From: sheriffcoltrane23x@gmail.com   
      
   Slow and insidious' mini strokes cause vascular dementia   
   Vascular is the second leading form of dementia in Canada, affecting about   
   100,000 people   
   Keith Beaty / Toronto Star file photo   
   Vascular dementia is often caused by a series of small, silent strokes. Early   
   signs include reduced ability to solve problems or multi-task.   
   Published on Feb 24 2011   
   Judy Gerstel   
   A decade before Don Engel was diagnosed with vascular dementia at the age of   
   65, following a stroke, he knew something wasn't quite right.   
   Occasionally, he recalls, "I lost control of where I was and where I was   
   going."   
   Now, at the age of 80, the retired shop teacher and Woodstock resident is on   
   medication that helps with the symptoms of vascular dementia.   
   He's been able to get back to woodworking, his hobby for more than 30 years.   
   Before, he says, "I'd go down to my shop to do woodworking and when I looked   
   at the table saw, there seemed to be two blades instead of one."   
   But, he admits, even now, "Reading an article and trying to figure out what   
   they are talking about, that's a whole different story. Trying to write a   
   letter, that'd be a horrible job."   
   Engel is one of about 100,000 Canadians with vascular dementia.   
   It's the second most-common form of dementia after Alzheimer's, affecting 20   
   per cent of the half a million people in Canada with dementia.   
   And while the causes of Alzheimer's are not well understood, it's known that   
   vascular dementia is caused by strokes, often a series of small, "silent"   
   strokes.   
   As well, although the early stage of Alzheimer's is characterized mostly by   
   memory loss, says Baycrest senior scientist Carol Greenwood, vascular dementia   
   affects executive function, multi-tasking, problem-solving and reasoning.   
   When most people think of a major stroke, says Greenwood, they're aware that   
   there's been damage and that something has happened.   
   But the undiagnosed, small, silent strokes that result in mild cognitive   
   impairment leading to vascular dementia are "slow and insidious," explains   
   Greenwood.   
   They're not uncommon.   
   "By age 63, one in 10 people have already had these tiny strokes," says Dr.   
   Vladimir Hachinski, a clinical and research neurologist at the University of   
   Western Ontario and an internationally recognized expert on stroke. "With each   
   decade, the numbers go    
   up. And people who have had silent strokes are more likely to have bigger   
   strokes.   
   "For each stroke that is diagnosed, five more go undetected."   
   How can these tiny strokes with no symptoms be detected? "We should take any   
   change in cognitive ability seriously and not just attribute it to old age,"   
   says Hachinski. Any change, regardless of age, should be investigated -- for   
   example, "ability to    
   play chess or bingo, navigating around the city, or doing taxes."   
   Testing for small strokes includes a physical exam, a history and a cognitive   
   screening test, described by Hachinski as "very sensitive," called MOCA   
   (Montreal Cognitive Assessment).   
   MOCA will indicate if executive function has been impaired, Hachinski says. If   
   strokes are suspected, a CT scan will detect them.   
   Hachinski insists that more must be done to diagnose silent small strokes and   
   mild cognitive impairment before they worsen. He describes them as "a coming   
   menace," referring to our aging population.   
   "I'm very worried," he says. "We need a radical rethinking of all this. We   
   have to get smarter about it."   
   He suggests that individuals, family members and physicians need to be more   
   aware of the possibility that people over the age of 60 might be experiencing   
   these small strokes.   
   "We have to pick up on it when it's causing only small things to go wrong," he   
   emphasizes. "We can do something about stroke. We could prevent 80 per cent of   
   all strokes by treating risk factors."   
   The most dangerous risk factors are high blood pressure and diabetes, followed   
   by obesity, high cholesterol, and being overweight.   
   And the single most protective thing we can do, for both mind and body,   
   Hachinski says, is exercise -- and there's no need to overdo it. "Moderate   
   exercise has the biggest gain for effort," he notes.   
   Don Engel knows how important it is to stay active and exercise. "I feel the   
   exercise gets the blood moving and gets more oxygen to the brain," he says.   
   "It does something for you. You can feel the difference."   
   Although he still volunteers at the local seniors' centre, Engel doesn't get   
   out the way he used to and spends much of his time caring for his wife   
   Barbara, who has arthritis.   
   "She can do a lot of things by herself," he says, "but I don't like going out   
   and leaving her by herself, because she did fall awhile back and broke her hip.   
   "I feel I have to be here to make sure she gets along."   
   The facts on vascular dementia   
   Q: What is the difference between Alzheimer's and vascular dementia?   
   A: Dementia is the description of a problem with memory and thinking. The   
   ability to do normal activities, such as banking or finding your way around,   
   is affected. Alzheimer's is the leading cause of dementia. Vascular dementia   
   is the second-leading    
   cause. Parkinson's can also cause dementia. Alzheimer's is caused by amyloid   
   plaques in the brain. Vascular dementia is caused by repetitive strokes. A   
   combination of Alzheimer's and vascular dementia may soon overtake Alzheimer's   
   as the leading cause. --   
    University Health Network neurologist David Tang-Wai.   
   Q: How can it be determined whether Alzheimer's or vascular dementia is the   
   problem?   
   A: Imaging scans can determine whether strokes have occurred in the brain.   
   Family history also helps suggest the cause of the dementia. Memory is often   
   most affected by Alzheimer's, while executive function, such as reasoning and   
   multi-tasking, is most    
   affected by vascular dementia. However, a recent study found that most   
   neuropsychological tests don't distinguish Alzheimer's disease from vascular   
   dementia.   
   Q: What are the risk factors for vascular dementia and what can be done to   
   prevent it?   
   A: High blood pressure and diabetes are the major risk factors for the strokes   
   that cause vascular dementia.   
   A recent study published in Archives of Internal Medicine found that heavy   
   smoking in midlife is associated with a 172-per-cent increased risk of   
   developing vascular dementia (and a 157-per-cent increased risk of developing   
   Alzheimer's disease).   
      
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