The third type of Vascular Dementia (VD) or VCI is Subcortical Vascular Dementia or what is known as Binswanger’s Disease. It is a very rare form of Dementia. According to NINDS, it involves extensive microscopic damage to the small blood vessels and nerve fibers that make up white matter.
White matter is the “network” portion of the brain. It is believed to be critical for relaying messages between the regions of the brain (like a superhighway if you will).
You client may present with symptoms that are related to the disruption of the subcortical neural circuits. The disruptions will affect their short-term memory, organization, mood, attention, decision making and will alter their behavior so that they may act out inappropriately. Psychomotor slowness is a characteristic feature of Binswanger’s and involves an increase in the time it takes for your client to think of a specific letter and be able to write it down on a piece of paper.
The troubles don’t stop there though. Your client may present with a whole host of other symptoms. They may include urinary incontinence that is unrelated to a urinary tract condition. They may show that they are having trouble walking; they become slow and clumsy. They may lack facial expression and have speech difficulties.
Binswanger’s disease symptoms tend to begin after the age of 60, so you may not see any vast changes since they may have already been set into play, but they may tend to progress in a stepwise manner. In addition to the vast list of other symptoms, people with Subcortical Vascular Disease often have high blood pressure, a history of stroke, or evidence of disease of the large blood vessels in the neck or heart valves. Doctors are currently treating people with this disease by attempting to prevent additional strokes. They most likely will also try to prescribe meds to control blood pressure.
Subcortical Vascular Disease is a very difficult type of Dementia. Many things ride on this diagnosis; medical issues as well as emotional and psychological issues. You will have your hands full; need a lot of patience – and prayer. But, no matter what, your client did not choose this – and it could happen to you, so just remember to provide dignity by always displaying that With Age Comes Respect!