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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My wife is 57 and was diagnosed with mixed dementia last November, but was diagnosed with dementia nearly 4 years ago, what does this do with life expectancy, I understand that from final diagnosis of mixed dementia the clock is really ticking, I assume 4 to 5 years if I'm correct but is her life expectancy massively reduced 4 years ago or when she received the final diagnosis of mixed dementia, confusing question I know but I'm still trying to get my head around all this

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Hi Gary,
Thanks for getting in touch. We're sorry to hear about your wife's dementia diagnosis.
It is very difficult for us to comment on individual cases, so we would recommend speaking with the GP. In the meantime, you may find these 'How dementia progresses' webpages useful: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how…
For further information, advice and support, we recommend speaking with a dementia adviser on 0333 150 3456. You can read more details about our Dementia Connect support line (including opening hours) here: https://www.alzheimers.org.uk/get-support/dementia-connect-support-line
We hope this helps, Gary.
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Alzheimer's Society blog team

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Hi my mum was diagnosed with mixed dementia at the memory clinic in 2016/17 I can't quite remember. She is still living with me and is 89 I also care for my husband. I just cannot cope with her much longer, she repeatedly heads off for Scotland with just her credit card in hand and I have to go and get her once she is tired enough,otherwise she wont get back in the car. What help is out there? I have today dropped off a letter to the doctors as I cant talk on the phone without her getting aggressive. I also care for my husband 67 with late stages of MS... this is hell and I think the time has come for me to settle mum into a home, but where and how? please help me.

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Hi Debra,
Thanks for getting in touch. We're sorry to hear about the situation with your mum, especially as you're also trying to care for your husband.
We recommend speaking with a dementia adviser. You can call our Dementia Connect support line on 0333 150 3456 and somebody will be able to give you tailored information, advice and support. You can read more details about the support line (including opening hours) here: https://www.alzheimers.org.uk/get-support/dementia-connect-support-line
In the meantime, we have some advice on our website on care homes, titled 'Care homes: When is the right time and who decides?' This information is also available as a downloadable factsheet: https://www.alzheimers.org.uk/get-support/help-dementia-care/care-homes…
We hope this is helpful, Debra.
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Alzheimer's Society blog team

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My 80yr old dad has mixed dementia and recently he has been very dizzy lightheaded and unsteady on his feet.i was wondering would this be all related to dementia

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Hi Tracey,
Thanks for getting in touch.
It might be worth speaking with one of our dementia advisers on 0333 150 3456. They can listen to your concerns about your dad, provide advice and support. Our advisers are available seven days a week. You can find opening hours for our Dementia Connect support line here: https://www.alzheimers.org.uk/get-support/dementia-connect-support-line
We hope this helps, Tracey.
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Alzheimer's Society blog team

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Hi ,my Husband is 77 years old and he had a TIA some 8 or 10 years ago,I thought I saw changes in him at that time ,but nothing too significant.
Four years ago he had a stroke which left him half blind ( he can only see to his left,unless of course he turns his head ), since then he has been diagnosed with Vascular Dementia ,went to a memory clinic once and refuses to go again.
Our GP prescribed him Donepezil but it made him worse and refused to take anymore.
My problem is he was always a little bit jealous if I got to know a man (any man ) even though we were never apart from one another and have been married for 57 years.
So now he has dementia he has it in his head (quite wrongly ) that I'm having an affair with our Son in Law. No amount of denying this will he believe ,I've even sworn on the Bible a few times, trying to convince him it's all in his head. Our daughter knows what her dad thinks and has just shrugged it off ,saying " he's always been like this ".
It's really getting me down ,I can cope with everything that dementia throws at us ,but to have to keep denying something day after day 8s soul destroying.
Also does Vascular Dementia mean he will get violent as the illness progresses.

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Hello, my mum is 83 and was diagnosed with advanced Alzheimer's in August 2019 and then vascular dementia too in September 2019. No medication due to advanced and we look after her at home as a family. Mum sleeps probably 20hrs a day. While asleep she is often restless and screws up her face as if in pain but she isn't able to tell us if she is which worries and concerns us. She is also just starting to not always want/can't eat a meal. All a worry when not knowing about this illness.

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Hello,

My mum died in November 2019 soon after her 69th birthday. She had been diagnosed with early on-set AD when she was 58; after a long period of what appeared to be profound depression.

I donated her brain tissue for Dementia research as I felt this was a positive thing to do.

Anyway, I have just received a letter from the research institute telling me that not only did mum have AD, she also had Dementia with Lewy Bodies and mild limbic-age related TDP-43 encephalopathy (LATE).

How common is it to have this type of mixed dementia, particularly at such a young age?

Does anyone else on here have experience of having a relative with this type of mixed dementia?

And, do we know how likely these diseases are to be passed on in families (either together or separately)? I worry both my myself and my son.

Thanks,

Evie

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My Mum was taken into hospital after being found in the Bath. She is 82 and has dementia undiagnosed until yesterday as she would never go to the doctor’s. She lives at home with a care package 4 times a day. She has been diagnosed with mixed dementia and the hospital put a DOL in place. Mum would never agree to an LPA so we have no authority over finances or health. What happens now as the Doctor doesn’t believe she can go home. Mum has minimal savings and a house worth £120000. We know we will have to use this for her care but how can we sell if we have no authority. My sister tried to live with Mum last year but that broke down hence the care package. It’s so distressing as Mum keeps crying and saying she wants to go home. We are waiting for the social hospital team to have a meeting.

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Hi Kate, I'm very sorry to hear about your Mum. We'd be very happy to offer you support with this. If you call our Support Line one of our advisers will be able to help.

Our Support Line is open Monday to Wednesday (9am-8pm), Thursday to Friday (9am–5pm) and Saturday to Sunday (10am-4pm), and can be reached on 0300 222 11 22.

Thank you

Alzheimer's Society

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My Dad has been diagnosed with Mixed Advanced Dementia and has had Dementia for the past 5 years. He started off and still is on donepezil but last year in September was also put on Memantine which has really progressed the Mixed Dementia or was it just coincidence. We kept saying that he was not good with the memantine and eventually they took him off this. They then introduced "calming tablets" Tramazadone as he was getting extremely agitated which was 250mg per day. Now they have given him olanzapine 5mg along with lorazepam when and only when needed. He is like a walking zombie to be honest so we ourselves have reduced the trazadone (250mg) to see if this helps. We do know the Mixed Dementia has and is getting worse but don't want him a zombie all the time. All he keeps asking for is to go home

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My mum who is on 66, she has mixed dementia, my sister noticed the symptoms before the doctors actually done the tests, it’s been 3 and a half years now...doctors gave her donepezil (5mg) but now it’s been put up to (10mg). But when it comes to giving the meds at night before bed time she has started to become violent towards me, and I don’t know what to do

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My mum has Alzheimer’s and we discovered this 4 years ago when she said she had headaches every day. The GP referred her for a head CT scan. She is a lot worse now In bed a lot but can walk and talk and eat. The Carers (private) make a big difference- helping her wash, helping with food, She still says she has a headache all the time and goes to lie down most of the day. Wonder if headaches are sometimes part of dementia or maybe it feels like a headache but is just confusion in her head. Any ideas? Medication for headaches doesn’t help.

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Hi Judy, thanks for getting in touch.

Headaches are very difficult things to give specific advice or information on, since there are so many different types and their significance ranges from typically ‘benign’ (albeit painful) to being potentially indicative of something very serious.

It goes without saying that everyone gets headaches and they are also common in older people too. So it’s difficult to know whether the headaches are related to the underlying disease causing your mum's dementia. There may be a little bit of crossover between migraines – a very specific type of headache – and dementia, although this is not well understood. And there are also some conditions that are common in dementia that can also lead to chronic headaches, such as depression, anxiety or impaired blood supply to the brain (known as cerebral ischaemia) which can often persist for a long time after a person has had a stroke.

In general, older people tend to be more susceptible to what are called ‘secondary headaches’, where the pain is caused by an underlying medical condition rather than it being the main symptom. So these might include pain from head or neck trauma (such as may happen from a fall), infections, drug side effects or something causing an imbalance in the person’s normal metabolism. If the person is regularly taking too many painkillers these can actually cause something called ‘rebound headaches’, in which case this needs to be managed carefully under the advice of a doctor.

Other causes of chronic headaches may be related to postural or musculoskeletal problems that can cause tension headaches. So a hunched posture can lead to excessive strain on the neck and shoulder muscles leading to pain up the back of the head (common also in office workers).

Eye strain is another common cause, so ensure that eye tests are carried out regularly (at least once a year) and make sure they are wearing their glasses to read and watch TV (and that they’re as clean as possible).

There are lots of other reasons for headaches in older people but on the whole these tend to be more ‘acute’ (quick onset and short-lived). The fact that your mum has had headaches for at least 4 years without any apparent serious consequences means that a clinician will probably be less worried that a serious condition is developing, and the focus will be more on managing the pain. That said, it’s still very important to explore all of the potential reasons for your mum's headaches rather than just accepting them as part of the dementia. This may need a thorough review by the person treating her, such as a neurologist, old age psychiatrist or, at the very least, her GP – including a full medication review.

Although unlikely to have caused four years’ worth of headaches, it’s still worth noting that some things can make headaches more likely to happen, or at least feel worse. These include dehydration, stress, alcohol, infections, and not eating regularly. So ideally try to avoid these as much as possible.

I hope this is helpful,
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Alzheimer's Society knowledge team

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Gosh this is a good site. I am brand new here. My aunt aged 89 who lives 200+ miles from me was diagnosed with mixed dementia in September via mri scan but has been exhibiting symptoms for a couple,of years. I am her next of kin and only relative plus I have LPA. Aunty denies her diagnosis and says she’s just a bit forgetful. We’ve had a summer of her trying to give money to con men over the phone or in person which she obviously cannot recall. When my phone rings, my heart is in my mouth. Is it the police, the fraud dept of the bank, the social services or the neighbours. I’m trying to hold down a busy full time job and help her too. She is able currently to live at home alone, she says she eats regularly ( but who really knows as no one is there with her ), she goes to Help The Aged regularly to help in their shop, she can shop for herself, and wash etc, it’s just her cognitive function and her memory. V repetitive and easily befuddled by these con men. I’m not sure how I’m going to be able to help her when she denies there is anything wrong and we are just limping from crisis to crisis. I am grateful,to have found this forum and will make a note of the Alzheimer’s number in case I need support or have questions.

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Good site to learn more about day to day experiences of sufferers and carers and what sopport is available for both. Thankyou, Julie

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Hi my husband is 68 and was diagnosed with mixed dementia 6 months ago but having symptoms last two years he was a builder when he worked and still thinks he can do anything hence lots of rows as he can’t and gets very frustrated with himself and me he will not have any help will not go to any clubs etc so I feel lost I myself had a Tia a year ago due to stress and do not know where to go from here

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Hi Viv, thanks for getting in touch.

That sounds like a difficult situation for both you and your husband.

You may want to call our helpline which can offer information, advice and emotional support. If you're feeling a lot of stress then they may have some suggestions that can help. You can find the details for the helpline on this page: https://www.alzheimers.org.uk/get-support/national-dementia-helpline

If you'd like to talk to other people with similar experiences, you could also visit our online community Dementia Talking Point. Some people find it useful to read about other people's experiences or you can sign-up and ask a question or join the conversation. You can find the community here:
https://forum.alzheimers.org.uk/forums/

I hope this is helpful. If you have any other questions don't hesitate to call the helpline or get back in touch
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Alzheimer's Society blog team

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I’m sorry I am not contributing anything of value to this forum but thank you to everyone who has written their ‘stories’. Having a mother, currently with undiagnosed dementia and relating to so many on these issues it is good to know we are not alone and the symptoms that we find so frustrating are quite normal. Particularly the not accepting help and being so difficult when all we want to do is help. We have reached the stage now where mum has become a softer person but still adamant nothing wrong, although she does keep saying she is going barmy, and she just wants to go home (she is home). It is so very sad as well as incredibly wearing but sadly it is reassuring that we are not alone. The current system doesn’t work particularly well for early intervention which would have made the last few years a lot easier for us all.

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My mum is 78 years old and was diagnosed last year (2018) with Vascular Dementia and Alzheimers. Myself, brother and my children had wondered for a couple of years if she had dementia or was it just old age. After fluid on the lung last October, we noticed a decline in her ability to physically care, clean her flat and cook. She is at last settled in a wonderful care home. She has a trigger mat at the end of her bed as she has had four falls since being resident there (November 2018), one resulting in a broken arm. Mum is side stepping the trigger mat to go to the bathroom at night. She knows who her family are. I'm just wanting to know what to expect from now on.

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