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Q1: A relative of 86 was diagnosed with vascular dementia in another part of the country before moving here to the North of England. His current GP says there is no point in subjecting him to more memory tests etc as nothing can be done for this form of dementia. If this is the case, I agree with her and we have let the matter rest.

I am not clear, however, whether the drugs mentioned in your article, Dementia: a distant memory, are strictly for treating Alzheimer’s or can be used in vascular dementia. If the latter, perhaps we should revisit the issue. What would be involved and how are “middle-stage, moderately severe symptoms” defined? My relative could afford to be treated privately if the drugs could be used effectively at an earlier stage, which is where I suspect he is now. Name and address withheld.

A: Vascular dementia is the result of brain tissue being progressively starved of essential supplies of oxygen and other nutrients. The usual cause for this ever-increasing brain damage is multiple small strokes. The essential first step in treatment is to try to prevent any increase in the cerebral vascular disease. Blood pressure should be checked and normalised, statins taken to improve the structure of the blood vessels and to lower serum cholesterols and I would also always recommend a visit to a neurologist to see if there are other measures he could recommend.

Three drugs, Aricept donepezil, Exelon rivastigmine and Reminyl galantamine, are all drugs that can be used to treat mild dementia of any origin as they may produce some improvement in a patient's memory. Aricept has even been shown to improve the memory of young people, for example students, airline pilots and city workers, who have no history of dementia or of any troubles that could have caused brain damage. When these drugs can't be prescribed on the NHS by a doctor specialising in dementia because the patient hasn't got dementia that is sufficiently severe they may be obtained by getting a private opinion.

The definition of the various stages of severity is partly determined by the score a patient achieves by doing a simple intelligence test called the Mini Mental State Examination.

The seven-stage system of assessing dementia would describe symptoms of moderate dementia, stage four in this classification including an inability to manage personal affairs, becoming easily agitated, having an obvious loss of intellectual ability, a loss of knowledge and interest in current affairs.

Moderately severe is stage five in the seven stage classification and includes being unable to dress, being incontinent, forgetting major and important family events, being unable to live alone safely.

For those doctors who divide dementia into three grades, those in the middle grade are described as showing forgetfulness of recent events, people's names, confusion over time, day and place and an inability to recognise familiar surroundings. These patients also have difficulties in conversation including abnormal repetitiveness and poor comprehension of other people's remarks. In this stage the patient is likely to be indifferent to personal hygiene and appearance, to be messy around the house, depressed and easily moved to anger, aggressiveness and occasionally to paranoid thoughts.

It is always worthwhile having the opinion of an expert on dementias if there's ANY chance of an improvement. If commonly used anti-dementia agents would be likely to help, a trial of them is worth paying for provided that the reader can afford it, as our reader says he can.

Q2: In you final lines of the article (November 1) you mention Exelon patches. Please are these able to be purchased privately or can you get them from a supplier or does one go via the the Doctor. By your saying, "The good news is ..." I presumed the NHS could be bypassed by paying. Many thanks. Arthur Wilman.