It Isn't A Stairway (to Hell)

by Heidi Sandstrom

When I first started reading about dementia back in 2013, I wanted to understand the prognosis.  Various websites told me that vascular dementia followed a progression of stair steps.  For example, this note at Dementia Care Central: "Symptoms of vascular dementia may have a sudden onset if they are related to a stroke or mini-stroke. People with this type of VaD, sometimes called multi-infarct dementia, have a so-called “stepwise” progression of their symptoms, meaning that their symptoms stay the same for a while and then suddenly get worse."
And this from the Mayo Clinic:  "Sometimes a characteristic pattern of vascular dementia symptoms follows a series of strokes or ministrokes. Changes in your thought processes occur in noticeable steps downward from your previous level of function, unlike the gradual, steady decline that typically occurs in Alzheimer's disease dementia."

Well, it ain't necessarily so.
I discovered that decline is not always completely declined.  Sometimes the person with vascular dementia takes a step up -- the brain finds a work around.  This can be disconcerting.  He may be able to do something one day that he wasn't able to do the day before.
I found in my caregiver's forum that I'm not the only one with this experience -- that people talk about their spouses going from stage 4 back to stage 3.
For example, three days ago Will didn't read anything all day.  He just sat and watched the world out the window.  Then, last night, I came home from the church movie I host and found that he was reading away and he continued reading until after 9:00 pm.
There's also the experience of the person with dementia being "on stage:"  being able to rise to occasions and perform more normatively in front of others, like doctors.  This can create issues for people who are trying to get a diagnosis in order to make their shared lives function more smoothly. 
Dementia care central is correct, however, in saying that the unpredictable "stepwise" progression, whether or not it continuous or shifty, "can be a challenge for caregivers."

By Priscilla du Preez

The dementia journey can be more like a roller coaster than a walk down the stairs.