Overview of Vascular Dementia Discussion

Write 6 pages on Vascular Dementia disorder. 1-This paper must include: Description of vascular dementia disorder. 2- Pathophysiology and neurophysiology of the disorder c. Typical clinical presentation d.Screening and diagnostic methods e.Evaluation, treatment and management plans f. Teaching/health promotion /follow-ups and referrals g. Risks to patient and society for non-compliance with treatment, if applicable. h. Role of the Advanced Practice Psychiatric Mental Health Nurse Practitioner. i. Christian Worldview Overview of Vascular Dementia Discussion

Vascular dementia disorder is a problem associated with reasoning, memory, judgment, planning, and other thought processes that could arise due to damage to the brain. The disorder arises due to the impaired blood flow to the brain, causing a stroke that blocks the brain arteries.  However, only severe stroke that affects the reasoning and thinking of the brain results in vascular dementia disorder. Other conditions that damage the blood vessels leading to a reduction in blood circulation to the brain also results in vascular dementia (Kalaria, 2018). Risk factors of vascular dementia disorder include the factors that deprive the brain of nutrients and oxygen. Other risk factors include the risks of stroke and heart disease such as smoking, high cholesterol quantity, diabetes, and high blood pressure. These risk factors when controlled lowers the risk of acquiring vascular dementia disorder.

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Pathophysiology and Neurophysiology of the Disorder

Factors such as the extent and nature of vascular pathologies, the degree of intracranial and extracranial vessel involvement, and the anatomical location where brain damage occurred determine the neurophysiology of vascular dementia disorder. The neurophysiology of the disorder is characterized by lacunar infarcts, arteriolosclerosis, diffused white matter, and subcortical and cortical micro-infarcts. The brain experiences myelin loss resulting in abnormalities, cerebrum focal degeneration, and brain atrophy (Kalaria, 2018). Lacunar infarcts, dilation of perivascular space, micro-infarcts, arteriolosclerosis, and amyloid angiopathy of leptomeningeal cerebral are all neuropathological predictors of vascular dementia disorder. These predictors define dendro-synaptic and neuronal changes that lead to cognitive deficits attributed to executive dysfunction of the brain.

Typical clinical presentation

Patients diagnosed with vascular dementia disorder always show signs of confusion and have trouble concentrating and paying attention. The patients may also show signs of reduced ability to take actions or organize thoughts into chronological order.  Patients with vascular dementia disorder also show signs of reduced ability to analyze the circumstances prevailing in their external environment (Smith, 2017). They are faced with the difficulty of evaluating the situation they face and thus cannot develop an effective communication plan to air their concerns and opinions about a given subject matter.

A patient with vascular dementia disorder also presents signs of difficulty in decision-making, memory lapse, too much agitation, restlessness, and unsteady gait. The patients may also show signs of too much apathy with issues and depressions. Some patients may show signs of frequent and sudden urge to urinate due to the decline ability to control the passage of urine.  The patient’s vascular conditions on thinking abilities will decrease in respect to the severity of the damage and the section of the brain that suffers damage (Smith, 2017). Patients with vascular dementia disorder also show the clinical manifestation of troubled speaking, difficulty in constructing speech, poor balance, difficulty walking, sudden headache, numbness and paralysis on one side or face of the body. Accumulation of brain damage results in multiple strokes that affect the blood vessels and brain nerve fibers.

Screening and diagnostic methods

            There are different approaches to diagnosis and screening of vascular dementia disorder based on a range of definitions of the disorder. Screening and diagnostic of vascular dementia disorder take into consideration the role of vascular factors in cognitive changes. Consequently, neurological testing can be used to diagnose vascular dementia disorder (Smith, 2017). This diagnosis method is conducted through a computerized test which gives a detailed evaluation of the cognitive skills such as memory, judgment, problem-solving, planning, and reasoning.

Another diagnostic method for screening a patient for vascular dementia disorder is magnetic resonance imaging, also known as MRI to take brain image. The MRI can be used to confirm the presence of stroke and any vascular changes in the brain with the severity and pattern of tissue damage that is consistent with cognitive impairment (Perneczky, Tene, Attems, et al., 2016). The screening also looks at non-vascular factors to ascertain the presence of factors that are not associated with a decline in cognitive ability. Overview of Vascular Dementia Discussion

Professional cognitive screening is also recommended to ascertain the situations that present a possibility, rather than a strong probability that the cognitive changes in the brain are caused by vascular factors. The professional cognitive screening should be done on all at-risk population especially those who have suffered r mini-stroke (TIA) (Smith, 2017). Professional cognitive screening should also target populations with blood vessel and heart disease.  The screening should also ascertain signs of depression among high-risk groups that may results in cognitive impairment, thus causing vascular dementia disorder.

Vascular dementia disorder may also be diagnosed through physical assessment of symptoms that could indicate signs of vascular dementia. The doctor may also take a full medical history on conditions such as strokes or high blood pressure (Perneczky, Tene, Attems, et al., 2016). Additionally, the physical assessment should examine mental abilities using cognitive tasks and questions. The doctor should also consult with friends and family members to evaluate past changes in behavior. Medical tests may also be conducted to check the function of balance, nerves, coordination, and reflexes.

Evaluation, Treatment, and Management Plans

Evaluation of signs and symptoms of vascular dementia begins with the review of areas that experience reduced blood flow to determine the extent of memory loss. In some cases, memory loss may mirror that of Alzheimer’s disease if the vascular damage affects the areas that store and retrieve information (Blumenthal, Cai, May, et al., 2017). Patients are also evaluated for clinical signs of uncontrolled crying and laughing, difficulty finding the appropriate words to use in a speech or to communicate, and impaired function while in social situations.

Currently, there is no drug approved for the treatment of the symptoms of vascular dementia disorder.  However, evidence-based practice form clinical trials show that drugs that treat the symptoms of Alzheimer’s disease can also be used to treat these symptoms (Blumenthal, Cai, May, et al., 2017). Essentially, the treatment of this disorder is aimed at reducing the continued presentation of the symptoms to prevent the worsening of the disease.  Therefore, the treatment of vascular dementia disorder targets diabetes mellitus, hyperlipidemia, and hypertension symptoms in the patients.

Vascular dementia treatment strategy also focuses on controlling the risk factors which could expose the brain blood vessels to further damage. Targeting the symptoms and risk factors of vascular dementia disorder during treatments also improves the treatment outcome by either preventing further decline in cognitive abilities or postponing the presentation of clinical signs and the manifestation of the disorder. Treatment plans for vascular dementia disorder should be developed with the help of a physician to manage the symptoms and circumstances that could cause the disease (Blumenthal, Cai, May, et al., 2017). Other treatment plans including physiotherapy, memory cafes, occupational therapy, and psychological therapy (Pimouguet, Le Goff, Wittwer, et al., 2017).

Teaching/health promotion /follow-ups and referrals

Since there is no approved treatment for disorder related to vascular dementia, it can only be managed through teaching, health promotion, follow-ups, and referrals for specialized care and advanced treatment. The health promotion strategies are aimed at encouraging the patient to stick to the care and treatment plan so that the symptoms and clinical presentation of vascular dementia disorder slow down (Pimouguet, Le Goff, Wittwer, et al., 2017). Conversely, the health promotion strategy should encourage the patient to eat a healthy diet, lose weight, stop smoking, and maintain physical fitness and regular exercise, avoid alcohol, prevent blood clots, take meals low on cholesterols, and always check blood pressure levels. Overview of Vascular Dementia Discussion

A patient is also advised to go for regular checkups, take medication as prescribed, and eat healthy food. Also, patients with vascular dementia disorder are supposed to engage in regular physical exercise, get enough sleep, and always avoid activities that could expose them to risks of falls and exhaustion. Consultation and psychiatrist consulting is also recommended for a patient with vascular dementia disorder. The patient should also remain open and share their progression with the disorder with their families to help them get relieved of stress (Pimouguet, Le Goff, Wittwer, et al., 2017). They should be provided with a caregiver to help them in physical activities such as cooking and bathing.  Dementia patients should seek the help of an occupational therapist and speech pathologist to help them in setting up their homes to increase their independence and reduce confusion.

            Follow-up after discharge involves treating the patient with antiplatelet agents and anticoagulants. The patients could also be given drugs that control serum glucose, blood pressure, and cholesterol. Most importantly, patients are advised to steak to an adequate diet and embrace lifestyle changes. Telephone calls, revision of medical records, family interviews, and patient reviews are used to ascertain the progress of the patient with the treatments as well as the status of life within the 24 months stress (Pimouguet, Le Goff, Wittwer, et al., 2017). For referrals, the dementia patient may also be subjected to a follow-p in a specialized neurology clinic for two years with regular visits. The patient may also be subjected to a periodic screening of all admissions to ascertain the recurrence of the condition.

Risks to Patient and Society for Non-Compliance with Treatment

            Non-compliance with the treatment of vascular dementia disorder results in more risk of recurrent stroke, less effective stroke prophylaxis, and high chances of death. The physicians may also be reluctant to prescribe effective drugs and supplements such as anticoagulants to non-complaint patients.  Non-compliance with the treatment of vascular dementia also leads to potential side effects and poor feasibility of the treatment and management plan.  Non-compliance with treatments also results in futile intervention among demented stroke patients (Blumenthal, Cai, May, et al., 2017). Such non-compliance may also result in a deleterious condition, degeneration of vascular, and dementing illness. The society may also face the risk of bearing the burden of caring and coping with the cognitive impairment and clinical manifestation of the disease which would worsen.

Role of the Advanced practice PMHN

            The Advanced practice PMHN plays the role of taking care of patients with vascular dementia disorder. The nurse provides both mental and physical health care through regular checkups, administering drugs (Moller, 2017). Advanced practice PMHN works with communities, individuals, groups, and families to assess their mental health needs. The nurse develops, implements, and evaluates the effectiveness of a nursing plan of care and diagnosis tool. The nurse also offers primary healthcare services, assess, conduct diagnosis, and treat patients with vascular dementia disorder through medication prescription and psychotherapy administration.

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Christian Worldview

The Christian worldview on dementia perceives a human being as a wholesome being in spirit, mental, physical, and emotional form. The Christian worldview of human nature perceives human beings as sacred and made in the image of God.  Christians also believe that whenever one is sic, God is the ultimate decision-maker on the fate of the patient (Rieg, Newbanks & Sprunger, 2018). The Christian worldview on vascular dementia disorder is compatible with the human properties theory which asserts that human beings are complete when their cognitive and physical body parts function effectively to gain moral status. The Christian worldview thus emphasizes the significant role of cognition, memory, perception, understanding, and thinking to be morally upright which patients with vascular dementia may be lacking. Overview of Vascular Dementia Discussion

The Christian worldview also attaches the intrinsic value and dignity of humanity which enables them to differentiate a wrong form a right. Thus, when a person suffers from vascular dementia disorder that affects the cognitive and physical abilities of the individual, Christians question the intention of God in accusing such an inability to the patient (Rieg, Newbanks & Sprunger, 2018). Based on this worldview, Christians believe that they have a moral obligation to foster positive relationships and treat patients with vascular dementia disorder with respect for life and human dignity. None the less, Christians have an eternal hope that patients with vascular dementia will experience improvement in the cognitive changes during recovery and rehabilitation (Rieg, Newbanks & Sprunger, 2018). Conversely, they are always driven to provide healthcare and caregiver support to patients with vascular dementia disorder.

References

Blumenthal, J. B., Cai, S., May, C., Scarinzi, G., Gernat, E., Mordecai, K. L., … & Intrator, O. (2017). Dementia Evaluation, Management, and Outreach. Federal Practitioner, 34(1), 42.

Kalaria, R. N. (2018). The pathology and pathophysiology of vascular dementia. Neuropharmacology, 134, 226-239.

Moller, M. D. (2017). Advancing the role of advanced practice psychiatric nurses in today’s psychiatric workforce. Current Psychiatry, 16(4), 15.

Perneczky, R., Tene, O., Attems, J., Giannakopoulos, P., Ikram, M. A., Federico, A., … & Middleton, L. T. (2016). Is the time ripe for new diagnostic criteria of cognitive impairment due to cerebrovascular disease? Consensus report of the International Congress on Vascular Dementia working group. BMC medicine, 14(1), 162.

Pimouguet, C., Le Goff, M., Wittwer, J., Dartigues, J. F., & Helmer, C. (2017). Benefits of occupational therapy in dementia patients: findings from a real-world observational study. Journal of Alzheimer’s Disease, 56(2), 509-517.

Rieg, L. S., Newbanks, R. S., & Sprunger, R. (2018). Caring from a Christian Worldview: Exploring Nurses’ Source of Caring, Faith Practices, and View of Nursing. Journal of Christian Nursing, 35(3), 168-173.

Smith, E. E. (2017). Clinical presentations and epidemiology of vascular dementia. Clinical Science, 131(11), 1059-1068.Overview of Vascular Dementia Discussion