What is mixed dementia?

‘Mixed dementia’ is a condition in which a person has more than one type of dementia. Alzheimer’s disease and vascular dementia is the most common type.

Other combinations of dementias are also possible – particularly Alzheimer’s disease and dementia with Lewy bodies.

Man smiling in a garden

A mixed dementia diagnosis

Understanding vascular dementia

At least one in every ten people with dementia is diagnosed as having more than one type. Mixed dementia is much more common in older age groups, such as those over 75 years.

Despite many older people having both Alzheimer’s disease and vascular problems, relatively few are diagnosed with ‘mixed dementia’. Doctors tend to only use the term ‘mixed dementia’ when a person has clear clinical features of two types of disease that directly contribute to dementia symptoms.

What are the symptoms of mixed dementia?

Symptoms of mixed dementia vary depending on the types of dementia a person has. Often someone will have a greater amount of one type of dementia than another. In such cases, we talk about this type being ‘predominant’.

Common types of mixed dementia

Occasionally, mixed dementia can be a combination of three types of dementia-causing disease. But most diagnoses tend to be a mixture of two types. Here, we look at two common types of mixed dementia – Alzheimer's disease and vascular dementia, and Alzheimer’s disease and Lewy body disease.

Alzheimer’s disease and vascular dementia

This is the most common type of mixed dementia. The person affected has two different diseases in their brain that contribute to their dementia symptoms.

Understanding Alzheimer’s disease

Alzheimer’s disease is caused by a build-up of faulty proteins in and around brain cells – particularly cells that help to form memories. Earlier stages of Alzheimer’s disease are strongly associated with memory problems, language difficulties, and becoming confused more easily.

Our dementia advisers are here for you.

The ‘vascular’ part of mixed dementia is caused by problems with the supply of blood throughout the brain. Sometimes this can be caused by having a stroke or a series of mini-strokes. In other cases it can be due to a more gradual deterioration of small blood vessels over many years. Vascular disease prevents brain cells from getting enough oxygen and nutrients.

These are needed to function properly. The symptoms of vascular dementia depend on what part of the brain is affected. Generally, the condition tends to result in much slower processing of thoughts and information, difficulties with planning or problem-solving, and trouble concentrating for more than a short period.

Alzheimer’s disease and Lewy body disease

Less often, dementia can be caused by a mixture of Alzheimer’s disease and Lewy body disease.

Understanding Lewy body disease

Lewy bodies are the clumps of faulty proteins that build up in the brain cells of people who have Parkinson’s disease or dementia with Lewy bodies. Lewy body disease has quite distinct features not seen in the other dementias.

It tends to affect different parts of the brain that control body movement and processing of sensory information. People with Lewy body disease often have very disturbed sleep and visual hallucinations. They may also experience rapid ‘fluctuations’ in their ability to function properly, feeling confused or disorientated quite suddenly. Memory tends to be less affected than in people with Alzheimer’s disease.

What are the treatments for mixed dementia?

There is currently no cure for any type of dementia, including mixed dementia. Drugs and other treatments can help maintain a better level of cognitive function for longer. This does not stop the underlying damage happening in the brain.

Medication for mixed dementia

The most common kinds of medication used to treat mixed dementia are cholinesterase inhibitors. These boost levels of a chemical in the brain that helps cells communicate with each other. Unfortunately, there’s currently no medication that can improve the symptoms of vascular dementia. However, someone with vascular disease may be able to prevent strokes or other ‘events’ by continuing to take their medication for high blood pressure or diabetes.

Therapies for mixed dementia

As well as drug treatments, there are other therapies that may help to improve function or quality of life. These include cognitive behavioural therapy, cognitive stimulation therapy, cognitive rehabilitation, and reminiscence therapy. Learn more about the different approaches for coping with memory loss. A person with mixed dementia involving Lewy body disease may be offered physiotherapy to help with movement problems.

More practical and emotional support near you

There are dementia services and support groups in your area. Find out what's available where you are.

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Is it normal to hear voices in your head with Alzheimer’s disease? Thank you

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Hi Kerry,

Thanks for your comment.

People with Alzheimer's disease, or in fact all forms of dementia, can experience what is called auditory hallucinations. This means hearing things that aren’t there, like voices or footsteps, and it can be quite common.

But if auditory hallucinations are causing a person with dementia distress they can be addressed to some extent with a range of non-drug approaches and good person-centered care.

In the case of mixed dementia (which this article is about) it might be that, in addition to having Alzheimer’s disease, a person may have another type of dementia that is more strongly associated with hallucinations - such as dementia with Lewy bodies.

This should really be discussed with a clinical team providing post-diagnostic care as it could affect the way a person's condition is managed.

We have further information on our website about hallucinations, with lots of practical advice, which you may find useful: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/hal…

We hope this helps.

Alzheimer's Society knowledge team

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My husband was diagnosed with Vascular Dementia/
Pick's Syndrome 7 years ago following a massive Ischemic Stroke on his left side! He is at home and completely bedridden now I am his caregiver he is 69 ! He is still very witty with his sense of humor but his language is quite fowl this has been happening more often and he still believes his life is still the way it was before the Stoke !
I can see the decline in him more in the last year he does have a nurse and his Doctor that comes to the house quite frequently .He is having a hard time sleeping at night again and he can be aggressive at times ! I would like to know more about the regression of Pick's syndrome if possible!
I am very concerned he still knows who I am and our children although sometimes he thinks our Granddaughter is our daughter and our daughter is me when I was younger!

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Hi Barbara, thanks for getting in touch.

The best place for dementia information specific to your situation is the Dementia Connect support line. Call on 0333 150 3456 to speak to one of our dementia advisers - they can listen to your husband's situation and offer information and support. More details about the support line (including opening hours) are available here: https://www.alzheimers.org.uk/dementia-connect-support-line

In the meantime, we have some information on Pick's disease, which is also known as Frontotemporal dementia (FTD) or frontal lobe dementia. It is one of the less common types of dementia. You can read about it here: https://www.alzheimers.org.uk/about-dementia/types-dementia/frontotempo…

To learn more about the progression of dementia, we have further information on our website here: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how…

We hope this helps, Barbara. Please do call our support line to speak with an adviser about receiving more dementia information, whether its digital copies or paper copies in the post.

Alzheimer's Society blog team

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Hi all. My father in law was diagnosed with mixed dementia last year. It's been very difficult for us (my husband and I) to ensure he is ok. My sister in law is abroad teaching and my mother in law passed away this year also. We both work full time and just do not know where to turn for help/support. He says he is going to get better, we do not discuss this with him. He gets very down and very sorry for himself. This may seem an awful thing to say but he hasn't been the most 'kindest' father to my husband even before the diagnosis. He will call my husband at work 3/4 times a day, and they won't be pleasant calls. I suppose what I'm hoping for is advice for us for support. I know this sounds awful as we are the carers, but it does take its toll on us , especially my sons husband who is so very patient and kind with my father in law. Thank you for any advice given.

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Hi Sarah,

Thanks for your comment, and sorry to hear you've all been having a difficult time.

We'd recommend speaking with one of our dementia advisers by calling the Dementia Connect support line on 0333 150 3456. (More information about the support line, including opening times, can be found here: https://www.alzheimers.org.uk/dementia-connect-support-line)

You may also benefit from talking with other people affected by dementia within our online community, Talking Point. Feel free to browse and read others' experiences, or create an account to reply and connect with others. You may find similar situations to yours and your father in law's shared there: https://forum.alzheimers.org.uk/

Please do call the support line on 0333 150 3456 if you need to speak to someone during this challenging time.

Best wishes,

Alzheimer's Society blog team

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Hi all. I haven’t been diagnose with anything Yet or seen a doctor for that matter however I’m keen to get some advice. I am 44 and suffering with increased appetite, memory loss as in I can’t remember a conversation that I’m actively taking part in sometime. Disturbed sleep, Memory loss with names, dates, days sometimes too. Within work some actions I’ve been asked to do, checks I would instinctively have done before but That don’t Even enter my mind now, I’m getting increasingly frustrated with myself for not doing what I’m capable of and wondering if this is something I need to get looked at ? Any guidance gratefully accepted.

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Hi Hilary,

Thanks for your comment and sorry to hear you've been experiencing these symptoms. It sounds really difficult and frustrating for you.

Everybody forgets things from time to time and memory problems do not always mean dementia. But if you are noticing problems with your memory, it’s important to speak to a GP. It’s important to find out the reason for the problems as there may be treatment or support available to you that can help.

You can also call our Dementia Connect support line on 0333 150 3456. One of our trained dementia advisers can learn a bit more about how you've been feeling and give advice and support. You can find more details of the support line here: https://www.alzheimers.org.uk/dementia-connect-support-line

We also have lots of information on our website that you may find useful, including this page on memory problems: https://www.alzheimers.org.uk/memoryproblems

Hope this is helpful, Hilary, and please do speak to a GP if you're worried.

Thanks,

Alzheimer's Society blog team

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Think it’s a good idea to get tested sooner rather than later. I’m glad I did as got my diagnosis when in the early stages and have medication, information, advice and support, plus I can make improvements to my lifestyle, and live as well as I can whilst my dementia progresses (early stage of Alzheimers at age 68 and retired for a year).
Is scary and would rather know and do what I can to help myself to cope, and to live as well as I can. I do talk about it with a few key people (not counselling although might be an option in a bit) and am fortunate to have that support. The hardest thing is to keep forgetting…. and to not be the ‘player’ I was in the same way. Trying to be accepting and kind to myself. Worried how it might progress and have to block looking too far ahead as much as I can. Have my private moments of feeling v sorry for myself and weeping. Need to be my own best friend more than ever. Think group support if I can find it will work better than 1:1 counselling in a while. Just not sure how fast this will progress and….is scary and heartbreaking for me.

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Elaine, thank you so much for your comment. We really like what you said about being your 'own best friend more than ever'.

Would you be interested in sharing your story with us for the blog? We'd love to hear more about you, your diagnosis journey, and any other words of advice or insight that could benefit other people with dementia.

Here are some guidelines on writing about your experiences, which may come in handy: https://www.alzheimers.org.uk/blog/share-your-dementia-story-our-blog Otherwise, you can send our team an email at [email protected] and we'll get the ball rolling with you. We'll support you every step of the way.

We look forward to hearing more from you, Elaine!

Alzheimer's Society blog team

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My mom was recently diagnosed with mixed dementia.We started noticing signs around 2016. Worse we lost my younger sister early March this year. She is currently on medication. My question is do we have to tell her that she has dementia. Her condition is not yet severe as she can still do a lot for herself. Please advide

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Hi Mamzoli,

We're really sorry to hear about your mum and your younger sister. This sounds really difficult for you.

You may find it helpful to talk call our Dementia Connect support line. Our dementia advisers can learn more about your situation and give you information, advice and support. The number for the support line is 0333 150 3456, and you can read more about it here: https://www.alzheimers.org.uk/dementia-connect-support-line

Many people find it helpful to know about their diagnosis so that they can feel in control and plan ahead. Our free publication, 'The dementia guide', is written for people with a dementia diagnosis and covers the most important topics they might need to know: https://www.alzheimers.org.uk/publications-about-dementia/the-dementia-…

Hope this is helpful, Mamzoli - please do call the support line for more detailed advice and support relevant to your situation.

Alzheimer's Society blog team

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I was diagnosed with vascular dementia in 2013 and with alzheimer's early 2019. I was told to try and learn another language and keep my mind as active as possible as learning such as a language can activate bits of the brain not used as is the case with brains damaged by injury. I have lost a great deal of memory, I read math and technology and now use a calculator for pre 11+ math and have to use memory aids especially for medication, I use insulin and other ( must not forget or overdose meds) but despite thatI have just scored 85 on one free IQ test and 98 on another, I am deteriorating but with help am still living independantly with some support. So accept help keep your brain active and you who care do the best to keep the sufferer mentally active and help them do all they can for themselves. I am a Jehovah's Witness so study and read a lot, so reading subjects you like and are interested in can also help; I'm now 8 years from my first diagnosis so you can have many useful independant enjoyable years ahead all the best and may Jehovah care for you and bless you all, sufferers and carers :-)

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My wife who is 57 years old was diagnosed with mixed dementia approximately 3 years ago but has had dementia for about 5 years, over this time things have been more difficult with trying to care for her & going to work at the same time, I read so much about the subject of dementia but the whole thing is just confusing because of the amount of information, so my questions are, what is the life expectancy, are we eligible for home care whilst I'm at work & why does my wife look into space & doesn't know why or where she's been & why does this happen?.

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Hi Gary,

This sounds like a very confusing time. We strongly recommend calling our Dementia Connect support line on 0333 150 3456. Our dementia advisers are here to listen to your situation, answer your questions and provide advice and support related to your needs and your wife's needs. The support line is available seven days a week: https://www.alzheimers.org.uk/dementia-connect-support-line

Some people also find it helps to talk with others who have gone through or are going through similar experiences. If you think this would help, you can visit our online community, Talking Point, for peer support: https://forum.alzheimers.org.uk/ It's free and open day or night.

We hope this is helpful, Gary.

Alzheimer's Society blog team

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Hi
So sad to read everyone’s stories and how hard it is it is a horrible disease. My mum was diagnosed with mixed dementia in January although we think she has had it for at least 2-3 years. She isn’t able to live alone so my sister gave up her job, sold her house and moved in to care for her. She has been through phases of not knowing any of her 4 children and talking to us about us as if we are carers and not family, asking if we all had the same dad, then a couple days later she knows us again. Sometimes she is aggressively argumentative, very confused and absolutely not the person she was. She wears multiple layers of interesting clothes but it keeps her happy. I know it is hard for my sister so I try to help and give respite. I have frustrations with one family member who keeps telling my mum she doesn’t have to speak to the dementia nurse when she comes and she could refuse the visit. I don’t understand why she would say that as it is confusing for my mum who thinks she is fine and gets angry if anyone tells her otherwise. We can clearly see decline when it happens. We have a great package from the council where we pay £7 a month and have access to as much equipment as needed. At the moment that includes a sensor on the bed and lasers at the doors because she was starting to walk out at night when my sister was in bed and a video monitor so if the bed sensor goes off my sister can see if she has fallen. She used to be very prudish and now talks inappropriately and about things she would never have done and doesn’t think about taking off clothes. I know it’s difficult to say how each person will decline because everyone is different but there is more support than we realised out there it just isn’t offered and we had to try and find out ourselves but the nurses are great help.
We were advised to get a scrap book with photos of the family etc when they were younger and also what they look like now which apparently helps with the recognition. I know a lot of times my mum doesn’t know who my sister is and thinks she has 3 different carers even thought it’s one person and her daughter. I just wanted to share, you are in such a hard position and are doing what you can, I know we r so proud of my sister and couldn’t manage without her. We were lucky because she worked in a closed dementia unit before she gave her job up but it’s very different when it’s your own mum. I think anyone caring for a loved one with dementia is amazing and selfless

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Hi, I’d love to try and connect with you.
My Dad was diagnosed with mixed dementia in Jan too x

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Hi Georgina
Sorry to hear that. Happy to connect it’s sometimes good to talk to someone else going through the same thing x.

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Hi Sharon
Your mums story sounds just like my mum. Over the past year we have seen a real decline in her. My wonderful sister Margaret who has already seen my Dad through Vascular Dementia who passed almost 5 years ago is now main carer for mum. I completely agree with your sentiments as she truly is an amazing and selfless person. Oh and she has been diagnosed and gone through treatment for bowel cancer while looking after mum.

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My 86 year old father is registered blind and was diagnised with vascular dementia March 2020, following a few falls. Symptoms had been present for a while prior to diagnosis. His GP referred to a memory clinic who assessed him and ran tests inc MRI for the results. Results since changed to mixed dementia (vascular & dementia).
My 82 year old mum is his sole carer in their home. My sister sadly died just before his formal diagnosis. I live 3.5 hour drive away and due to covid and not having a car have been severely restricted in being able to visit them. Mum has 'coped' admirably but as his symptoms match on and his presentation declines i am very concerned for her own health and state of mind. I have been suggesting that she at least starts the ball rolling re considering a care home. In the last 2 days she has told me she doesn't think she can cope 'much longer'. I have suggested she speaks to their gp and also age uk. Is there anyone else she should speak to re this next stage? Also, because of being registered blind and mixed dementia would he meet criteria for any funding?? I understand that local authorities can do deferred payment schemes, paid off on death of both parties when house is sold- so you have info on this please?
Many thanks

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Hi Beverley,

Thanks for getting in touch. We would recommend calling our Dementia Connect support line on 0333 150 3456. Our dementia advisers can listen to the situation about your mum's needs, as well as your father's, and provide information and advice on the next steps. The support line is available seven days a week: https://www.alzheimers.org.uk/dementia-connect-support-line

We hope this is helpful.

Alzheimer's Society blog team

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Hello
My wife of 54 years has had mixed dementia, (Vascular and Alzheimer's,) for the last 3 of those. She also has Rheumatoid Arthritis and Osteoporosis, and uses Rivastigmine patches along with other medication, I am her full time carer and we have managed things well so far. however, just recently there seem to have been a sudden, noticeable deterioration. She has less mobility now, and doesn't want to communicate sometimes, she still remembers people, but has difficulty with names, and walking is more difficult.
Is this deterioration a gradual situation, and is it likely to worsen quickly, or does it go in stages and level out for a while at each stage?
My main worry is what comes next, and how long can I cope.

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My mother, who lives with me, has mixed dementia (Vascular and Alzheimer's) as well. My mother's gerontology doctor has stated that declines can be gradual then sudden and that there is no warning to what precipitate these changes. This makes it scary and difficult to plan for. I can tell you I am planing for my mother one day not walking since we were told that there is a strong liklihood that would happen. Therefore, I had a contractor come in and create wider doorways and a zero entry shower so mom can age in place. With the changes tou are seeing, I would contact your wife's doctor. They might choose to see her and perform either cognitive tests or like my mothers doctor an MRI .
Lastly, you expressed concern about if this becoming overwhelming. There are several steps that you might take.
Let your wife's doctor know. He/She might be able to refer you to services in your area such as:
Area Agency on Aging,
Alzheimer's Association, or
Thru you hospital there might be a dementia family support group that can help you with your concerns.
Lastly, some churches and synagogues can also provide some assistance.
This disease isn't just hard on the ones experiencing it but on the carers too. Our lives can revolve so much around them, we often can't find joy or focus on anything that reminds us of our lives before. I play music and dance for 10 minutes, or download a book. This helps me not get overwhelmed. I hope this helps. Please take care of yourself. My thoughts and prayers are with you both.

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Hello Eva
I must apologise for not responding to your message sooner. I must have missed it earlier and have only just seen it when I was alerted to another response. Once again, my apologies.
Thanks for your advice, there are a few things that I never thought about. Since posting my question, we have been given funding for a personal assistant who does three, two hour sessions which is a great help with bathing my wife every couple of days, and also gives me a bit of time to do things for me.
I too have music as my hobby, and have a baby monitor video and can watch her when I play my piano, or I am on my computer.
My wife doesn't seem to have deteriorated much more just recently, so life is a little better for me. Hope things go well for you. Good luck.
Geoff

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Hello Geoff
How are you? Did you receive a comment or advice? I am going through similar with my Dad with my mum being faced with similar dilemma. It’s really hard and I feel for you. Talking to those who know and have been in same situation previously helps I find. Take care

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Hello Claire
Yes I had a couple of replies, one which I missed until just now when I got the alert about your message. I'm doing fairly well thanks, I hope you are too. This terrible disease is difficult for us all, and the only thing to do is give our best care and lots of love to them. Hope things go well for you and your mum. Best wishes. Take care.
Geoff

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How important is it to have a dementia patient staged regularly? My husband has recently had a camera test via his throat due to swallowing problems. He was diagnosed as having MCI 5 years ago but then they said that was a mistake, that he has mild vascular dementia. Since then he has declined slowly but recently the decline is more rapid. At this procedure they questioned his capacity because he couldn’t tell them what procedure he was having and why or what the risks were despite a nurse explaining this and me doing so umpteen times before he went. Originally they said I couldn’t accompany him due to Covid regs, then they relented. I hold LPA which I had registered with the hospital, I strongly advise others to do that, but they wouldn’t accept this. Instead they wanted him to make DNR which we both agreed we wouldn’t do due to first hand experience of the Liverpool Care Plan which was anything but care when my mother in law died. If he hasn’t got capacity to sign a consent form, why would he capacity to make a DNR? I was told they wouldn’t need my signature, that a doctor would sign for the test. It really worries me that someone who doesn’t know him, probably has never even met him, can make such decisions on his behalf when someone who has been married to him for 54 years can’t. Whose more likely to know what his wishes are?

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Hi, I think I would seek a solicitors opinion on that as you do get the first 20 mins free telephone consultation.

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DNR aka "Do Not Resuscitate"
Make sure that your Solicitor and /or whoever keeps details of your Will etc. is fully aware of your attitude to DNR.
Now everyone can/ and hopefully will donate their body at death ( New Legislation)
I would recommend this in your Will and have done for over 50 years

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My wife was diagnosed with mixed dementia a year ago. She was put on 4.6mg rivastigmine patches which were ok for a while although they did not show any noticeable improvement. But eventually she started to have hallucinations and visions and we stopped the patches. She has tried rivastigmine capsules and galantamine but both cause instant unpleasant side effects, nausea and sickness for 48 hours, so now she doesn't want any medication and I quite understand. But I worry that she is missing something that could help. Consultations with GPs and clinics are almost impossible in these Covid times.

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My husband is 71 and has mixed dementia.( Alzheimer’s and vascular). We’ve been married 50 years ( high school sweethearts). He’s not recognizing me as his wife of 50 years but thinks I’m his girlfriend and he walked out on his family. It’s called capgras syndrome. He thinks one of us, prob me, is an imposter. At least he likes me but this is heartbreaking for me and my daughters. ( they are married with kids). He’s also failing physically. I’m his sole care giver. I’m sad . He can’t be left alone. I do everything now. I’m tired. My girls are not close by. I don’t know what to do next to help him. I guess I just needed to vent. Thank you

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Hey, Kate. I just wanted to say that you’re entitled to all the support you can get. This is a nasty disease and you shouldn’t feel like you have to cope with it on your own. Sometimes there’s a stigma around getting help from the networks dedicated to these sorts of things. When you call in help, like carers or even a care home, you’re handing over the care of your husband to people who have shifts and get paid for doing it. They’re able to go home and have their own lives alongside their job. It seems like you may be backing yourself into a corner where you don’t have any sort of room in your life for your own self care - which is essential to being a good carer. You matter too. It can be best to hand over the care, partially or wholly, to people with experience in these things and you both may end up better off.
I hope you’re taking care of yourself, and making time to do so.

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I am wondering whether dementia is hereditary. My mother has mixed dementia. Her father had Alzheimer’s and her mother on hindsight had early stage vascular dementia. On my fathers side two of my aunts had Alzheimer’s. 3 of my nieces and nephews had a grandmother who had Alzheimer’s. Seeing/hearing the affects of dementia with my mother in the last few months is stressful. She no longer sounds like my mother and is more or less restricted to a care home bedroom.

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Hi Alison,

Thanks for you comment. We're really sorry to hear you've been having a stressful time with your mother.

We have a page on this which you may find helpful: https://www.alzheimers.org.uk/about-dementia/risk-factors-and-preventio…

The majority of dementia is not inherited. In rarer types of dementia there can be a strong genetic link, but it's small percentage of overall cases of dementia.

We also have some other pages on risk factors for dementia, as well as advice on prevention: https://www.alzheimers.org.uk/about-dementia/dementia-risk-factors-and-…

Hope this is useful, Alison. If you need more advice or would like to talk to somebody about your mother's care - please call our Dementia Connect support line on 0333 150 3456. The opening hours and (other ways to contact us) are available here: https://www.alzheimers.org.uk/get-support/national-dementia-helpline

Thanks,

Alzheimer's Society blog team

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this disease is breaking my heart.

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That sounds like a cry from the heart...and my heart goes out to you. It sounds like you are somewhere I’ve been and still am sometimes. Any help or support I can offer? My mum has mixed dementia and, after living with us for a while, is now in a home.

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