In-home care for vascular dementia

What’s different about vascular dementia at home

Vascular dementia happens when reduced blood flow damages brain tissue, after a major stroke, a series of small strokes, or disease of the brain’s small blood vessels.

The Alzheimer’s Association estimates that about 5% to 10% of people with dementia have vascular dementia alone, and that it more often appears alongside Alzheimer’s as mixed dementia. It is believed to be underdiagnosed.

Several features shape care at home:

• Thinking slows before memory fails. Early signs of small-vessel disease often include trouble planning, poor judgment, reduced attention and difficulty finding words. Memory loss may or may not be prominent.

• Changes can come in steps. After a stroke, symptoms can appear suddenly; some improve during recovery. With small-vessel disease, decline can be gradual. Families often describe long plateaus followed by a noticeable drop.

• Emotions can be harder to control. Uncontrolled laughing or crying and trouble in social situations can occur.

• Physical effects of stroke may be part of the picture: weakness on one side, balance problems, speech difficulty (aphasia), or swallowing trouble (dysphagia).

• Risk factors still matter. High blood pressure, high cholesterol, diabetes and smoking are linked to vascular dementia. The Alzheimer’s Association notes that treating these underlying conditions is central to care. No drug is approved specifically for vascular dementia.

Know the stroke warning signs

Because another stroke can cause a sudden step down, everyone who spends time with your loved one should know the warning signs. The CDC’s BE FAST check: Balance (sudden dizziness or loss of balance), Eyes (sudden trouble seeing), Face (one side droops), Arms (one drifts down), Speech (slurred or strange), Time to call 9-1-1. Note when symptoms started, and don’t drive the person to the hospital yourself; paramedics can start treatment on the way. Our companions are taught to call 9-1-1 first and the family second.

What a companion does differently for vascular dementia

• Gives extra time. Slowed processing means questions need a pause and tasks need one step at a time. Rushing causes frustration that can look like stubbornness.

• Breaks tasks down. Planning is often what fails first, so a companion sets out the steps of making lunch or getting ready for church, then lets your loved one do as much as they can.

• Supports heart-healthy routines. Walks at a safe pace, help preparing meals that follow the doctor’s diet advice (lower salt, diabetic-friendly), and medication reminders for blood pressure, cholesterol or diabetes pills. Companions remind; they don’t administer.

• Works around physical limits. Steadying on the weaker side, using the walker or cane the therapist recommended, and watching for coughing at meals.

• Handles emotional swings calmly. Sudden tears or laughter aren’t treated as a crisis; the companion stays matter-of-fact and moves on gently.

• Watches for steps down. The note after each visit records anything new: a change in speech, walking, alertness or mood. That record helps the doctor tell a new stroke or an infection from gradual change.

After a stroke: coming home

Many people are first noticed to have vascular dementia after a hospital stay for stroke. If your loved one is homebound and needs therapy or skilled nursing, Medicare home health may cover part-time visits; a companion can cover the hours between those visits. Our page on care after hospital discharge and our comparison of companion care vs. home health care explain how the two work together.

Questions to bring to the next doctor visit

1. Is this vascular dementia, Alzheimer’s, or mixed? Would imaging or a Memory Disorder Clinic evaluation help?

2. What blood pressure, blood sugar and cholesterol targets should we aim for, and how should we track them at home?

3. Would physical, occupational or speech therapy help right now?

4. Are any medications adding to dizziness, falls or confusion?

5. Is it still safe to drive? Our guide on giving up the keys may help with that conversation.

Bring a log of what you’ve noticed between visits; our printable care log makes this easier. A doctor who sees a written record of good weeks and bad days can make better decisions than one who relies on a rushed recollection in the exam room.

Florida resources for vascular dementia

• Memory Disorder Clinics: Florida funds 17 clinics for diagnosis and referral, such as the Tallahassee Memorial HealthCare clinic, the Health First Memory Disorder Clinic in Melbourne, the Madonna Ptak Center in Clearwater, the Lee Physicians Group Memory Care Clinic in Fort Myers and the Broward Health Memory Disorder Center in Deerfield Beach.

• Caregiver support and respite: your local Aging and Disability Resource Center through the Elder Helpline, 1-800-96-ELDER, and the Alzheimer’s Disease Initiative.

• Alzheimer’s Association Helpline: 800-272-3900, for all types of dementia, including vascular and mixed.

Signs you need more help

• Any sudden change in speech, vision, balance or strength: call 9-1-1.
• Falls, or new trouble with stairs, bathing or getting out of a chair.
• Missed blood pressure or diabetes medications.
• Coughing or choking with food or drinks.
• Poor judgment with money, driving or cooking.
• Depression or withdrawal, which is common after stroke and worth raising with the doctor.
• A caregiver who is doing all the lifting and is getting hurt.

If physical care needs climb, compare memory care with a nursing home. Use our Florida cost guide to plan, and see our service areas.