Mixed dementia, also known as multifactorial dementia, is when you have brain changes from two or more types of dementia at the same time.
The most common form of mixed dementia is a combination of Alzheimer’s disease and vascular dementia. But mixed dementia may involve other combinations, like Alzheimer’s disease and dementia with Lewy bodies (DLB) or Parkinson’s disease dementia.
It’s also possible to have mixed dementia with more than two types of dementia, like Alzheimer’s disease, vascular dementia, and DLB.
Stages of Mixed Dementia
Just like other forms of dementia, mixed dementia is a disease that gets worse over time.
There are seven stages of mixed dementia. They are:
Normal functioning. When mixed dementia first starts to develop, you may have no signs or symptoms of dementia at all. The way your brain works, also known as cognitive functioning, may be normal.
Very mild cognitive decline. In the second stage, you may have small lapses in memory. You may forget things here and there, which may seem like a normal part of aging.
Mild cognitive decline. During stage three, you may notice early signs of dementia. You may have trouble remembering things and finding words to describe something.
Moderate cognitive decline. Your memory loss may become more noticeable. It may start to get in the way of daily tasks like keeping up with your bills and making plans.
Moderately severe cognitive decline. Your day-to-day functioning may become a struggle. You may need help with self-care tasks like taking a shower and getting dressed.
Severe cognitive decline. You may need a lot of help with things you do every day. It may be hard to communicate with others.
Very severe cognitive decline. You may no longer be able to do basic functions like walking and talking. At this point, you may need full-time, around-the-clock care.
Mixed Dementia Causes
Doctors are still learning what causes mixed dementia.
Evidence suggests having more than one type of brain change from dementia may make your risk of mixed dementia higher.
It’s possible that it’s related to vascular conditions, because most cases of mixed dementia involve vascular dementia.
Some doctors think it may be linked to low blood flow to your brain combined with other risk factors.
More research is needed to understand the cause of mixed dementia.
Mixed Dementia Risk Factors
Most people develop mixed dementia when they’re older. It may happen when you’re 50 years old or later. It’s most common in those older than 75.
Mixed dementia isn’t limited to one gender, but it’s more common in men. It happens in all racial and ethnic groups.
The main risk factors for mixed dementia include:
- Being older
- Blood vessel damage in your brain
- High blood pressure
It’s also based on risk factors linked to the type of dementia involved.
Risk factors for Alzheimer’s disease include:
- Older age
- Family history of Alzheimer’s disease
- Genetics
- Head injury
- Heart problems
- Loneliness
- Untreated depression
Risk factors for vascular dementia include:
- Older age
- Atherosclerosis
- Atrial fibrillation
- Excessive alcohol consumption
- High cholesterol or blood pressure
- History of heart attack or stroke
- Obesity
- Smoking
- Uncontrolled diabetes
Risk factors for DLB include:
- Older age
- Family history of DLB
- Family history of Parkinson’s disease
- Family history of REM sleep behavior disorder
Mixed Dementia Symptoms
Symptoms of mixed dementia vary from person to person. That’s because mixed dementia may involve different brain changes and may affect different parts of your brain.
Common signs of mixed dementia include:
- Behavior changes
- Confusion and disorientation, even in situations and settings that are familiar
- Depression
- A hard time with daily tasks like getting dressed and self-grooming
- A hard time making decisions
- A hard time recalling recent or past events
- A hard time with language
- Forgetfulness
- Hallucinations, especially with DLB
- Crankiness
- Memory loss
- Mood changes
- Problems with motor skills, like balance and coordination
- Personality changes
- Poor judgment
- Visual or spatial problems, like flawed depth perception and spatial awareness
For most people, symptoms are similar to those of the type of dementia. You may have a mix of symptoms, based on which types of dementia you have.
Some symptoms of Alzheimer’s are:
- Impaired judgment, reasoning, and decision-making
- Longer time to complete tasks
- Losing things
- Memory problems
- Mood changes
- More anxiety or aggression
- Problems keeping up with bills
- Vision and spatial issues
- Wandering or getting lost
Some symptoms of vascular dementia are:
- Communication problems
- Concentration and attention issues
- Confusion
- Depression or apathy
- Disorganized thoughts or actions
- Memory problems
- Organization problems
- Planning problems
- Restlessness and agitation
- Slower thinking
- Trouble making decisions
- Urination changes, either more frequent urination or trouble controlling it
- Unsteady gait
Symptoms of dementia with Lewy bodies include:
- Changes in reasoning
- Changes in thinking
- Changes in your nervous system, like blood pressure, digestion, heart rate, sexual response, and sweating
- A hard time interpreting what you see
- Changes in thinking skills
- Parkinson’s symptoms, like slow movement, tremors, or rigidness
- REM sleep behavior disorder, which may involve acting out your dreams
- Some memory loss, but usually less than with Alzheimer’s disease
- Visual hallucinations
It may be hard to tell if you have mixed dementia, instead of one form of dementia, based on your symptoms. Doctors hope to know more with long-term studies.
Mixed Dementia Diagnosis
It’s challenging to diagnose mixed dementia because it involves brain changes that are hard to measure in someone who’s still alive. It’s easier to see these brain tissue changes during an autopsy. Researchers are doing autopsy studies to find out more about mixed dementia.
Doctors often diagnose one type of dementia, then find out after an autopsy that it was mixed dementia.
If you have symptoms of dementia, write them down and take the list to your doctor. If you have signs and symptoms of two or more types of dementia, they may diagnose you with mixed dementia.
Your doctor may use these tools:
- Blood tests
- Brain scans
- Cognitive testing
- Complete physical
- Mental ability assessment
- Neurological exams
- Personal history and family medical history evaluation
They may also do extra tests to rule out other conditions.
Mixed Dementia Treatment
Just as with other forms of dementia, there’s no cure for mixed dementia. There’s also no medication that can stop it from getting worse over time. But certain medications and other treatments may help with some symptoms.
If part of your mixed dementia is Alzheimer’s disease, your doctor may recommend a drug that’s FDA-approved for treating some symptoms of Alzheimer’s. These include cholinesterase inhibitors (donepezil, galantamine, and rivastigmine), aducanumab, donanemab, lecanemab, and memantine. But the maker of aducanumab announced it will no longer make that drug after Nov. 1, 2024.
Your doctor may give you medication to help with movement issues, sleep problems, and pain.
If you have vascular dementia, your doctor may prescribe medication to treat your blood pressure problems.
Certain lifestyle changes may help with symptoms. They include:
- Getting more exercise
- Listening to calm music
- Relaxation techniques like meditation
- Spending time with your family or friends
You can also try psychotherapy and occupational therapy, which may help you with daily activities, language, memory, and problem-solving.
Your doctor may recommend alternative therapies for dementia, but research is needed to see if they’re effective. They include aromatherapy, light therapy, massage, and transcutaneous electrical nerve stimulation (TENS).
Mixed Dementia Complications
Like other forms of dementia, mixed dementia may lead to complications.
Complications may include:
- Balance and movement problems
- Bladder problems
- Bowel problems
- Concentration problems
- Health problems
- Heart disease
- Not being able to function in daily life
- Increased risk of brain strokes
- Lack of alertness
- Mental health issues, like depression
- Restlessness and agitation
- Social interaction problems
- Visual and auditory hallucinations
Mixed Dementia Prognosis
Just as with other forms of dementia, brain changes from mixed dementia often get worse over time. As symptoms progress, it may be harder to do things you usually do. You may become more disabled over time. You may not live as long as you would without it.
Mixed dementia life expectancy varies widely from person to person. How long you live may depend on things like what caused your dementia, how old you were when you were diagnosed, and if you have other health conditions.
Living with Mixed Dementia
While there’s no cure for mixed dementia, there are things you can do to improve your quality of life.
Your doctor may recommend therapies to help you function better, such as:
- Cognitive rehabilitation
- Cognitive stimulation therapy
- Emotional support
- Music or art therapy
- Occupational therapy
- Physiotherapy
- Reminiscence therapy
- Talk therapy
Try these tips for living better with mixed dementia:
Make it easier to remember things. Write down appointments, events, and to-do lists.
Make bill paying easier. Set up automated payments and have a trusted family member or friend help you manage your finances.
Sleep better. Go to bed and wake at the same every day, avoid caffeine, and create a relaxing bedtime routine.
Create more enjoyment in your life. Do your favorite activities and get social. If you live by yourself, ask people to visit.
Exercise to feel good. This can also help you maintain a healthy weight.
Accept help from family members, friends, and neighbors. They can help with things like cooking, driving, and shopping.
Reach out to professional caregivers and community organizations, which can help you with in-home help, meals, and transportation.
For more support, try these resources:
Alzheimer’s Association. Get reliable information, referrals, and support.
The Association of Frontotemporal Degeneration. Get support and find online groups.
Lewy Body Dementia Association. Find virtual support groups.
Takeaways
Mixed dementia is when you have brain changes from more than one type of dementia. Usually, it’s a combination of Alzheimer’s disease and vascular dementia. Your symptoms may be similar to those of the types of dementia you have. Doctors are still learning about mixed dementia, which may make it easier to diagnose in the future. There’s no cure for mixed dementia, but your doctor may recommend therapies and lifestyle changes to improve your quality of life.
Mixed Dementia FAQs
How quickly does mixed dementia worsen?
It varies from person to person. How fast it progresses may depend on which types of dementia you have, your overall health, and your genes. Your thinking may decline gradually, or you may go through the stages of mixed dementia quickly. You may have good days and bad days, with more or fewer symptoms. It doesn’t always follow a straight line.
Is mixed dementia worse?
It depends. It’s hard to predict what will happen over time because it varies a lot from person to person. But if you have mixed dementia that involves Alzheimer’s disease and vascular dementia, it’s possible that you may not live as long as you would if you had only Alzheimer’s disease.
At what age is mixed dementia most common?
You’re more likely to develop mixed dementia if you’re over age 65. It’s most common in people over 75. You may develop mixed dementia in your 40s or 50s, but it’s not common.
How do you know if it’s mixed dementia?
It’s hard to tell if it’s mixed dementia. Most of the time, people with mixed dementia are diagnosed with one type of dementia, based on their symptoms. But if you have symptoms of more than one type of dementia, your doctor may give you a mixed dementia diagnosis.
Is there medication for mixed dementia?
No. There’s no FDA-approved medication to treat mixed dementia. But if Alzheimer’s disease is part of your mixed dementia, your doctor may give you drugs that are FDA-approved for Alzheimer’s disease.
How long can a person live with mixed dementia?
It’s hard to know how long you’ll live with mixed dementia. It may depend on things like what caused your dementia, how old you were when diagnosed, and if you have other health conditions.
