What are the other Names for this Condition? (Also known as/Synonyms)

• MD (Mixed Dementia)
• Multifactorial Dementia

What is Mixed Dementia? (Definition/Background Information)

• Mixed Dementia (MD) is a condition in which symptoms of two or more types of dementia are present simultaneously in an individual. The most common type of Mixed Dementia is a combination of Alzheimer’s disease and vascular dementia
• Dementia is a term used to describe symptoms that affect thought processes to the point of disrupting a person’s ability to perform everyday activities. It may be caused by a wide variety of factors
• There is little information known about the cause of this condition. However, all of the risk factors associated with various types of dementia may lead to the development of Mixed Dementia. Most individuals are diagnosed with one type of dementia, usually Alzheimer’s disease, and it is later discovered that it was a case of Mixed Dementia based on autopsy results
• In majority of cases, Mixed Dementia is not diagnosed when the affected individual is alive, but is more often recognized after their death. Examination of brain tissue by a pathologist and additional lab testing may help exclude Alzheimer’s disease, which may have been proposed as the cause of dementia, when the individual was alive
• There is no cure for Mixed Dementia, and so the focus of treatment is to alleviate the symptoms present, using a combination of lifestyle changes, medication, psychotherapy, and relaxation methods
• Due to the progressive nature of this condition, the prognosis is typically poor. Individuals diagnosed with Mixed Dementia see a worsening of their symptoms and eventually succumb to the condition

Who gets Mixed Dementia? (Age and Sex Distribution)

• Mixed Dementia most commonly occurs in adults aged 50 years and older
• Although both genders may develop this condition, it is more prevalent in males
• Mixed Dementia may be observed in all racial and ethnic groups

What are the Risk Factors for Mixed Dementia? (Predisposing Factors)

The risk factors of Mixed Dementia may be described based on the risk factors of the associated conditions that include:

Alzheimer’s disease

• Advancing age 
• Family history of Alzheimer’s disease
• Genetics 
• Head injury
• Unhealthy heart
• Untreated depression
• Loneliness 

Vascular dementia

• Advancing age 
• History of heart attack or stroke
• Atherosclerosis: This is a condition in which plaque builds up in the arteries, which reduces the flow of blood to the brain
• High cholesterol
• High blood pressure 
• Uncontrolled diabetes 
• Smoking
• Obesity
• Excessive alcohol consumption
• Atrial fibrillation: It is a heart condition in which the upper chambers of the heart beat abnormally faster than the lower chambers, resulting in blood clots that may travel to the brain and cause a stroke

Dementia with Lewy bodies

• Advancing age
• Family history of dementia with Lewy bodies
• Family history of Parkinson’s disease: It is a disorder in which there is a breakdown of brain cells, resulting in a decline in motor skills, such movement and speech, eventually leading to death
• Family history of REM sleep behavior disorder, which is a disorder in which the paralysis that regularly occurs during sleep is absent, and individuals physically act out dreams

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Mixed Dementia? (Etiology)

Presently, there is very little information known about the cause of Mixed Dementia.

• Most cases of Mixed Dementia involve vascular dementia, so it is likely that vascular-related condition may lead to the development of this disorder
• A reduced level of blood flow to the brain, present along with other risk factors, may also contribute to development of the disorder

What are the Signs and Symptoms of Mixed Dementia?

Individuals with Mixed Dementia simultaneously display symptoms of the different types of dementia. The signs and symptoms of Alzheimer’s disease may include:

• Memory loss
• Poor judgment 
• Loss of initiative
• Difficulty performing daily tasks
• Getting lost
• Losing or misplacing objects
• Changes in mood and personality
• Increased anxiety and aggression

The signs and symptoms of vascular dementia may include:

• Sleep disturbance
• Agitation, restlessness, and violence
• Decline in mental abilities
• Problems with movement
• Hallucinations 
• Delusions

The signs and symptoms of dementia with Lewy bodies may include:

• Slow thinking
• Difficulty with organizing thoughts and actions
• Trouble with understanding
• Forgetfulness
• Changes in mood and behavior
• Changes in sleep patterns
• Restlessness, agitation, and violent behavior
• Problems with memory and language
• Loss of control over urination
• Depression or apathy
• Social isolation

How is Mixed Dementia Diagnosed?

Mixed Dementia is very difficult to diagnose and is most commonly not recognized until after one’s death, based on the autopsy results. Most individuals are diagnosed with only one type of dementia, most commonly Alzheimer’s disease.

A combination of the following methods may be used to diagnose Mixed Dementia:

• Complete physical and neurological examinations
• Extensive personal and family medical history evaluation
• Assessment of mental abilities
• Blood tests
• Brain scans
• Cognitive testing
• Examination of brain tissue by a pathologist (post-mortem)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Mixed Dementia?

The complications of Mixed Dementia may include the following:

• Restlessness and agitation
• Bladder and bowel problems
• Mental illnesses, such as depression
• Difficulty with balance and movement
• Physical health problems
• Inability to function in regular life
• Higher likelihood of brain strokes (in future)
• Heart disease
• Inability to socially interact
• Inability to concentrate
• Lack of alertness
• Visual and auditory hallucinations

How is Mixed Dementia Treated?

Presently, there is no cure for Mixed Dementia. The focus of treatment is to improve and manage the signs and symptoms present in each individual. The following treatment procedures may be employed:

• Bringing about lifestyle changes such as through:
  • Exercise
  • Listening to calming music
  • Spending more time with close family and friends
• Use of medications to:
  • Improve memory
  • Help relax rigid muscles and ease movement
  • Address pain, sleep disorders, or movement problems
  • Improve blood pressure, high cholesterol, and diabetes
• Psychotherapy that involves:
  • Occupational therapy to identify problems in daily functioning and work out a practical solution
  • Cognitive stimulation improve memory, problem solving skills, and language
• Meditation and relaxation methods

How can Mixed Dementia be Prevented?

The exact cause of Mixed Dementia is not known, and hence, there are no methods or guidelines presently available for its prevention. However, controlling the contributory risk factors may minimize the possibility of its development. Some risk mitigating methods may include: 

• Leading a healthy lifestyle: The two most common types of dementia, Alzheimer’s disease and vascular dementia, may develop due to cardiovascular diseases, such as heart attacks and brain strokes, which can be prevented through a healthy lifestyle
• Smoking cessation
• Avoiding alcohol
• Keeping oneself intellectually active (such as solving cross-word puzzles, engaging in literary activities and teaching)

What is the Prognosis of Mixed Dementia? (Outcomes/Resolutions)

• Due to its progressive nature, the prognosis for Mixed Dementia is generally poor
• An effective treatment may slow down the progression of the condition; however, the symptoms are known to worsen over time, leading to fatal outcomes

Additions and Relevant Useful Information for Mixed Dementia:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/emotional-well-being/