Mixed dementia refers to the coexistence of more than one type of neurodegenerative pathology in the brain, most commonly Alzheimer’s disease combined with vascular dementia or Lewy body dementia.
According to a study conducted by the National Institute of Aging, around one-third of people above the age of 85 battle with memory and concentration problems. Mixed Dementia is a condition where a multitude of factors lead to degenerative changes in the brain. The most common forms are Alzheimer’s disease with vascular dementia and Alzheimer’s disease with Lewy body dementia. Symptoms often result from damage to different parts of the brain and may usually overlap.[2]
Read on to learn about the early signs of mixed dementia that often go unnoticed.
Forgetting the names of people or objects
Difficulty in recalling recent events
Misplacing items
Mood and Personality changes, often observed by family members
Concentration problems
Decision-making issues
Movement and balance issues
Sleep disturbances
Visual Hallucinations
Repetitive language
These overlapping symptoms often appear gradually and vary from person to person, making daily tasks difficult to manage.
Mixed Dementia most commonly results from the co-existence of Alzheimer’s disease and vascular dementia. Symptoms are often subtle and confusing, making it difficult to understand the main reason behind their development. According to autopsy studies conducted by Schneider, 38% of dementia patients showed signs of AD and vascular disease, indicating that mixed dementia is more common than previously thought.[1]
Alzheimer's pathology and vascular disease often coexist and can interact, increasing the likelihood and severity of cognitive symptoms. Cerebrovascular injury and reduced blood flow may promote or exacerbate the accumulation of Alzheimer-related proteins (amyloid and tau), but the precise causal pathways are still under study.
Another hallmark of AD is the development of Tau tangles. Tau is a protein found in healthy brain cells that acts like railway tracks to keep the internal transport system stable. Reduced blood flow leads to decreased oxygen and energy in brain cells, leading to chemical changes that cause Tau proteins to detach and clump abnormally, causing neurofibrillary tangles. Imagine a busy train station where the tracks suddenly twist, trains can’t move, deliveries are disrupted, and chaos occurs. Similarly, in the brain, these changes further disrupt the flow of nutrients inside the cell, causing cellular stress and cell death.
As the disease progresses, more and more brain cells are damaged, leading to disruption of the internal network within the brain and giving rise to symptoms of memory loss, confusion, balance, and movement problems. Researchers are investigating more into the actual mechanism behind mixed dementia.
Emerging research also shows a possible link between Parasitic and Viral infections, causing brain inflammation and possible cognitive decline. While the evidence is still evolving, timely management of infections and being up to date with vaccinations can play an important role.[9]
MedBound Times connected with Dr. Sudhir Kumar, MBBS; MD (Internal Medicine), DM (Neurology), a leading neurologist based in Hyderabad, India, to discuss the early signs, symptoms, and progression of dementia alongside the importance of early diagnosis in dementia.
Dementia does not appear overnight. It often begins with small, easy-to-miss changes, such as a misplaced wallet, repeating questions, or struggling to find the right word. Over time, these subtle lapses start to affect everyday life. The first signs are often changes in behavior or thinking, not just forgetfulness. Family members may notice that a loved one seems withdrawn, confused in conversations, or has trouble following familiar routines. Recognizing these patterns early can make a real difference.
Dr. Barry Reisberg created the Global Deterioration Scale (GDS) in 1982 to help clinicians categorize the stages of dementia.[3]
Seven Stages of Dementia:
Stage 1: No cognitive decline
Normal cognitive functioning. Symptoms are often unnoticed.
Stage 2: Very mild cognitive decline
Difficulty in recalling names of family members, objects, and recent events.
Stage 3: Mild cognitive decline
Gets lost while driving. Increased forgetfulness and concentration problems. The family becomes aware.
Stage 4: Moderate cognitive decline
Struggles with complex tasks. Reduced ability to count.
Stage 5:Moderately severe cognitive decline
Forgets information or events. Assistance with daily activities is often needed.
Stage 6: Severe cognitive decline
Significant memory issues and personality changes. Disoriented to time and space. Possibly forgets ‘who they are’.
Stage 7: Very severe cognitive decline
Impaired ability to walk or eat. Loss of verbal ability and motor skills with total dependence on the caregivers.
Clinical evaluation
Cognitive function assessment: Helps to differentiate between Alzheimer’s dementia, vascular dementia, and mixed dementia.
Medical History:
A history of cardiovascular risk factors like high blood pressure, high blood sugar, smoking history, or stroke signifies vascular factors for dementia. Patients with family members suffering from AD most often indicate a genetic component to the disease occurrence.
Neurological Examination: Reflex changes, slow movements, balance issues, and motor deficits can help physicians in reaching a diagnosis.
Neuroimaging:
MRI is commonly used to look for structural and vascular changes (white-matter hyperintensities, lacunes, atrophy). Amyloid or tau PET imaging (and specialist CSF or blood tests) can detect Alzheimer-type pathology earlier, but these biomarker tests are typically done in specialist settings and require expert interpretation. [4] [5] [6]
Biomarkers:
Research is underway to detect proteins linked to Alzheimer’s, like amyloid‑β and tau, which will make it easier to detect early brain changes without invasive tests. Neuro-inflammatory markers, neuronal damage markers, and tests to detect changes in the eyes or retina are also being studied to help catch the disease earlier and impact treatment outcome.[7]
Medications for Alzheimer’s symptoms
Donepezil and Rivastigmine can help with memory and concentration problems. Newer drugs targeting amyloid or tau proteins are being studied in clinical trials; however, they carry risks such as brain inflammation and bleeding, and their long-term safety and efficacy are still under investigation.[8]
Control of Vascular Risk Factors
Controlling high blood pressure, high blood sugar, and cholesterol helps reduce further brain damage.
Lifestyle interventions
Regular exercise, a balanced diet with a focus on brain-boosting foods, and quitting smoking can help support brain health. Cognitive stimulation, social engagement, and structured routines can also improve daily functioning.
Supportive care
Maintaining structured routines.
Communicate calmly: Listen, reassure, and use familiar objects or photos.
Make home safe: Remove trip hazards, add handrails, and secure dangerous items.
Caregivers’ support groups and counselling also help in preventing burnout and exhaustion.
Each person with mixed dementia experiences the condition differently, encouraging people with dementia to develop simple hobbies, listen to soothing music, and meet friends and family, which helps provide a sense of comfort and normalcy. Families and caregivers play a major role in motivating the patients by focusing on small achievements more than disabilities.
Many modifiable lifestyle factors can delay the onset or reduce the risk of getting diagnosed with dementia.
Eating a balanced diet rich in antioxidants
Regular physical activity
Attending book clubs/brain-boosting activities/ writing a journal
Maintaining normal blood sugar and blood pressure levels
Maintaining a healthy BMI
Smoking cessation
Limiting Alcohol Use
While mixed dementia has no cure, the right combination of medications and lifestyle changes can ease symptoms and slow progression. Together, these approaches aim to improve daily functioning and quality of life, offering not just practical benefits but also reassurance and hope to patients and their families that they can continue to live meaningfully and stay connected to their loved ones.
Mixed dementia is a complex condition shaped by overlapping brain pathologies, making timely recognition especially important. While there is no cure yet, early diagnosis, structured support, and appropriate medical care can slow symptoms and help individuals maintain independence longer. With awareness, supportive care, and community involvement, families can navigate the challenges with greater clarity and confidence.
Disclaimer:
This article is for educational purposes only and should not be used to self-diagnose, test, or treat any medical condition. Dementia and sleep disorders are complex conditions that require professional evaluation and guidance. Always consult a qualified healthcare provider before starting or changing any medication, treatment, or routine related to your health or sleep.
References:
Schneider JA, Arvanitakis Z, Bang W, Bennett DA. Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology. 2007;69:2197-204, https://pubmed.ncbi.nlm.nih.gov/17568013/
National Institute on Aging. What are the symptoms, types, and diagnosis of dementia? [Internet]. Bethesda, MD: National Institutes of Health; c2025 [cited 2025 Oct 16]. Available from: www.nia.nih.gov/health/alzheimers-and-dementia/what-dementia-symptoms-types-and-diagnosis
Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139(9):1136-1139. doi:10.1176/ajp.139.9.1136. https://pubmed.ncbi.nlm.nih.gov/7114305/
Lee H, Wiggermann V, Rauscher A, Kames C, Beg MF, Popuri K, Tam R, Lam K, Jacova C, Shahinfard E, Sossi V, Pettersen J, Hsiung GR. Brain imaging abnormalities in mixed Alzheimer’s and subcortical vascular dementia. Can J Neurol Sci. 2023 Jul;50(4):515–528. doi:10.1017/cjn.2022.65. https://pubmed.ncbi.nlm.nih.gov/35614521/
Yang D, Masurkar A, et al. Early-Stage MRI Volumetric Differences in White Matter Hyperintensity and Temporal Lobe Volumes between Autopsy-Confirmed Alzheimer’s Disease, Cerebral Small Vessel Disease, and Mixed Pathologies. Dement Geriatr Cogn Dis Extra. 2022 Apr 26;12(1):69-75. doi:10.1159/000524499. PMID:35702161.https://pubmed.ncbi.nlm.nih.gov/35702161/
Beynon R, Sterne JAC, Wilcock G, Likeman M, Harbord RM, Astin M, Burke M, Bessell A, Ben-Shlomo Y, Hawkins J, Hollingworth W, Whiting P. Is MRI better than CT for detecting a vascular component to dementia? A systematic review and meta-analysis. BMC Neurol. 2012 Jun 6;12:33. doi:10.1186/1471-2377-12-33. PMID:22672344. https://pubmed.ncbi.nlm.nih.gov/22672344/
Zheng M, Wang S, Jia J. Potential diagnostic markers in Alzheimer's disease: current perspectives and future directions. Neurodegener Dis Manag. 2025 Sep 5:1–13. doi: 10.1080/17582024.2025.2554515. PMID: 40911035. https://pubmed.ncbi.nlm.nih.gov/40911035/
Matsuzono K, Sato K, Kono S, Hishikawa N, Ohta Y, Yamashita T, Deguchi K, Nakano Y, Abe K. Clinical benefits of rivastigmine in the real world dementia clinics of the Okayama Rivastigmine Study (ORS). J Alzheimers Dis. 2015;48(3):757-63. doi: 10.3233/JAD-150518.https://pubmed.ncbi.nlm.nih.gov/26402119/
Piekut T, Hurła M, Banaszek N, Szejn P, Dorszewska J, Kozubski W, et al. Infectious agents and Alzheimer’s disease. J Integr Neurosci. 2022; 21(2):73.
Edited by Dr. Shikhar Dabas and M Subha Maheswari
