Mixed Dementia—Yes, Your Partner Can Have More Than One

Today I want to bring your awareness to something because it's not often really talked about. However, I think it's really important to know that it does exist — and that is mixed dementia. Now, before we get into the details of what mixed dementia is, I think it would be helpful if we first redefine dementia just so that everyone's on the same page, OK?

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Dementia is actually a syndrome, meaning that it is a collection of symptoms that affect memory, thinking, behavior, emotion, in such a way that it significantly interferes with daily functioning. These symptoms are caused by various diseases or conditions. So, it's important to realize that dementia itself is not actually a disease. Instead, it's this term for a collection of symptoms that are being caused by some type of disease or condition. And, whatever is impacting the brain to then cause dementia is doing so by creating these brain changes and also triggering brain cell death, which is important to know. It's essentially causing brain failure.

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Now, with mixed dementia, essentially, there is more than one dementia at play, meaning there is more than one thing causing the symptoms of dementia at play. The trickiest part about mixed dementia is that it's very infrequently diagnosed during a person's lifespan, in most cases mixed dementia is not confirmed until there is an autopsy. So, for example, the NIA did some type of study where they did these long term cognitive assessments and then they followed up with a brain autopsy once the person passed away. Now, 94 percent of the participants who were diagnosed with dementia were diagnosed with Alzheimer's specifically. But, when they looked at the autopsies of those diagnosed with Alzheimer's, those results showed that 54 percent also had coexisting pathologies in addition to the hallmark Alzheimer's brain changes. And, the most common coexisting abnormality that was found was previously undetected blood clots or some other evidence of vascular disease. And then, the second most common coexisting brain change was Lewy body. So, the two most common types of dementia are going to be Alzheimer's Disease and Vascular Dementia and Alzheimer's Disease and Lewy Body Dementia.

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And the reason that I want you to be aware of this is because as your partner progresses through their dementia, you might start noticing a lot of symptoms. Some that with your research may be anticipated and others you may feel like "hey, this isn't exactly characteristic of what I've been researching." It could be possible that your partner has more than one type of dementia. And, when a person does have more than one type of dementia, it can complicate the progression of the dementia. It can cause it to progress faster or it can just cause very unique behaviors to appear when there is more than one thing that's impacting the brain, essentially.

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It is also important to note is that currently there is currently no cure for any type of dementia, whether it's Alzheimer's, vascular dementia, frontotemporal dementia, Lewy body dementia, all the other types of dementia, including mixed dementia. As we know, for something like Alzheimer's disease, there is about five FDA approved drugs for mixed dementia. However, there is no specific FDA approved drugs for mixed dementia. A lot of times, the medications that they use to try to help manage the symptoms are going to be the cholinesterase inhibitors. But there really is no specific medication for mixed dementia.

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Now, I will say that since it is already very infrequent for mixed dementia to be diagnosed during a person's life span, it is tricky when it comes to bringing up your partner's symptoms to medical professionals. They either blow it off or they just want to give you some type of medication for them, instead of actually trying to figure out what's going on. And, it's even becoming more common that a person is just getting diagnosed with dementia, unspecified and then there's no real follow-up. Essentially, when you get dementia, unspecified as a diagnosis, it just means, "we note that there are symptoms related to dementia, but we don't know what's causing it."

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There's a whole debate about how important a diagnosis is, but the reality is, the more you know about your partner's condition, the better care they are going to be able to get — not only from their care partners, but from medical professionals as well. When we consider that people living with dementia are already overdrugged and there are some drugs that are contraindicated for some types of dementia, this becomes especially important to know if the person has more than one type of dementia. So, when it comes from a medication stand point, you want to be careful about just giving you partner everything the doctor recommends, especially if they are the type to brush off the symptoms. It could be doing more harm than good. It's important to be aware of your partner's symptoms and bring them up to the doctor if they are bringing you concern. Don't stop bringing them up until they are addressed or at least acknowledged.