Tag Archive | multi-infarct dementia

Profiles In Dementia: Winston Churchill (1874-1965)

Winston Churchill Vascular DementiaWinston Churchill had a health profile most of his adult life that pointed to the inevitability of cognitive impairment in his later years.

Churchill was an alcoholic (during War War I and II, when the British needed strategic decisions to be made in the middle of the night, an inebriated Churchill was in the thick of things because even drunk he apparently was a better strategist than most of his sober peers).

Churchill also had chronic and worsening hypertension, in part from stress and in part from an unrestrained diet of much rich and artery-clogging food.

As early as 1947, Churchill’s physician, who was complicit in the lies about Churchill’s health all the years he held public office and who propped him up with amphetamines and calmed him down with depressants, noted in his diary that “[Churchill] is no longer fertile in ideas…his once-teeming mind has run dry.”

Beginning in 1948, Churchill began to regularly experience TIA’s in different parts of his brain. Accompanying the mini-strokes, at times, was temporary numbness on one or the other sides of his body, which resolved in a few hours or a few days.

Churchill would also experience the temporary dysphasia in the 30 minutes to an hour afterward that is characteristic of TIA’s, but the language center of his brain was spared permanent damage until his last major stroke in 1953.

With amphetamines and carefully scripted speeches, therefore, Churchill was able, at least from a verbal aspect, to hide the neurological damage and the cognitive decline that those closest to him were aware was progressing rapidly.

But the signs were everywhere in retrospect. Churchill’s speeches and governing were rooted in the first and second world wars. He was glaringly oblivious to post World-War-II politics, issues, and legislation.

He was literally in the-all-too-common vascular dementia time warp of the past and increasingly unaware of the present and had no concept of the future.

With his doctors and his staff carefully concealing his progressing dementia from the public, Churchill managed to limp along in office through continuous TIA’s and three major strokes, until 1955, when he finally resigned because his cognitive impairment and the physical effects of the strokes and dementia were impossible to conceal anymore.

Churchill lived for 10 more years, but vascular dementia was his constant companion and as it progressed, he retreated and regressed until he remembered no one and nothing and it was impossible to see the man he’d been at the zenith of his life.

 

 

Profiles in Dementia: B. B. King (1925 – 2015)

B. B. King 2014The blues were born in the Mississippi Delta shortly before the dawn of the 20th Century. The genre, known for its stories of hard times and suffering, originated with African-American sharecroppers who endured long, hot and hard labor picking cotton in the sweltering heat of the summer sun, lived in squalid conditions, and were kept in manipulated indentureship and perpetual debt by never quite making enough money to pay off their bills at local merchants.

While a few blues artists – Robert Johnson, W.C. Handy, Bessie Smith, and Billie Holiday – brought the sound of the blues into the mainstream of music during the first half of the 20th Century, it was not until the late 1940’s and early 1950’s that blues blossomed and hit its stride as a bona fide genre of American music.

Among now-familiar names like Lead Belly, Howlin’ Wolf, John Lee Hooker, Elmore James, and Willie Dixon emerged a young Mississippi Delta bluesman named B. B. King

An accomplished guitarist with an one-of-a-kind voice that wrung out every bit of pain, sorrow, and pragmatism that the blues had to offer, King, in many ways, became the face of the blues for a lot of America.

While blues artists had a profound influence on rock – British artists of the 1960’s drew heavily on their influence and vast body of work and groups like the Yardbirds, Cream, and Derek and the Dominos, fronted by Eric Clapton, were the crossroads where blues and rock met and married, producing generations of rock-blues musicians that continue today (listen to Nirvana’s haunting acoustic version of “Where Did You Sleep Last Night?,” and it’s as though you can hear Lead Belly singing along in the background) – in general, they continued to exist, much like jazz musicians, in a popular, but tightly-defined, niche in the landscape of popular American music.

Except for B. B. King. With his famously-named guitar – Lucille – and his showmanship as a guitarist, along with highly-accessible songs, including his eponymous “The Thrill Is Gone,” King managed to gain a large popular audience. 

Young B. B. King B. B. King stayed on the music circuit, performing along the way with artists like Clapton, The Rolling Stones (King opened for them on their 1969 tour), and U2, despite battling diabetes and high blood pressure for decades.

In the last few years, blues fans have consistently pointed out that B. B. King’s performances were erratic at best: King missed musical cues, forgot lyrics, and often went into long, rambling, and random soliloquies while onstage.

B. B. King’s last performance was on October 3, 2014 in Chicago. However, the performance had to be cut short because King wasn’t feeling well enough to continue. He was hospitalized with dehydration and exhaustion.

On May 1, 2015, after two hospitalizations due to complications from diabetes and blood pressure, B. B. King’s website announced that King had entered hospice care at his home in Las Vegas.

On May 14, 2015, B. B. King died. The official cause of King’s death was complications from dementia (vascular dementia).

Sadly, B. B. King’s family has already begun the legal fight over who will control his estate (there are allegations that King’s long-time manager, Laverne Toney, whom King appointed as his power of attorney, mishandled King’s care and money).

It’s a tragic footnote to an incredible life.

 

The Layperson’s Guide to Vascular Dementia, Multi-Infarct Dementia, Small Vessel Ischemia, and TIA’s

There are many kinds of dementia. In the next few posts, we’ll take a look at a few of them, along with Alzheimer’s Disease, which is a distinct neurological diagnosis from dementias.

Before we start, it is important to note that our loved ones can suffer from only Alzheimer’s Disease or only one kind of dementia. Or they may suffer from Alzheimer’s Disease and multiple kinds of dementia. That distinction is important to loving caregiving, which includes medical advocacy for our loved ones, because each brain disease is distinct, affects the brain differently, and has specific characteristics and symptoms and treatment.

I will admit here that one of my pet peeves while caring for my mom was hearing some people who have no real knowledge of these diseases lump everyone who suffers from them under Alzheimer’s Disease and giving advice on how to deal with that, not realizing the complexity of the situation posed by the presence of both dementias and Alzheimer’s Disease.

So, for non-caregivers or those who are unfamiliar and inexperienced with these diseases who may be reading this, please don’t assume because you’ve seen or read The Notebook that you’re an expert on the subject and please don’t offer medical diagnoses and advice.

The best gift you can give is to just listen and offer non-medical support. Most caregivers get so deep into the details and all the aspects of these diseases because they need to be able to take care of their loved ones in so many ways that if there were such a thing as a non-M.D. expert on them, most caregivers would qualify.

This post will discuss vascular (multi-infarct) dementia. The cause of this dementia is small vessel ischemia in the brain, which presents itself as chronic transient ischemic attacks (TIA’s). TIA’s are sometimes also referred to as mini-strokes.

TIA’s can occur when the small vessels in the brain get temporarily blocked, cutting off the blood supply and oxygen to that part of the brain. The cumulative affect of these is what causes the damage that is present in vascular dementia. Multi-infarct dementia just means that there are many areas in the brain where this vascular damage has occurred and accrued.

Although high blood pressure is a culprit, high levels of stress and a history of migraines are also players in these kind of TIA’s.

In my mom’s case, all three were factors, but high levels of stress were what brought on the majority of her TIA’s. I suspect she started having these as a small child, because there were times that she just couldn’t remember what happened in a specific instance but she’d referred to it as “blacking out.”

She never lost consciousness with them that I witnessed, but she used the same expression to describes times when we kids were all babies and she was under a lot of stress and she couldn’t remember certain instances of things.

Her TIA’s were common as we grew up, and although we never got over the shock of the suddenness of symptoms and the helplessness we had to do anything about it, we all got pretty good at taking care of her when she had one, and that lasted for Daddy until his death, and for me into adulthood until Mama’s death.

Her TIA’s always presented the same way. They were sudden. Her face would lose all color and her lips would get very pursed as she seemed to salivate more. There was a sort of paralysis except for her right hand. She would start rubbing her thumb across the first two fingers and that would last until the episode was over. I suspect there was a sense of unreality associated with the TIA, so the feeling of her fingers rubbing together was the only reality for her in those episodes.

I’d always hold Mama’s left hand and kind of stroke it so she knew I was there and she wasn’t alone. When the TIA was over, she’d immediately try to talk and everything came out totally garbled. That would last about thirty minutes and then she’d be okay.

And she never remembered them happening. I remember the first time I was giving her medical history as her POA at an ER (and this was way before the dementias and Alzheimer’s Disease) and I named TIA’s as part of her medical history and she disagreed with me and said she didn’t remember ever having those. I laughed at the time and told her that not remembering them was part of the symptom of having them.

small-vessel-ischemia-brain-mriOver time, though, as small vessel ischemia recurs, eventually clusters of damage occur in the brain. This disrupts the normal neurological pathways of how information is learned and communicated. One of the most clear indicators of vascular dementia is difficulty in communication. One of these difficulties is misnaming things.

For example, the brain knows that a pencil is a pencil. Someone suffering from vascular dementia knows a pencil is a pencil. But because of the damaged pathways, there is often a break in the connection between knowledge and speech, so someone with vascular dementia is just as likely to call a pencil an apple.

Another clear indicator of vascular dementia is slower processing time. A brain with vascular dementia will fight to reroute stored information to speech. However, because of the extensive damage, it has to take a much more convoluted and lengthier route to do that conversion.

A third clear indicator of vascular dementia is that it occurs in sudden, steep steps of decline (brought on by recurrent TIA’s and new clustered areas of damage in the brain). These can occur in a very short period of time, as they did in my mom’s case.

In addition to these definitive indicators, vascular dementia also has features in common with other dementias, including difficulty learning anything new, cognitive impairment, problems with short-term memory, extreme emotional swings, and confusion.

There are no specific treatments for vascular dementia. Unlike any other organ in the body, once the brain has sustained damage, that damage is permanent.

However, there are medications that can address the symptoms of vascular dementia. The two most likely to help are cognitive enhancers: Excelon (although this comes in oral form, the 24-hour patch is best, if there’s no allergic reaction, to get the continual effect of medication that comes in a starting dose of 4.6 mg, a stabilizing dose of 9.5 mg, and a high dose at 13.3 mg)  and Namenda (given in 5 mg increments, two to three times a day).

When I discuss the medications in later posts, I will give some practical experience and advice on these two medications, especially with regard to Medicare, the “donut hole,” and working with your loved one’s psychiatrist to get the medication at either no charge or a reduced rate during the “donut hole” period. Both of these are patented, so there’s no cheaper generic version. And paying full price for them will break the bank.

In the next post, we’ll take a look at Lewy Body dementia: what is is, how it’s diagnosed, what it looks like, and effective treatments for the symptoms.