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.

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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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Mum is 90 and has been diagnosed with Alzeimers and Vacular dementia. The local Iccles team have prescribed Memantine about 6 weeks ago. This has resulted in mum being comatose most of the time. She was admitted to hospital as the nurses in the nursing home couldn't wake her. She spent 5 days there.

My sister and I are worried stiff as no one seems to be helping mum return to how she was before she was prescribed with Memantine. We accept she was noisy and challenging but now she is zombie like. Please help with advice if you can. Kind regards Kathy Sawdon

Hello Kathy.

We’re very sorry to hear your family are going through such a stressful time. As requested, an adviser from our Helpline team will be contacting you privately with the email address you provided.

We hope this helps.

We sometimes prescribe Memantin at eveningtime, and only half dose (10 mg) for better quality of life.

Hi my name is Debbie I live in Ruabon near Wrexham North Wales my mum and dad both suffer with this problem and a group of us are doing the memory walk on Sunday the 2nd of September 2018 from Trevor basin to LLangollen love Mrs da Evans xx

My husband sleeps 14 hrs a night and then during the day as well is this normal behaviour ?

Hi Sylvia, thanks for your comment.

It is quite common for people with dementia, especially in the later stages, to spend a lot of their time sleeping. As dementia progresses even simple tasks (such as communicating or eating) can become exhausting. The task takes more and more out of them, and as a result the person sleeps more and more.

It is also worth noting that the quality of sleep someone has deteriorates as they get older. So a 90-year-old person may sleep for 14-15 hours a day, but it is unlikely to be good quality sleep. It is not the same as a 25-year-old sleeping for 14-15 hours.

It can also be influenced by people’s sleeping patterns before they had dementia, some people need more sleep than others.
If the person is in the later stages and the have gradually started sleeping more and more, it is likely to be due to the dementia progressing. However, if it has come on suddenly or the person doesn’t seem well it may have another cause. It may be worth speaking to the GP, to rule out any infections or conditions that could be having an impact. It may also be worth asking for a medication review with the GP or speaking to a pharmacist as medication can cause a range of side effects.

If the person is sleeping a lot but it isn’t having a negative impact on them it is often best to just go with it. If you need any more advice or support with your husband's care don't hesitate to contact our helpline: https://www.alzheimers.org.uk/get-support/national-dementia-helpline

Regards,

Helpline advisor

My Mother-in-Law was diagnosed with mixed dementia in July this year but was showing symptoms for a few years beforehand. She doesn't accept her diagnosis and believes there is nothing wrong with her other than a bit of forgetfulness because she is 86. She is very recently widowed and so we are now seeing how many challenges she faces. We are all struggling to know what to do for the best because she is adamant that she can look after herself. She is a very house proud lady and takes pride in her personal appearance. Sadly she is no longer able to operate equipment in the kitchen so she's trialling meals on wheels but thinks it's a short term thing until she's stronger and then she can go back to cooking for herself, something my late Father-in-law was doing for her for some consider able time now.
We're so worried something will happen when she's on her own but are torn because surely she should keep her independence for as long as she can. How do we best approach this situation when she doesn't accept there is any problem at all? Thank you.

I am sorry to hear about your Mother-in-Law. Many people either have no insight into their condition or are in denial. Either way, it is not a matter of acceptance on her part, which is unlikely, but rather a matter of others acting in her best interests to meet her needs and keep her safe.

If she should need personal care at some point, the local adult social care team can provide care in the home:

Assessment for care and support in England: http://bit.ly/2nqhDKE

And this link provides some ideas on safety in the home: Living with Dementia – Keeping safe at home: http://bit.ly/2sSAz6m

Do call us on the helpline if you would like to talk these things through: 0300 222 1122.

Kind regards,

Helpline Advisor (Alzheimer's Society)

Although my father didn't have dementia, at the age of 90, he started have trouble with many things round the house and also his legs started giving way. We put camea's in his home so that we could check on him without have to physically go to the house, this way he kept some of his independence. We found them great and could even talk to him through them. We have now put one in my mother in laws home as she has mixed dementia and is starting to act out of character. Although they have only been in a few weeks we have found it so beneficial.

My 90 year old Mum is now in a nursing home but sadly for us the rift between two of our siblings mean we do not truly know how mum is. The home have said it is likely to be vascular dementia in a lady of that age. Mum had always lived with us since Dad's death 8 years ago and now she is down South in a home near my sister. My one brother who lives up near to me and myself have no contact at all with the other sister and brother so we do not really know how mum is as they now have LPA for her health and welfare and do not speak to us. This is so distressing for us and I am praying she will not have to suffer much longer. My partner's grandma had alzheimers from the age of 65 and passed away aged 78. As mum is 90 years of age we are preparing ourselves for the call from the Home to say she has passed away. I have to say this site is marvellous in that it provides lots of information and advice. Sending out love to everyone having to deal with this dreadful disease x

Hello, my mum, 82, has recently been diagnosed with mixed dementia. Although forgetful she, at the moment lives happily and independently with family help for shopping etc. However, this week's she started on donepazil and she seems to have had an acute deterioration in both memory, sleeping and general confusion. She and we are wondering if this is related to the medication? I've looked at the research and cant find anything to suggest that this had may initially caused a deterioration in cognition however due to these issues mum is now considering stopping treatment already. Would be really grateful for advice and to hear others experiences of the early days with this drug. Many thanks.

Hi Ann, I’m glad to hear that your mum is doing well, and concerned about the changes she is experiencing. Sometimes these can be the result of an infection such as a UTI or chest infection, in which case the changes are often reversed after a course of antibiotics. Donepezil can sometimes cause mild stomach upsets in the early stages, but these tend to disappear as the body becomes accustomed to the medication, which is then increased. I would certainly mention her symptoms to her GP or the pharmacist for advice. You can also get good medical information from Admiral Nurses, who are dementia-trained nurses. They run a helpline 0800 888 6678 open between 9am to 9pm Monday to Friday and 9am – 5pm on Saturdays and Sundays.

My dad was diagnosed with mixed dementia last year he too was on Donepezil, he declined quite quickly refused food & drink as a result became very dehydrated which needed a trip to hospital, when the Dr in the hospital went through his meds with him (she was quite rude actually as wouldn’t allow me to break down what she was trying to explain to a man that was quite obviously poorly & distressed, she was talking in Dr language which upset him, I was told to be quite as I was talking to much she clearly doesn’t know how to work with Dementia) my dad agreed to start taking his meds but refused point blank to take anymore of the Donepezil, his choice & since that day he is his old self infact a lot happier he’s enjoying life to the full.

Hi, my mother too has mixed dementia which I was only informed of this week,assuming it was still early onset dementia. I haven’t hear of that drug. Is it in small doses though ? 10mg or 5mg ? Is your mom tiny ?my Mom is on mementine, I believe, if she’s tiny it’ll have a bigger effect too? Also i didn’t realise their hygiene slides and they pick up all sorts, water infections most common causes confusion for sure, she could have that?? but my mom picked up E-Coli I know not good, and twice, we have carers in 4 times a day, but she’s fallen & stuck in Hospital now and now she’s choking on tea/coffee so all drinks thicken, they can catch chest infections, pneumonia even, as the pipe work in the Oesophagus doesn’t work properly, causing food / drink to miss the stomach entirely, but Nestle thickening helps, in juice and hot chocolate, no coffee now though 😞 she’s loosing the ability to walk unaided, but one minute amazing the next not too good & wants to go but without 24 hour, due to choking we are not sure, very sad not going home :(
Good luck take care of your self too it’s essential

My Dad has Alzheimer’s and mixed dementia. He was diagnosed 3 years ago and has been on doneprizol since then. He’s recently become much more confused and unable to care for himself including dressing himself at times. He’s had a course of antibiotics for a UTI/chest infection but he doesn’t seem to be getting back to the way he was a fortnight ago. Could this be the dementia progression ? Dad lives with us so someone is with his 24/7 but I’m worried about him.

My grandad has just been diagnosed with mixed dementia. He's 91 years old and lives on his own. He is a very proud independent man and admits his memory is getting worse. We have noticed he is starting to forget basic things like where the tv remote is - he has kept it in the same place for lots of years. I think he may even be forgetting how to turn the tv on. I am worried we don't realise how bad he is and I am concerned about him being in the house by himself. On a selfish note I am upset at the thought of hmy grandad not knowing who I am or other family members.

Hi, my Mum (79yrs) has been diagnosed with Alzheimer's last year and they think she may have had it for up to 4 years. My Dad (81yrs) is has been struggling to cope with my Mum. She use to cook & clean all the time, but the last 8/9 months she stopped and my Dad, didn't tell me, they have been living on takeaways or sandwiches as my Dad has never cooked. I knew my Mum had a fall back in August hitting her head and then again on my birthday 30 September she tripped and fell on her face also hitting the side of her head. Since then her condition has gone ten fold, she doesn't remember she has 3 children or 5 grand-children, she repeats questions over & over again. She also see children, stating where have they gone, we state what children and she gets very upset, saying 'don't be stupid, they were just here talking to us' or she says to me, she can't wait for my daughter to come home and I say, but I am here, then she looks at me very strange. She cannot concentrate on anything and get angry, frustrated, always moaning she is lazy sitting in the chair falling asleep, we offer to take her out and she says no. As my dad has been getting upset with her and can't cope, my husband & I decided we would give up our rental property and move in with them to help, that was two weeks ago. I have noticed come about 11am and to about 4/5pm, my Mum just moans, gets nasty about everything and states my dad doesn't want her after 61yrs of marriage, it is upsetting for him, nothing is right know matter what we do for her. My question is if there is an answer, I would be grateful. How long would this last nasty and her imaginary friends and being rude to people, is it a 1, 2 or 3yrs situation or much longer, as I have been chatting with my Dad, once my Mum goes to bed and we think she may have had Dementia for about 10yrs or longer after reading much of the information on the internet, but the Doctors sent a specialist from Exeter hospital, around to my parents last September and he said she had Alzheimer's, may up to 4 years. I have been told by many friends, that we are crazy moving and looking after my parents, especially as I am disabled due to an accident 4yrs ago and lost the sight in one eye and limited with the other, but I get by and they are my parents who I love very much and my husband is great with my Mum. We know this is not going to be easy, but the thought of my dad & me putting Mum into a nursing home scares my dad and he also needs looking after, so we have to try. Many thanks in advance for any advise. Jenny

My 87 year old mother is in hospital and has mixed dementia. We were told by the hospital that she should not return to her own home as she would be unsafe. Whilst being in hospital her dementia has become much worse and she often has no understandable speech (lots of vocabulary but nothing makes sense) and often becomes agitated and aggressive to staff and other patients. We finally found a care home that we liked but they have just assessed her and said they can't take her because of: Mobility due to frailty, High risk of falls and agitation and aggression to staff. What happens if nowhere will take her?

What would happen to a person in the early stages of mixed dementia if put in a nursing home they do not like and if they are denied access to family and friends for a 6-week settling in period? Also what is the effect if she is not allowed to talk about her house?

I wouldn't let any of my family be denied access to family and friends in a nursing home, and why wouldn't she be allowed to talk about her house..?

My dad is 82 and was diagnosed at the Doctors surgery and initial memory clinic appointment with Mixed dementia just over 2 years ago. He is in total denial about his diagnosis and has refused to attend any further diagnosis appointments as he says he is just "a bit forgetful". I have noticed the progression more over the past 6 months and whilst he can recount pretty much every minute detail of his life from the age of 5 until around 5 years ago, he is unable to recall much at all from the past 5 years and is unable to retain any new information. His short term memory seems to be totally non-existent. I recently took him on a holiday to give my mum a bit of a break and spent a week living alongside him, visiting family and friends from his past. I was shocked to discover how little of what we did together on a day to day basis remained with him and also how difficult it was to get him to eat and drink (he said he wasn't hungry or thirsty), to bathe (he said it was too cold) and to change to clean clothes (he was adamant that he had already done so). When I tried to insist on these things he became angry and defensive and, to prevent any distress I backed off. My mum is having to deal with this on a daily basis without help and I am worried for her. From a physical perspective Dad is relatively fit, despite the underlying health issues that pre-dispose the vascular dementia, he walks daily and can, at the moment, take himself on the local bus to town and back without a problem. He is a very proud man and had always been extremely independent, however, my week away with him made me realise that he is now withdrawing from current conversations, repeating questions every few minutes and re-telling the same stories each time we meet new people. More importantly he wanders off and gets disorientated, which is a big worry. I am concerned about how this disease will progress and what my family can put in place to help Dad.

Hi my mum has been diagnosed with Alzheimer’s
/Vascular Dementia.
My major concern is that mum lives alone and cannot manage, she went into hospital and now has carers, we were told it would be three times a day once home she is only getting carers twice a day. The morning ones come at 7..50 one morning and then turn up at 12.05 the next morning, it’s different each morning. They spend approx 10 mins with her. The evening carers come one day 4.20 and another 5.30.
The carers will only ask mum is she wants medication, food or bathing. They have said if she refuses they leave it. Mum had no hot food for 6 days when she came home, in the end I insisted they cook and leave the food but Mum throws it away..
Mum should have cream on her bottom four times a day, they don’t put it on. Mum insists on washing herself but doesn’t actually bother doing it. We feel that the re enablement carers are just leaving her to die. We asked how long do they just let her say no to food etc, they just say if she refuses we can do nothing.
One carer opened a tin of cornbeef and put in a bowl with a plate on top it has stayed in the fridge 7 days, bread dated 18 days old is still in the fridge. Food is left and when out of date is not removed even though I have asked that it be thrown away.
Mums discharge was rushed through and no personal alarm was in place and no hand rails. We had to say she couldn’t come home until everything was in place but the hospital dragged their feet. Mum has been to,d she cannot have a bath because the bathroom has no heating all they said was wash at the kitchen sink.
Mum has been told they will take her to a day Centre, three times the Social Worker said she would come and mum waited but no one came to take her.
Mum sits at home all day, she has no interest in tv, radio etc. She says she is lonely and she doesn’t want carers. She cries and says she wants to die.

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