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Dementia

Is Slurred Speech a Sign of Vascular Dementia?

Strokes can cause problems with speech, walking, strength, thinking, and memory.

Most people know that strokes can cause one side of the face to droop, weakness of an arm or a leg, trouble walking, and slurred speech. Did you know that strokes can also cause dementia?

Strokes occur when an artery sending blood from the heart to the brain becomes blocked off; that part of the brain doesn’t receive enough blood and dies. Most strokes occur in an instant. Similar to a heart attack, strokes are an emergency because treatment works best when instituted immediately. We say act FAST when you notice a stroke, using the mnemonic below:

  • Face: Ask the person to smile. Does one side droop?
  • Arms: Ask the person to raise both arms. Does one drift downward?
  • Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
  • Time: If you observe any of these signs, call 911 immediately.

http://www.stroke.org/understand-stroke/recognizing-stroke/act-fast

Strokes are often called vascular disease or sometimes cerebrovascular disease to emphasize they are affecting blood vessels of the brain or cerebrum. When people have a number of strokes—or occasionally even one if it affects a critical brain region—they can develop problems with thinking and memory. If the problems are mild and function is normal, we call it vascular cognitive impairment. If the problems are severe enough to affect day-to-day function, it is called vascular dementia.

The symptoms of vascular dementia are somewhat different from the symptoms of Alzheimer’s. Although trouble with memory is often present in vascular dementia, the most prominent problems include difficulties paying attention, processing information, and planning activities, impulsivity and poor judgment, slurred speech, and impaired language.

To make a diagnosis of vascular dementia, the symptoms must represent a decline from one’s prior level of functioning, confirmed with objective pencil and paper tests, and be due to strokes. Strokes can be seen on an MRI or CT scan of the brain.

Can you have had a stroke and not know it? It turns out that the most common type of stroke is silent. When small blood vessels of the brain become damaged and then occluded after years of the blood pumping against them, it causes tiny, almost microscopic strokes. When many of these tiny strokes are present, we call it, small vessel ischemic disease. The majority of people that I see have some degree of small vessel ischemic disease by the time they are in their 60s, and it is more common in older age.

If you have any of the risk factors below, you are at increased risk for stroke. The good news is that, with the exception of age, you can take charge of your life and reduce your risk of stroke. Work with your doctor to make sure that your medical conditions are under good control. If you are smoking, quit today. Learn how to exercise for better health, eat a healthy diet, and keep a healthy weight. Lastly, if you drink alcohol, drink in moderation.

Major Risk Factors for Stroke

Medical factors

  • Prior stroke
  • Prior stroke warning sign (transient ischemic attack, or TIA)
  • Heart disease
  • Disease of other blood vessels in the body
  • Diabetes
  • High cholesterol
  • High blood pressure

Lifestyle factors

  • Smoking
  • Sedentary lifestyle
  • Unhealthy diet
  • Obesity
  • Alcohol more than 1 drink per day for a woman or 2 drinks per day for a man

Uncontrollable factors

  • Old age: after age 55 the stroke risk doubles every decade

Can you diagnose a stroke or vascular dementia just by observing someone? Well, on the one hand, you can certainly know that someone’s thinking and memory have declined if you have observed them over time and can clearly see that they are showing new problems with impulsivity, attention, judgment, speech, language, memory, and/or their abilities to process information, solve problems, and plan for the future. On the other hand, without a proper evaluation including a history, neurological exam, pencil and paper testing, and a brain scan, you cannot know the cause of their decline.

I was recently at a conference where I saw one of my older colleagues with new slurred speech and difficulty walking. I was sure that he had a stroke, and I even speculated where in the brain it was. When I returned home I mentioned this to a friend who informed me that, no, he actually developed hip and knee arthritis as well as tongue cancer that required removal of part of his tongue, causing the slurred speech. It was a good lesson to me, to not try to diagnose someone without a proper evaluation.

© Andrew E. Budson, MD, 2017, all rights reserved.

References

Budson AE, Solomon PR. Memory Loss, Alzheimer’s Disease, & Dementia: A Practical Guide for Clinicians, 2nd Edition, Philadelphia: Elsevier Inc., 2016.

Budson AE, O’Connor MK. Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It, New York: Oxford University Press, 2017.

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