Dementia Support Line
Advice
What is mixed dementia?
‘Mixed dementia’ is a condition in which a person has more than one type of dementia. A combination of Alzheimer’s disease and vascular dementia is the most common type.
At least 1 in 10 people with dementia is diagnosed as having mixed dementia.
Other combinations are also possible – particularly Alzheimer’s disease and dementia with Lewy bodies.
Getting a mixed dementia diagnosis
A lot of people have more than one type of disease in their brain, particularly as they get older. The most common types are Alzheimer’s disease, vascular or blood vessel disease, and Lewy body disease.
When an older person has dementia, it’s probably not because of a single type of brain disease but rather a combination of different ones. Unfortunately, it’s still very difficult to see all the different types of disease in the brain of a living person.
This is why a doctor is likely to base their diagnosis on the main type of disease they think is present and causing symptoms. The most common diagnoses are Alzheimer’s disease or vascular dementia.
Sometimes, a doctor may find that a person has clear signs and symptoms of at least two different types of dementia. When this happens, they will make a diagnosis of mixed dementia.
What are the symptoms of mixed dementia?
There’s no fixed set of symptoms for mixed dementia. This is because a person’s symptoms depend on the relative contributions of each type of dementia that they have.
To know more about the likely symptoms of mixed dementia, you need to learn about the symptoms of the different types involved. It’s common to have more symptoms of one type than another.
Common types of mixed dementia
Most diagnoses of mixed dementia tend to be a combination of two different types. Here, we look at the two most common types of mixed dementia – Alzheimer's disease with vascular dementia, and Alzheimer’s disease with Lewy body disease.
Alzheimer’s disease with vascular dementia
This is the most common type of mixed dementia. It’s caused by a person developing Alzheimer’s disease and at the same time having diseased or damaged blood vessels supplying their brain.
The two different types of disease combine to make symptoms worse than they would be on their own.
Understanding Alzheimer’s disease
Alzheimer’s disease is caused by a build-up of faulty proteins in and around brain cells. The most common and well-known symptom of Alzheimer’s disease is having problems with memory – particularly memories of recent events or conversations.
However, a person with Alzheimer’s is also likely to get lost easily, have trouble finding words when they’re speaking and become confused about time or place.
Understanding vascular dementia
The ‘vascular’ part of mixed dementia is caused by problems with the supply of blood throughout the brain.
These can be caused by a stroke or a series of strokes when blood vessels in the brain become blocked or bleed. More often it’s caused by thousands of tiny and fragile blood vessels in the brain gradually becoming damaged and worn out over time. Either way, vascular disease stops brain cells from getting the oxygen and nutrients they need to work properly.
The symptoms of vascular dementia depend on what part of the brain is affected. Generally, the condition tends to make it harder to think quickly and process a lot of information at once. A person may have difficulties with planning, solving everyday problems and making decisions. They may struggle to focus and easily lose the thread of a conversation. It’s also common for someone with vascular dementia to have depression.
Alzheimer’s disease and dementia with Lewy bodies (DLB)
Less often, dementia can be caused by a mixture of Alzheimer’s disease and Lewy body disease.
Lewy body disease is the brain disease that can either cause dementia with Lewy bodies (DLB) or Parkinson’s disease dementia.
Understanding Lewy body disease
Lewy bodies are the clumps of faulty proteins that build up in the brain cells of people who have dementia with Lewy bodies (DLB) or Parkinson’s disease. Lewy body disease has quite different symptoms to other types of dementias.
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. Some medications and other therapies may help to improve dementia symptoms for a while. However, there is currently no medicine that can slow down the underlying diseases and prevent further damage from happening in the brain.
Medication for mixed dementia
The most common medication used to treat mixed dementia is called donepezil.
This boosts levels of a chemical in the brain that helps the cells to communicate with each other better. There are also two other medications that work similarly to donepezil. Another one called memantine is often prescribed when it’s not possible for a person to take donepezil. It can also be used in combination with donepezil as dementia symptoms get worse over time.
Unfortunately, there’s currently no medication that has been shown to improve the symptoms of vascular dementia or frontotemporal dementia.
Therapies for mixed dementia
There are several type of therapies that may help to improve a person’s abilities or their quality of life. These include occupational therapy, talking therapies and emotional support, cognitive stimulation therapy, cognitive rehabilitation, and reminiscence therapy. Some locations may also offer music and arts-based therapies.
A person with mixed dementia involving Lewy body disease may be offered physiotherapy to help with movement problems.
Learn more about the different approaches for coping with dementia symptoms.
No matter what type of dementia you have, we’re here for you.
Kate Wood
saysMy 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.
Alzheimer's Society
saysHi 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
Isobel Lee
saysMy 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
Scottish Stuart
saysMy 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
Judy Dunkley
saysMy 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.
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
Maxine
saysGosh 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.
Julie Sime
saysGood site to learn more about day to day experiences of sufferers and carers and what sopport is available for both. Thankyou, Julie
Viv cornell
saysHi 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
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
Jules
saysI’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.
Gillian Pearce
saysMy 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.
Angela Allen
saysMy 90 year old Father in Law was diagnosed with moderate Alzheimer’s & Vascular Dementia last year. After being take to A & E after a nasty fall this morning, the Doctor stayed ‘There’s no such thing as mixed dementia’ Doctors need educating!
Pauline
saysI have mixed denture x2years now I like to have information as much I can Get so helpful to be in touch with people can help.
Hello Pauline, thanks for getting in touch.
In terms of getting information, Our free Dementia Guide might be a good place to start. It's a comprehensive guide to living with dementia, which you can either download or order a copy to arrive in the post: https://www.alzheimers.org.uk/publications-about-dementia/the-dementia-…
If you're interested in finding out what services and groups are available in your local area, you can enter your postcode into our Dementia Directory: https://www.alzheimers.org.uk/find-support-near-you
If you have any other questions, or would just like more information, advice or support, please don't hesitate to contact our helpline: https://www.alzheimers.org.uk/get-support/national-dementia-helpline
Best wishes,
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Alzheimer's Society blog team
Mr David Hailstone
saysGood Morning,
Thank you for a very imformative site.
My wife who is 83 was diagnosed with Mixed Dementia in Nov 2018
She was put on Donepezil to start with and this at first did not show any side effects, but after she was also put on the drug Mematine, things started to go downhill.
It started with Malaise and her saying her head did not feel right and getting really confused about everything.
She had terrible nightmares and saying men were coming up the stairs! She was extreamely frightened during the night.
I rang the Memory clinic and after a consultant was informed she said for her to stop taking the Mematine tablets.
This did stop some of the nightmares, but she was still very confused.
After speaking to our own Doctor, she said for my wife to stop the tablets completely, as they were not doing her any good.
After a few days, my wife has gone back to her old self , but still has some memory loss and confusion. It varies from day to day.
I know that there is no cure for Dementia, but it seems to me that the drugs that are supposed to help in slowing down the progression of this disease sometimes have an adverse effect on the patient.
Thank you for letting me get this off my chest! as it was very worrying at the time.
Fran Baker
saysMy mum is denying she has any kind of problems at all. She was diagnosed with Alzheimer's and Vascular Dementia on the 7th Feb this year but has had noticable symptoms since before 2012.
Her behaviour and personality is completely different from what she used to be. She has delusions and describes hallucinations to me, and is impossible to calm or reason with. Yes, I know that's the disease, but what can I do when she talks of owning other people's houses and wanting them removed from her house so she can have a relative in there instead? I have to try to explain so she won't go and upset the neighbours.
And she's saying that 'Men came and dug up her flowers' (the water board is coming next week to replace the drain cover with a new one as this one is cracked and thus dangerous - it's in the drive.) There were NO flowers on top of the drain cover, nothing has been destroyed or dug up but they've painted a big yellow X on the cover.
It's the difficulties I have in trying to explain (useless I know, but what else can I do?) If I try talking about something else to divert her she knows I'm changing the subject.
She doesn't believe anything I say.
I'm so much at my wits end that I've been prescribed anti-depressants (which make things worse).
I can't get to any local groups as I can't leave the house while my husband is at work.
I'm trapped in a living hell.
I have no rights - mum wouldn't sign anything, since she doesn't think there's anything wrong with her. No carer's allowance - she wouldn't sign that. No right to know what might happen to mum's disease, no rights on anything at all.
Trapped with someone who seems to mostly want me to leave.
Hi Fran,
Sorry to hear you've been having a tough time, it sounds like a really difficult situation.
Have you tried calling our helpline? They should be able to offer you some advice and emotional support, as well as pointing you in the direction of any relevant information that you may find useful. You can find the number and opening hours here: https://www.alzheimers.org.uk/get-support/national-dementia-helpline
Some people also find it useful to talk to other people who are having similar experiences. Our online community Talking Point has a forum for carers to share experiences and ask questions - here's a link if that's something that interests you: https://forum.alzheimers.org.uk/
I hope that's useful, and if you have any questions or need some advide please do contact us again or the helpline.
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Alzheimer's Society blog team
Suzanne Amos
saysFran, I know so well what you mean about being at your wit’s end with the situation with your mum. Sorry to hear it’s had to come to you being prescribed anti-depressants.
Tina Seager
saysFran, what you are describing could be a description of my sisters illness. I am not my sisters main carer but she turns to me ( she doesnt know her partner of over 30 years most of the time or thinks there are lots of him !) She wants him out of her house but he is her carer and she cannot stay on her own. It is her house and they are not married.
She tells me stories of people who push past her and go upstairs and take her things etc- its not true but I go along with a lot of it saying things like " how dare they" it seems to be the better way than me telling her it hasnt happened.
This is an awful situation Fran but hold on, there must be help available somewhere.
I think my sister anxiety needs to be treated and maybe then she may have a happier life, thats all we want is for her to be happy even if her condition deteriorates.
Try keeping a log of your Mums condition because there could be a few things going on like depression ( hers not yours)
Good luck Fran.
Stephanie
saysMy mum is only 65 and has MS her mobility is restricted and she is in a lot of pain. The doctors as we have checked with more than have diagnosed her with Alzheimer's and vascualr dementia as well as ms cognitive deterioration . So she has a mix as they call it. She has been deemed unsafe to go home and was placed in a nursing home. I dont know what her future will bring and not sure how one can have such a cruel mix thrown at them. I dont know how i can help her through this. I dont know how long we have with her.
How common is this mix and is this mix even possible?
Marian Dial
saysHi 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.
Ciara Wilmot
saysHello Marian. If your mum has full mental capacity (which can only be determined by a medical practitioner) Your mum has the right to refuse. She has control over who touches her and whether she wants to eat or not. That being said carers should be following food hygiene protocol and date checking in the fridge after all if they are not assisting with personal care what ARE they doing during the call. Carers get a bad rep for not doing their jobs but we physically cannot force someone just because we think its better for them. Believe me as a carer for 7 years it breaks my heart to write "care refused" in the care notes and lay at home worrying that Mrs so and so is sitting in a wet pad and will likely be very sore when we return in the morning. The best thing is to get the Dr to explain how vital it is for dignity purposes to be hydrated, clean and dry. Preservation of life may not be on her mind but like us all dignity will be. Good luck and I hope you can work with the carers to achieve the best outcome for your mum
Hi Marian,
This situation must be most upsetting for you. I would certainly complain to the local authority, giving this evidence of the poor care provided. You could also consider complaining to the NHS about the lack of a proper discharge procedure.
Without the intervention of an Occupational Therapist, they have clearly made an ‘unsafe discharge.’ The Patient Advice and Liaison Service (PALS) within the hospital can help you make a complaint. This link explains how patients should be discharged from hospital: http://bit.ly/2rUbef0
Call us on the helpline if you need further information: 0300 222 1122.
We can also advise you how to take the matter to the Ombudsman if you are not happy with the response to any complaint you might make.
Our local Dementia Advisers are there to support your mum and your family. Search for the nearest service at: https://www.alzheimers.org.uk/find-support-near-you
-- Alzheimer's Society helpline team