular dementia is.
Dementia is a broad term applying to a number of progressive types of cognitive impairment. Decline happens over time. The most common type of dementia is Alzheimer’s disease. Another type of dementia is called vascular dementia. It’s less common than Alzheimer’s but is still the second most common form of dementia.
In very basic terms, in Alzheimer’s the dementia is caused by excess protein amassing in the brain. However, in vascular dementia, the similar symptoms are caused when blood flow to the brain has been impaired. This happens during a stroke or transient ischaemic attack (TIA) (or mini stroke). This causes a form of brain damage that then leads to the vascular dementia.
Although it is caused by impairment to the blood flow to the brain, often during a specific event, vascular dementia can develop over time. Experts in vascular dementia have identified seven stages of vascular dementia. These stages represent different levels of cognitive decline affecting the individual’s ability to make decisions, exercise sound judgment, communicate, remember things and solve daily problems. Later stages reflect how the disease can also affect the individual physically, for example with continence and swallowing issues.
Alzheimer’s, in its later stages, can affect mobility. In individuals with vascular dementia, mobility can be problematic earlier in the progression of the disease, related to damage caused by the initial stroke or TIA. Often this causes balance and coordination issues, weakness and even paralysis. It is typically one-sided. Some improvement can often be gained through rehabilitation.
Sadly, there is no cure for vascular dementia. It’s important to manage the condition and provide care to offer best quality of life. Staying as active as possible and leading a healthy lifestyle can help to slow down progression. Decline may be steady, or it may occur in notable deterioration.
Who gets vascular dementia?
Vascular dementia affects around 150,000 people in the UK.
Those at risk of stroke are more likely to get vascular dementia. As such, it typically occurs in people over 65 with other underlying conditions. Those with high blood pressure, heart disease, obesity and diabetes are at higher risk. Smoking is also associated with vascular dementia. It is thought various other lifestyle factors can also affect your chances of getting vascular dementia, including drinking alcohol and being sedentary.
What are the 7 stages of vascular dementia?
There are 7 stages of vascular dementia broadly representing the deterioration expected with the disease. There’s no set time it takes an individual to progress through the 7 stages of vascular dementia, and individuals may spend a long time in one stage then move very rapidly through another. It is unpredictable and it’s not easy to identify how quickly someone might deteriorate.
So, what are the 7 stages of vascular dementia?
- Normal behaviour
Even though vascular dementia is present, someone may act completely normally as there aren’t yet any identifiable symptoms. However, this is stage one of vascular dementia because, if the individual was to have appropriate scans, the brain would already show signs of change. It’s possible to be in stage one for many years before any other symptoms show.
2. Mild changes
In stage 2 of vascular dementia, there are mild changes that hint that something is not well. Typically, this may include mild memory loss which is easy to dismiss as a normal part of ageing. In reality, memory loss is rarely a normal part of ageing. This may present as absent-mindedness or simple mistakes with daily tasks, such as forgetting to do something habitual. It may appear as mild confusion or difficulties with flexibility with thought (to deal with something unexpected).
3. Mild cognitive decline
During the third stage of vascular dementia, symptoms may still remain quite subtle, but there will be more evidence of cognitive decline. This is when loved ones may begin to notice that the individual is struggling with memory difficulties, or making changes to how they manage things to mask these. This stage is typically the longest stage in vascular dementia. It might be characterised by months and years of forgetfulness, routine errors in things the individual could previously do with no problem, and confusion and inflexibility of thought. The individual may struggle to concentrate and start to struggle with previous hobbies that require this, such as reading. They may find it difficult to make plans and arrangements.
At this stage, your loved one will begin to need more support and hands-on care. It is often during this stage that family members begin to feel the strain of care and consider how best to meet their loved one’s needs, usually sparked by concerns about the safety of the individual with signs of dementia. However, diagnosis may not even have been made at this stage.
4. Moderate decline
Diagnosis of vascular dementia, or any dementia, typically happens around stage 4. This is because symptoms of dementia are now becoming more evident on a regular basis to those around the individual. At this stage of vascular dementia, it is typical that the individual will struggle with many tasks of daily living, from taking medication reliably to preparing and cooking a meal. They will experience significant difficulties managing their household and care, and as such find it very difficult to remain safe at home.
Some families try to manage their loved one’s care at this stage by using home-based carers mixed with family support. Unfortunately, it’s usually around now that it becomes obvious that specialist 24/7 dementia care is needed.
With dementia care, your loved one is cared for around the clock, keeping them safe and ensuring they have the best possible quality of life.
5. Moderately severe cognitive decline
All of the activities of daily living are increasingly difficult in stage 5 of vascular dementia. There is some variation between stages, so it’s impossible to define when stage 4 becomes stage 5, but fundamentally during this stage you can expect the dementia to affect every area of life. People with vascular dementia at this stage cannot reliably look after themselves, although they may still be able to do some things independently, or with support. For example, they may be able to do some parts of dressing but not reliably, or they may not be able to determine the right clothing for the season. At stage 5, vascular dementia is considered late stage dementia.
However, while impairment at stage 5 is significant, it is still quite common that the individual can hold a conversation when it involves recalling events in the past.
6. Severe decline
Independent living is impossible by now and it is essential to consider dementia care for safety and wellbeing. Dementia care specialists, trained in dementia, can keep your loved one safe and provide the best quality of life. This enables you to visit your loved one without any caring responsibilities.
Unfortunately, it is at this stage that more physical issues become problematic. Incontinence is common, as is dysphagia (difficulty swallowing). Recognition of loved ones and familiar people may be intermittent or entirely absent. It’s also not uncommon that behavioural changes occur at this time, with the individual exhibiting behaviour not seen before, or more extremes of previous character traits e.g. aggression. There is an increased risk of infections associated with this stage. Dedicated nursing care is needed.
7. Very severe cognitive decline
In reality, it is unusual that people with vascular dementia live to stage 7. Usually other health problems have caused death before this, for example heart attack or stroke.
Stage 7 is the final stage of vascular dementia and individuals require around the clock care and supervision. Communication is extremely limited or impossible and care needs are very high.
Specialist dementia care
Specialist dementia care is suitable for those with vascular dementia throughout the 7 stages. It can improve the individual’s wellbeing, with tailored services, such as reminiscence therapy and exercise programmes. It’s often the way to offer the best quality of life for as long as possible. It also ensures that loved ones and family members can focus on making the most of the relationship in the end years, rather than providing care.
Find out more about our specialist dementia care in the south west at Eastleigh Care Homes.
