Decoding Mixed Dementia: What You Need to Know

Mixed dementia is the presence of more than one form of dementia in an individual, generally two types. If two forms of dementia exist, that person will show symptoms of both illnesses. It is important to verify whether that individual has mixed dementia, as two forms of dementia can cause a greater decline in cognitive health. This will affect the progression of dementia and the treatment process for that individual. Let’s decode the complexities of mixed dementia. 

What is Mixed Dementia?

The existence of two or more types of dementia that simultaneously affect the brain is known as mixed dementia. The most common combination is Alzheimer’s and vascular dementia, where issues like protein deposits and blood flow occur. Symptoms vary according to the dementias involved, but memory loss, personality changes, and thinking problems are commonly expected. A mixed dementia diagnosis is difficult and requires immediate medical intervention.  

Types of Dementia Commonly Found in Mixed Dementia

The presence of three different types of dementia in one individual is rare, as mixed dementia mostly comprises two types of dementia disease; the most common combinations are 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 affecting their brain that contribute to dementia symptoms. Alzheimer’s is caused by the accumulation of faulty proteins in brain cells that cause memory problems. Symptoms include memory loss, difficulty communicating, and confusion. 

An irregular blood supply causes vascular dementia throughout the brain and causes strokes. It prevents oxygen and nutrient supply to the brain, which is required for proper functioning. Dementia symptoms depend on the affected part of the brain, which includes trouble concentrating and difficulty solving problems. 

Alzheimer’s Disease and Lewy Body Disease

The presence of Alzheimer's and Lewy body disease in an individual with dementia is rare. Lewy body is the accumulation of faulty proteins in the brain cells of individuals with Parkinson’s disease or dementia. It affects the brain region, which operates the body's movement and decodes sensory information. Individuals with Lewy bodies experience sleep problems, hallucinations, confusion, rapid fluctuations in functioning, and sudden disorientation. Alzheimer's affects the memories of a person, whereas it is largely unaffected in Lewy body.

Causes of Mixed Dementia

Mixed dementia is a combination of more than one dementia, so there are many causes and risk factors involved in its development. Let's delve into it closely:

Interplay of Alzheimer's Disease and Vascular Changes

Alzheimer’s and vascular changes cause brain damage through protein deposits and impaired blood flow. Both accelerate cognitive decline and worsen the symptoms of dementia. Vascular changes like inflammation and reduced blood flow disrupt the blood-brain barrier, which can create a recovery-conducive environment. Alzheimer’s makes brain regions vulnerable, which causes vascular damage. Research is actively underway on the interaction between Alzheimer's and vascular changes and how they share biological pathways. 

Genetic Factors

The APOE ε4 gene is an established risk factor for Alzheimer’s, which also contributes to mixed dementia, especially when combined with vascular risk factors like high blood pressure and diabetes. The vascular component of mixed dementia is associated with atherosclerosis, blood vessel health, and genes related to stroke. There are various genes related to mixed dementia that contribute to the rare combination of Lewy body dementia and other rare forms. 

Age and Comorbid Health Conditions

Cognitive health changes naturally with age, making it prone to Alzheimer’s and vascular damage. With time, accumulation in the brain can increase the damage, and the chances of developing mixed dementia rise. Heart diseases, high blood pressure, and diabetes can restrict blood flow, starve brain cells, and worsen Alzheimer's, which can invite the changes of mixed dementia. Also, head injuries, arthritis, or COPD can create a pro-dementia environment. 

Neurodegenerative Processes and Brain Cell Damage

Neurodegenerative processes are irreversible changes that cause the death of brain cells; these include diseases like Alzheimer’s, Lewy body, and Parkinson's. These diseases create abnormal protein accumulation in the brain, affecting cellular functions. Strokes, head injuries, infections, and chronic health conditions can damage brain cells, leading to cognitive impairment, memory loss, and dementia. The brain sometimes gets affected by two neurodegenerative diseases together, which is mixed dementia. 

Symptoms of Mixed Dementia

Symptoms vary based on affected brain regions and brain changes. Various symptoms might be similar to or distinguished from other types of dementia, like Alzheimer’s or Lewy body. It is difficult to determine which type of mixed dementia an individual has only based on symptoms. 

Memory Loss and Confusion

This is one of the noticeable changes in an individual with dementia; they forget about recent conversations, misplace objects, and have difficulty retaining information or making sound decisions. They easily get disoriented by losing track of time and place, even forgetting their own identity. They ask repetitive questions, wander off, and easily get lost in familiar places. 

Challenges with Communication and Language

Individuals with mixed dementia might find it difficult to communicate, as it affects various regions of the brain, causing cognitive decline. They struggle with finding the right words, understanding the language, and making errors while speaking. They repeat phrases, add irrelevant information, cannot make sensible statements, and might miss certain social cues. 

Fluctuations in Cognitive Abilities

Mixed dementia causes rapid fluctuations in cognitive abilities; they are unpredictable, which makes it difficult to anticipate the next fluctuation. During fluctuation, different brain regions might be affected, such as memory, attention, and language, making them impaired. Individuals experience normal functioning scattered with episodes of confusion and disorientation. 

Difficulty with Daily Tasks

Cognitive decline causes difficulty in the daily functioning of an individual affected by mixed dementia. Due to memory problems and motor skill deterioration, they face difficulty bathing, dressing, and eating. Daily household chores and financial management are also affected, as planning and organizing are hard for them. Driving and traveling become unsafe due to impaired judgment. Personality changes and a decline in cognitive ability hinder communication. 

Diagnosis of Mixed Dementia

It is a complex process, as it involves identifying different types of dementia and the underlying brain pathologies causing cognitive decline. Detailed information about symptoms, past medical conditions, family history, and medication is gathered. Various neurological and physical examinations are conducted to assess the physical and cognitive health of an individual. A cognitive test can be done to evaluate memory, language, and other cognitive domains. Brain imaging, like MRI or CT scans, is conducted to determine the structural abnormalities in the brain. For the differentiation of Alzheimer’s and other types of dementia, PET scans or SPECT can be used, which help visualize neurotransmitter activities in the brain. 

Treatment Options for Mixed Dementia

Mixed dementia, or any other type of dementia, is largely untreatable, but medications and treatments can help maintain better cognitive health and manage various symptoms. 

Medications Used in Managing Mixed Dementia 

Cholinesterase inhibitors and memantine are common medications that are used to treat mixed dementia. They boost the level of certain chemicals in the brain that help in brain cell communication. Vascular dementia currently has no medication that helps with its symptoms, but medication for high blood pressure and diabetes may prevent strokes for individuals with vascular disease. 

Therapies for Mixed Dementia

Therapies can help improve functions or quality of life for a person with mixed dementia. Cognitive behavioural therapy (CBT), cognitive stimulation therapy, cognitive rehabilitation, and reminiscence therapy are few therapies that help with the illness. Physiotherapy can also help with the movement problems of a person suffering from mixed dementia with Lewy body. 

Lifestyle Modifications and Supportive Care

A healthy lifestyle can help manage mixed dementia and improve quality of life. A healthy diet, regular exercise, and the elimination of alcohol and smoking can keep brain cells healthy and slow down the decline of cognitive health. Maintaining sleep hygiene, such as having a sleep schedule, helps with cognitive functions. Loneliness can increase the chances of Alzheimer's, so social engagement and doing meaningful activities can prevent the onset of dementia. 

Finding Strength with Cadabams: Navigating Mixed Dementia Together

If you are searching for a solution to your problem, Cadabam’s Hospitals can help you with its team of specialized experts. We have been helping thousands of people live healthier and happier lives for 30+ years. We leverage evidence-based approaches and holistic treatment methods to help individuals effectively manage mixed dementia. Get in touch with us today. You can call us at +91 97414 76476. You can even email us at info@cadabamshospitals.com.

FAQ

What is the most common type of mixed dementia?

Alzheimer’s vascular dementia (AVD) or mixed Alzheimer’s and vascular dementia (MADV) is the most common type of dementia. Research has found that around 50% of individuals affected by dementia have both Alzheimer’s and vascular dementia pathologies. 

Which dementia is the most common form of dementia?

Global studies show Alzheimer’s disease is the most common form of dementia, accounting for over 60% of all dementia cases worldwide. These estimates can vary according to geographical regions. Different forms of dementia can coexist in an individual. 

How is mixed dementia confirmed?

To confirm the disease, various clinical evaluations for symptoms and medical history are conducted. Some cognitive tests, like memory and thinking abilities, are done to assess the cognitive abilities of an individual. An MRI and CT scan are conducted to look for multiple pathologies.