Mixed Dementia

September 23, 2020 | Blog | Reading Time 8:00 Minutes

The Brielle understands the unique needs that come with mixed dementia, and we provide exceptional service in a homelike atmosphere for people who have those needs. With supportive living services and enrichment programs, our community offers a warm welcome and an engaging lifestyle to those who need mixed dementia care.

Mixed dementia is quite common. This term is used when multiple types of dementia occur in the brain simultaneously. In a study conducted by the Rush Alzheimer’s Disease Center and Rush Institute for Healthy Aging, it was found that about 50 percent of people who have dementia have evidence of two or more coexisting dementias. Additionally, of the dementias diagnosed in people over 80 years old, this is the most common form of dementia found.

What Is Mixed Dementia?

Mixed dementia means that a person has more than one type of dementia at the same time. There are many possible combinations of dementias, however. Some people have vascular dementia along with Alzheimer’s disease, for example, which is the most common combination. People may also have a combination of Alzheimer’s disease and Lewy body dementia. It is also possible for a person to have elements associated with all three types: vascular dementia, Lewy body dementia, and Alzheimer’s disease.

With mixed dementia, it is not always simple to distinguish the symptoms related to one form of dementia versus another. It can even be difficult to know which forms of dementia a person has because symptoms can overlap. More so, the degree of cognitive decline in those who have mixed dementia varies significantly from one person to the next. That can mean it is harder to pinpoint the onset or the potential lifespan of a person who has mixed dementia.

Symptoms of Mixed Dementia

The symptoms of mixed dementia range widely, as the combination of dementias can vary. People who have Alzheimer’s disease, for example, have difficulty remembering information they recently learned. It is a progressive disease, so symptoms begin gradually and worsen with time, and they may include disorientation, behavior changes, and eventually, difficulty speaking or walking. Symptoms of vascular dementia can appear more suddenly, especially if they’re brought on by a stroke. They include confusion, difficulty concentrating, restlessness, and difficulty walking. Lewy body dementia, like Alzheimer’s, has a progressive decline. Symptoms may mimic Parkinson’s disease, including tremors and rigid muscles. Hallucinations and sleep problems may occur in Lewy body dementia as well.

With so much overlap between the types, symptoms of different types of dementia are often indistinguishable. A doctor’s goal is to determine which symptoms are present so that a specific diagnosis can be made, if possible. To do that, they must consider all types of symptoms. When they see overlapping symptoms for multiple forms of dementia, they nearly always label the condition as mixed dementia.

Symptoms of dementia overall can include cognitive changes such as:

  • Communication issues that make it difficult to find the right words
  • Diminished problem-solving skills
  • Reduced reasoning ability
  • Trouble with planning or organizing
  • Memory loss, often noticeable by other people
  • Confusion and disorientation
  • Difficulty with complex or multiple step-processes

Psychological changes are also present in most forms of mixed dementia. These may include:

  • Changes to a person’s personality
  • Increased anxiety
  • Depression
  • Paranoia
  • Agitation
  • Behavior that is inappropriate and often out of character
  • Hallucinations

Any combination of these symptoms should indicate a need to seek a doctor’s support.

Progression of Mixed Dementia

It can be difficult to distinguish one stage of progression from the next in people with mixed dementia. The most common stages and progression of this disease include:

  • No impairment and full functioning ability
  • Very mild impairment, such as increasing forgetfulness or feeling like a person is “getting old”
  • Mild impairment that may include repetition, loss of concentration, signs of memory loss, or confusion
  • Moderate impairment that often leads to incontinence, more memory loss, social withdrawal, difficulty with mental exercises, and loss of words
  • Moderately severe impairment that often requires some level of support from another person as symptoms worsen in memory loss, trouble with mental tasks, and inappropriate decision-making
  • Severe impairment that often requires assistance with dressing and toileting, as the person experiences sleep problems, may struggle to recall names of family members, and may have a shift in personality
  • Very severe impairment when a person needs assistance for most tasks, loses awareness of their surroundings, has language loss, and often has a loss of muscle control

With mixed dementia, the progression can take years or just a few months. The timeframe depends on the types of dementia a person has. Progression should be monitored over a period of time to ensure a person receives the level and type of care necessary as symptoms change.

Causes and Risk Factors of Mixed Dementia

The causes of mixed dementia can be hard to pinpoint. For most people, the specific causes may never be identified.

Developing mixed dementia can occur for various reasons, which makes risk factors hard to determine. If a person has risk factors for the development of any form of dementia, such as Alzheimer’s disease, vascular dementia, or Lewy bodies, then they also have risk factors for developing mixed dementia. Yet, there are some known risks. For example, it is expected that those who have hypertension and high blood pressure are more likely to develop vascular dementia, which can also be linked to mixed dementia. Genetics is believed to be a factor for many people, too. If a person has a family history of dementia, they are more likely to develop mixed dementia.

Other risk factors for the development of mixed dementia include things like a history of health problems, such as cardiovascular concerns, diabetes, and smoking. There is also some evidence to suggest those who have had traumatic brain injuries, some types of hydrocephalus (a buildup of fluid on the brain), and infections of the central nervous system are more likely to develop this condition. Long-term drug and alcohol use can also be an impacting factor.

Diagnosis of Mixed Dementia

There is no accurate way to conclusively diagnosis mixed dementia. Yet, doctors will look at the symptoms to make a determination about the risks that a person has for one or more types of dementia. To do so, they’ll use symptoms reported by the individual, as well as his or her family members.

Whenever symptoms seem to relate to more than one form of dementia, doctors are likely to label this condition mixed dementia. This suggests a person likely has more than one type of brain-related disorder occurring at once. Researchers continue to work for a better understanding of why some people have more than one set of symptoms and how one form of dementia may impact the onset and presence of others. Generally speaking, doctors base a diagnosis on symptoms related to cognitive function and brain abnormalities.

Treatment of Mixed Dementia

Many times, doctors will choose a treatment protocol for the most obvious or most likely form of dementia. There are no medications specifically associated with treating mixed dementia. Rather, doctors will prescribe and use treatments based on the most prevalent form of dementia present. For example, if a person has many of the symptoms of Alzheimer’s disease, doctors will focus on treatment in this area. This may include the use of medications for symptom management.

Medications for Alzheimer’s disease tend to be the most common choice. Early on, this may include the use of cholinesterase inhibitors that are used to reduce symptoms related to thinking, memory, and language. These medications can also help individuals to see improvements in judgment and thought processes. These medications primarily include Donepezil, Galantamine, and Rivastigmine.

As the condition progresses, doctors will use other drugs to improve reasoning, attention, and memory. This often includes medications such as Memantine, which is a combination of donepezil and memantine. These work to regulate the activity of glutamate, a chemical that is used in the brain to store information, and aids in improving mental function.

If a person has vascular dementia, doctors are likely to use medications to improve cardiovascular symptoms. There are no medications to treat vascular dementia specifically, but doctors will use other dementia treatments to minimize risks of strokes and other health events.

In addition to this, doctors will work to improve any specific areas possible in overall health and wellbeing. This may include lifestyle choices and improving overall health to reduce the pain or other symptoms a person has.

Care for Mixed Dementia

Dementia care should be specific to the individual. In the early stages of mixed dementia, no care changes will likely need to be made. Early on, a person functions as well as he or she has been with limited impairments. As impairments increase, however, more care tends to be needed.

When a person has developed moderate to severe forms of mixed dementia, they may need more help. This may no longer be a safe time to live on their own. Some individuals benefit from moving in with family, but as this condition worsens, they will need 24-hour care. As a result of this, it becomes very important for individuals to pay close attention to the needs of an individual as they change. And, those changes can happen very quickly.

Over time, the progression of mixed dementia will lead to the need for more advanced care. This often means living in a community where there is always someone available to them to help with things like dressing, eating, and toileting. Over time, they may become dependent on medical needs as well, requiring a full-time nurse.

As this condition intensifies, and they stop being able to communicate well, it is important to ensure that a person with mixed dementia is in a safe location where they feel comfortable and protected. They may not remember family or friends any longer. They may lose track of time or may even try to leave. Some people may become violent. Having a supportive environment in which a person receives constant enrichment and guidance is a critical factor for many men and women with mixed dementia.

At The Brielle, this type of round-the-clock, supportive care is available. In our memory care neighborhood, individuals can begin to receive supportive care early on, which may help to improve symptoms significantly and ensure a person enjoys a higher quality of life.

Learn more about dementia and how The Brielle can help. Download our community brochure, or contact us at 929-256-3005 to learn more about our programs for residents with mixed dementia.