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types of dementia

There are over 400 different types of dementia. All types of dementia are progressive, which means that the functioning of the brain will change over time. However, each type of dementia affects everyone differently and with the right support, it is absolutely possible to live well with dementia.

TYPES OF DEMENTIA

 

Dementia an overview - The word ‘dementia’ describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language. These changes are often small to start with, but for someone with dementia they have become severe enough to affect daily life. A person with dementia may also experience changes in their mood or behaviour.

The different types of dementia tends to affect people differently, especially in the early stages. Other factors that will affect how well someone can live with dementia include how other people respond to them and the environment around them.

A person with dementia will have cognitive symptoms (to do with thinking or memory). They will often have problems with some of the following:

  • day-to-day memory – for example, difficulty recalling events that happened recently,
  • concentrating, planning or organising – for example, difficulties making decisions, solving problems or carrying out a sequence of tasks (such as cooking a meal),
  • language – for example, difficulties following a conversation or finding the right word for something,
  • visuospatial skills – for example, problems judging distances (such as on stairs) and seeing objects in three dimensions,
  • orientation – for example, losing track of the day or date, or becoming confused about where they are.

 

Alzheimer’s disease - Dementia is the name for a set of symptoms that includes memory loss and difficulties with thinking, problem-solving or language. Dementia develops when the brain is damaged by diseases, including Alzheimer’s disease. Alzheimer’s disease is a physical disease that affects the brain.

The brain is made up of billions of nerve cells that connect to each other. In Alzheimer’s disease, connections between these cells are lost. This is because proteins build up and form abnormal structures called ‘plaques’ and ‘tangles’. Eventually nerve cells die and brain tissue is lost.

The brain also contains important chemicals that help to send signals between cells. People with Alzheimer’s have less of some of these ‘chemical messengers’ in their brain, so the signals are not passed on as well. There are some drug treatments for Alzheimer’s disease that can help boost the levels of some chemical messengers in the brain. This can help with some of the symptoms.

Alzheimer’s is a progressive disease. This means that gradually, over time, more parts of the brain are damaged. As this happens, more symptoms develop, and they also get worse.

The symptoms of Alzheimer’s disease are generally mild to start with, but as more brain cells are damaged over time the symptoms get worse and start to interfere with a person’s day-to-day life. This makes them different from the changes that lots of people have as they get older, such as being a bit slower at thinking things through or forgetting something occasionally.

There are some common symptoms of Alzheimer’s disease, but no one’s experience will be exactly the same as anyone else’s.

For most people, the first signs of Alzheimer’s are problems with their memory – in particular, difficulties recalling recent events and learning new information. This is because early on in Alzheimer’s the damage is usually to a part of the brain called the hippocampus. This has a big role in day-today memory. However, the person’s memory for events that happened a long time ago is not usually affected in the early stages.

As Alzheimer’s disease progresses, memory problems will usually affect someone’s daily life more and they may:

  • lose items (such as keys and glasses) around the house
  • forget a friend’s name, or struggle to find the right word in a conversation
  • forget about recent conversations or events
  • get lost in a familiar place or on a familiar journey
  • forget appointments or significant dates.

As well as memory difficulties, people with Alzheimer’s are also likely to have – or go on to develop – other problems. These include problems with thinking, reasoning, language or perception such as:

  • speech – they may repeat themselves or struggle to follow a conversation
  • seeing things in three dimensions and judging distances (visuospatial skills) – going up or down stairs or parking the car might become much harder
  • concentrating, planning or organising – they may struggle with making decisions, solving problems or carrying out a sequence of tasks (such as cooking a meal)
  • orientation – they may become confused or lose track of the day or date.

A person in the earlier stages of Alzheimer’s will often have changes in their mood. They may become anxious, depressed or more easily annoyed. Many people lose interest in talking to people, or in activities and hobbies. These changes can be challenging for both the person with dementia and those close to them to live with.

As Alzheimer’s progresses, problems with memory loss, language, reasoning and orientation get much worse. A person with Alzheimer’s disease will need more day-to-day support.

Some people start to believe things that are untrue (having delusions) – for example, being convinced that someone is stealing from them. Less often, people see or hear things that are not really there (having hallucinations).

Many people with Alzheimer’s also start to behave in ways that aren’t normal for them. These might include becoming agitated (for example, being very restless or pacing up and down), calling out, repeating the same question, having disturbed sleep patterns or reacting aggressively. This can be distressing and challenging both for the person and anyone caring for them. The person may need treatment and support for these behaviours which is separate from any treatment specifically for memory problems.

In the later stages of Alzheimer’s disease someone may become much less aware of what is happening around them. They may have difficulties eating or walking without help, and become more and more frail. Eventually, the person will need help with all of their daily activities.

In some people with Alzheimer’s disease, memory problems are not the first symptoms. This is called atypical Alzheimer’s disease. It is still caused by plaques and tangles, but the first part of the brain to be affected is not the hippocampus.

Atypical Alzheimer’s disease is not common in people diagnosed when they are over 65. Only around 1 in 20 people over 65 with Alzheimer’s disease have this atypical type. However, it’s more common in people diagnosed when they are under 65 (early-onset Alzheimer’s disease – see ‘Who gets Alzheimer’s disease?’). Up to one-third of people diagnosed with Alzheimer’s disease under 65 have atypical Alzheimer’s.

The atypical forms of Alzheimer’s disease are:

  • Posterior cortical atrophy (PCA) – this develops when there is damage to areas at the back of the brain. These areas process signals from a person’s eyes and help with spatial awareness. This means the early symptoms of PCA are often problems identifying objects or reading, even if the person’s eyes are healthy. Someone may also struggle to judge distances when going down stairs, or seem uncoordinated (for example when they’re getting dressed).
  • Logopenic aphasia – this develops when there is damage to the areas in the left side of the brain that produce speech. The person may have problems finding the right word, or take long pauses while they’re speaking.
  • Frontal variant Alzheimer’s disease – this develops when there is damage to the lobes at the front of the brain. The symptoms include problems with planning and decision-making. The person may also behave in socially inappropriate ways (such as saying things that other people might find rude) or seem not to care about the feelings of others.

Keeping mentally, physically and socially active can have a very positive impact on a person with Alzheimer’s disease. They should try to keep up with activities they enjoy and may also want to try new ones. For example:

  • taking regular physical exercise such as swimming, walking or tai chi
  • exercising their mind with reading or puzzles
  • joining a group to sing, dance or make music
  • doing arts, crafts or other hobbies
  • visiting a local museum or gallery, or going on day trips.

As the person’s dementia progresses, they may enjoy more general reminiscence activities such as talking about photographs or familiar objects. Activities may need to be adapted or done with an offer of support to make them enjoyable.

Over time, changes in the person’s behaviour such as agitation or aggression become more likely. These behaviours are often a sign that the person is in distress. This could be for different reasons – for example:

  • the person is thirsty or hungry, too hot or too cold
  • they are in pain or have another medical condition such as constipation or an infection
  • their environment is too noisy, bright or cluttered
  • they are confused because their glasses or hearing aids are not working or they’re not wearing them
  • they misunderstood something or someone
  • the person is frustrated or doesn’t have enough to keep them active.

Understanding the reason behind someone’s behaviour will help to support them. This can include making sure they have opportunities for social interaction, life story work, music, exercise or other activities they enjoy or find useful. These should be tried and, if they don’t work, the person should be referred to a specialist such as a clinical psychologist before drugs are considered (especially antipsychotics).

Vascular Dementia - Vascular dementia is the second most common type of dementia (after Alzheimer's disease).
The different types of vascular dementia have some symptoms in common and some symptoms that differ. Their symptoms tend to progress in different ways.

Stroke-related dementia

A stroke happens when the blood supply to a part of the brain is suddenly cut off. In most strokes, a blood vessel in the brain becomes narrowed and is blocked by a clot. The clot may have formed in the brain, or it may have formed in the heart (if someone has heart disease) and been carried to the brain. Strokes vary in how severe they are, depending on where the blocked vessel is and whether the interruption to the blood supply is permanent or temporary.

Post-stroke dementia

A major stroke occurs when the blood flow in a large vessel in the brain is suddenly and permanently cut off. Most often this happens when the vessel is blocked by a clot. Much less often it is because the vessel bursts and bleeds into the brain. This sudden interruption in the blood supply starves the brain of oxygen and leads to the death of a large volume of brain tissue.

Not everyone who has a stroke will develop vascular dementia, but about 20 per cent of people who have a stroke do develop this post-stroke dementia within the following six months. A person who has a stroke is then at increased risk of having further strokes. If this happens, the risk of developing dementia is higher.

Single-infarct and multi-infarct dementia

These types of vascular dementia are caused by one or more smaller strokes. These happen when a large or medium-sized blood vessel is blocked by a clot. The stroke may be so small that the person doesn't notice any symptoms. Alternatively, the symptoms may only be temporary - lasting perhaps a few minutes - because the blockage clears itself. (If symptoms last for less than 24 hours this is known as a 'mini-stroke' or transient ischaemic attack (TIA). A TIA may mistakenly be dismissed as a 'funny turn'.)

If the blood supply is interrupted for more than a few minutes, the stroke will lead to the death of a small area of tissue in the brain. This area is known as an infarct. Sometimes just one infarct forms in an important part of the brain and this causes dementia (known as single-infarct dementia). Much more often, a series of small strokes over a period of weeks or months lead to a number of infarcts spread around the brain. Dementia in this case (known as multi-infarct dementia) is caused by the total damage from all the infarcts together.

Subcortical dementia

Subcortical vascular dementia is caused by diseases of the very small blood vessels that lie deep in the brain. These small vessels develop thick walls and become stiff and twisted, meaning that blood flow through them is reduced. Small vessel disease often damages the bundles of nerve fibres that carry signals around the brain, known as white matter. It can also cause small infarcts near the base of the brain. Small vessel disease develops much deeper in the brain than the damage caused by many strokes. This means many of the symptoms of subcortical vascular dementia are different from those of stroke-related dementia. Subcortical dementia is thought to be the most common type of vascular dementia.

Some symptoms may be similar to those of other types of dementia. Memory loss is common in the early stages of Alzheimer's, but is not usually the main early symptom of vascular dementia.

The most common cognitive symptoms in the early stages of vascular dementia are:

  • problems with planning or organising, making decisions or solving problems
  • difficulties following a series of steps (eg cooking a meal)
  • slower speed of thought
  • problems concentrating, including short periods of sudden confusion.

A person in the early stages of vascular dementia may also have difficulties with:

  • memory - problems recalling recent events (often mild)
  • language - eg speech may become less fluent
  • visuospatial skills - problems perceiving objects in three dimensions.

As well as these cognitive symptoms, it is common for someone with early vascular dementia to experience mood changes, such as apathy, depression or anxiety. Depression is common, partly because people with vascular dementia may be aware of the difficulties the condition is causing. A person with vascular dementia may also become generally more emotional. They may be prone to rapid mood swings and being unusually tearful or happy.

Other symptoms that someone with vascular dementia may experience vary between the different types. Post-stroke dementia will often be accompanied by the obvious physical symptoms of the stroke. Depending on which part of the brain is affected, someone might have paralysis or weakness of a limb. Or if a different part of the brain is damaged they may have problems with vision or speech. With rehabilitation, symptoms may get a little better or stabilise for a time, especially in the first six months after the stroke.

Symptoms of subcortical vascular dementia vary less. Early loss of bladder control is common. The person may also have mild weakness on one side of their body, or become less steady walking and more prone to falls. Other symptoms of subcortical vascular dementia may include clumsiness, lack of facial expression and problems pronouncing words.

Vascular dementia will generally get worse, although the speed and pattern of this decline vary.

Stroke-related dementia often progresses in a 'stepped' way, with long periods when symptoms are stable and periods when symptoms rapidly get worse. This is because each additional stroke causes further damage to the brain. Subcortical vascular dementia may occasionally follow this stepped progression, but more often symptoms get worse gradually, as the area of affected white matter slowly expands.

Over time a person with vascular dementia is likely to develop more severe confusion or disorientation, and further problems with reasoning and communication. Memory loss, for example for recent events or names, will also become worse. The person is likely to need more support with day-to-day activities such as cooking or cleaning.

As vascular dementia progresses, many people also develop behaviours that seem unusual or out of character. The most common include irritability, agitation, aggressive behaviour and a disturbed sleep pattern. Someone may also act in socially inappropriate ways.

Occasionally a person with vascular dementia will strongly believe things that are not true (delusions) or - less often - see things that are not really there (hallucinations). These behaviours can be distressing and a challenge for all involved.

In the later stages of vascular dementia someone may become much less aware of what is happening around them. They may have difficulties walking or eating without help, and become increasingly frail. Eventually, the person will need help with all their daily activities.

There are many ways to help someone remain independent and cope with the cognitive symptoms of vascular dementia. For example, breaking complex tasks down into smaller steps will make them easier. An environment which is not too busy or noisy will make it easier to concentrate. For someone with memory loss, a regular routine and appropriate technology, such as pill boxes or electronic devices, can help.

It is important that a person with any type of dementia stays active and continues to do things they enjoy. Keeping mentally active (cognitive stimulation) is known to help with memory and communication. Life story work, in which someone shares their life experiences and makes a personal record, may help with memory, mood and wellbeing. As the dementia worsens, many people enjoy more general reminiscence activities.

If the person has physical difficulties, for example after a stroke, they will usually benefit from rehabilitation. This could mean working with a physiotherapist (especially for help with weakness, coordination, movement and balance), occupational therapist (for everyday activities) or speech and language therapist (for all aspects of communication).

 

Lewy Body Dementia - Dementia with Lewy bodies (DLB) is a type of dementia that shares symptoms with both Alzheimer's disease and Parkinson's disease. Lewy bodies are tiny deposits of a protein (alpha-synuclein) that appear in nerve cells in the brain. Researchers don't have a full understanding of why Lewy bodies appear, or exactly how they contribute to dementia. However, this is linked to two factors:

  • low levels of important chemicals (mainly acetylcholine and dopamine) that carry messages between nerve cells
  • a loss of connections between nerve cells, which then die.

Lewy bodies are the cause of DLB and Parkinson's disease. They are two of several diseases caused by Lewy bodies that affect the brain and nervous system and get worse over time. These are sometimes called Lewy body disorders.

The way someone is affected by DLB will depend partly on where the Lewy bodies are in the brain:

  • Lewy bodies at the base of the brain are closely linked to problems with movement (motor symptoms). These are the main feature of Parkinson's disease.
  • Lewy bodies in the outer layers of the brain are linked to problems with mental abilities (cognitive symptoms), which is a feature of DLB.
  • People with a Lewy body disorder can have problems with movement and changes in mental abilities at the same time.

A person with Parkinson's disease is at high risk of going on to develop dementia (Parkinson's disease dementia) as their condition progresses. Dementia may be more likely in a person who has developed Parkinson's later in life or who has been living with it for several years.

As with most types of dementia, the first symptoms of DLB may affect someone only slightly, but gradually they get worse and cause problems with daily living.

Problems with mental abilities

Problems with attention and alertness are very common in DLB. An important feature of the condition is that these problems may switch between being bad and then better - or the other way round - over the course of the day, by the hour or even a few minutes. Someone with DLB may stare into space for a long time or have periods when their speech is disorganised. People may also have difficulties judging distances and seeing objects in three dimensions. It is common to struggle with planning, organising and decision-making. Some people also experience depression. Day-to-day memory is often affected in people with DLB, but usually less in the early stages than in early Alzheimer's disease.

Hallucinations and delusions

Visual hallucinations (seeing things that are not there) occur frequently in people with DLB, often in the early stages of the condition. They can happen daily. Visual hallucinations are often of people or animals, and are detailed and convincing to the person with dementia. They can last several minutes and may be distressing. (Someone may also have visual misperceptions, such as mistaking a shadow or a coat on a hanger for a person.)

Auditory hallucinations - hearing sounds that are not real, such as knocking or footsteps - can happen but are less common.

Hallucinations and visual misperceptions partly explain why most people with DLB have delusions (persistently thinking things that are not true) at some stage.

Some common delusions held by people with DLB are believing that someone is out to get them, that there are strangers living in the house, or that a spouse is having an affair or has been replaced by an identical imposter. The person's relatives and carers may find these delusions very distressing.

If someone is having hallucinations or delusions, in most cases it is unhelpful to try to convince them that what they are seeing is not there, or that what they believe is untrue. What the person is experiencing is real to them at the time. Instead, carers can offer reassurance that they are there to support the person, and perhaps try distracting them.

It is important to get any glasses or hearing aids checked. Any problems with these can make difficulties with perceiving things worse. Misperceptions (different from hallucinations) can also be triggered by things in the environment such as excess noise and reflective or patterned surfaces. For more information, see our Sight, perception and hallucinations in dementia webpages. If hallucinations are distressing or likely to lead to physical harm, medication treatments may be offered.

Movement problems

Up to two-thirds of people with DLB have movement difficulties when the condition is diagnosed, and this number increases as DLB progresses. These symptoms are similar to those of Parkinson's disease, and include slow and stiff (rigid) movement with a blank facial expression.

The person's posture may be stooped and their walk may be shuffling. They may also have difficulty with their balance, and their limbs may sometimes tremble. Movement problems are one reason why a person with DLB is particularly prone to falls.

Sleep disturbance

Sleep disturbance is another common symptom of DLB and may start years before the diagnosis. Someone with DLB may fall asleep very easily during the day, but have restless, disturbed nights.

In the most common night-time sleep problem, the person has violent movements (eg yelling, hitting out) as they try to act out nightmares. This is called rapid eye movement sleep behaviour disorder and is found in different Lewy body disorders such as DLB and Parkinson's disease. For bed partners it can be very distressing or even physically harmful.

Other symptoms

Some people with DLB lose their sense of smell, become constipated or have urinary incontinence (passing urine when they don't intend to). They may also faint or have unexplained episodes when they lose consciousness for a few minutes.

Later stages

DLB is a progressive condition. Over time, symptoms increase and get worse. This is generally over a period of several years.

As the disease progresses, problems with day-to-day memory and other mental abilities become more similar to those of middle- or later-stage Alzheimer's disease. People can also develop behaviours that challenge (eg agitation, restlessness, shouting out).

Worsening movement problems mean that walking gets slower and less steady. As a result, falls become more common. In the later stages of DLB, many people have problems with speech and swallowing, leading to chest infections or risk of choking.

Eventually, someone with DLB is likely to need a large amount of nursing care. With correct diagnosis and support from a team of professionals, it is possible to live well with DLB. Support from SALT’s, Physio’s, OT’s, GP’s and other professionals are essential.

 

Creutzfeldt-Jakob disease - Creutzfeldt–Jakob disease (CJD) is caused by an abnormally shaped protein infecting the brain. This protein is called a ‘prion’. It is not known what causes prions to build up in the brain, but in most cases CJD is not thought to be inherited or transmitted from person to person.

CJD affects about 1 in every million people each year. The most common type is sporadic CJD. This normally affects people aged over 40. If a person has sporadic CJD, their symptoms of dementia usually progress very quickly (within just a few weeks or months). Early symptoms include minor memory loss, mood changes and apathy.

Within weeks the person may become clumsy and confused. They may also become unsteady when they walk and have slow or slurred speech. Their symptoms are likely to progress to:

  • jerky movements
  • shakiness
  • stiff limbs
  • incontinence
  • loss of the ability to move or speak.

By this stage the person is unlikely to be aware of their surroundings or disabilities. There is currently no cure for CJD, although some of the physical symptoms can be managed better with drugs, such as clonazepam for stiff limbs and seizures.

For sporadic CJD to be diagnosed, a person will have a medical procedure known as a lumbar puncture. In this, a thin needle is inserted between two bones in the lower back to remove some spinal cord fluid and look for specific changes in it. This normally involves a referral to the National CJD Research & Surveillance Unit.

A form of CJD called ‘new variant CJD’ was identified more recently. It may be caused by eating meat from cattle that have bovine spongiform encephalopathy (BSE). This is why new variant CJD is also known as ‘mad cow disease’. In the past, it caused a small number of people to develop new variant CJD. It is now very rare for a person in the UK to develop this condition.

 

Frontotemporal Dementia

There are two broad types of FTD:

  • Behavioural variant FTD – where damage to the frontal lobes of the brain mainly causes problems with behaviour and personality. These lobes are found behind the forehead and process information that affects how we behave and the control of our emotions. They also help us to plan, solve problems and focus for long enough to finish a task.
  • Primary progressive aphasia (PPA) occurs when damage to the temporal lobes – on either side of the head nearest the ears – causes language problems. This part of the brain has many roles. A key function of the left temporal lobe is to store the meanings of words and the names of objects. The right temporal lobe helps most people recognise familiar faces and objects.

The first noticeable symptoms for a person with FTD will be changes to their personality and behaviour and/or difficulties with language.

These are very different from the early symptoms of more common types of dementia. For example, in Alzheimer’s disease, early changes are often problems with day-to-day memory. In the early stages of FTD, many people can still remember recent events.

A person with behavioural variant FTD may:

  • lose motivation to do things that they used to enjoy
  • struggle to focus on tasks and become distracted easily
  • find it difficult to plan, organise and make decisions – these problems may first appear at work or with managing money
  • lose their inhibitions – behaving in socially inappropriate ways and acting impulsively or without thinking. For example, making insensitive or rude comments about someone’s appearance, making sexual gestures in public, staring at strangers, or being verbally or physically aggressive
  • lose the ability to understand what others might be thinking or feeling – they may be less considerate of the needs of others, lose interest in social activities or be less friendly. They may also have less of a sense of humour or laugh at other people’s problems. This can make the person appear cold and selfish
  • show repetitive or obsessive behaviours – for example, repeating phrases or gestures, hoarding or being obsessed with timekeeping. They may also take up new interests – for example, music or spirituality. These might give the person a positive focus but can become obsessive in nature
  • crave sweet, fatty foods or carbohydrates and forget their table manners. They may also no longer know when to stop eating, drinking alcohol or smoking.

FTD can also affect how sensitive a person is to physical or environmental stimulation such as temperature, sounds and even pain.

Most people with behavioural variant FTD are not fully aware of their symptoms. Instead, these changes are often first noticed by the people who are close to them.

There is currently no cure for frontotemporal dementia and the progression of the disease cannot be slowed down. Drugs that are commonly used to treat other types of dementia are not recommended for people with FTD. These drugs, known as cholinesterase inhibitors (for example, donepezil, rivastigmine, galantamine) can actually make the symptoms of FTD worse.

Many people with FTD have an active social life for some years after diagnosis. However, changes in their behaviour can make social situations more challenging, both for the person with dementia and those who care for them. Carers may find it less stressful if they try to accept socially inappropriate behaviour as part of the condition rather than confront the person – as long as the behaviour cannot harm anyone. While these situations may be awkward or embarrassing, it is important to remember that a person with FTD has little control over these actions. They are also unlikely to understand the impact of their behaviour on others.

If a person with FTD regularly behaves inappropriately in public, their carer may find it useful to:

  • try to remove any potential triggers for this behaviour – such as a noisy or crowded environment
  • distract the person – such as asking them a question about a completely different topic n explain to other people that the person has dementia.
  • Some people with dementia use helpcards that they can use to show they have difficulties and also advise how to help them when they’re out in the community.

It may also be easier for a carer to accept other changes in the person’s behaviour, if they are harmless. For example, if a person wants a fixed routine or to obsess over an activity (such as doing jigsaws or listening to music), it may be best to let them do so. However, some behaviours, such as over-eating and drinking too much alcohol, can lead to greater problems. Be aware of how much alcohol the person is drinking. If they are over-eating, it can help to only offer food at mealtimes and in suitable portions, and to swap unhealthy food for healthier options.

Try to understand why a person's behaviour has changed. Certain changes in behaviour, such as restlessness, agitation or aggression, may be a sign that the person is in distress. The reason for this could be:

  • they are too hot or too cold
  • they are in pain or have another medical condition, such as constipation or an infection
  • their environment is too noisy, bright or cluttered
  • they misunderstood something or someone – for example, interpreting a joke as being serious
  • they cannot control their emotions
  • the person is frustrated because their routine has changed or they are unable to communicate effectively
  • the person lacks a sense of purpose and does not have enough to keep them active.
  • Understanding why a person’s behaviour has changed may help carers support them better.

Try non-drug treatments before drugs treatments

Physical exercise, music or other activities that the person enjoys or finds useful are also very helpful. These activities are often the most effective way of helping a person with FTD to maintain a good quality of life. It is important to try this before considering any drug treatments, such as antipsychotics. If drugs are being considered, the person with FTD should be referred to a specialist who can advise on the risks and benefits.

 

Mixed Dementia

‘Mixed dementia’ is a condition in which a person has more than one type of dementia. Alzheimer’s disease and vascular dementia is the most common type. Other combinations of dementias are also possible – particularly Alzheimer’s disease and dementia with Lewy bodies.

Symptoms of mixed dementia vary depending on the types of dementia a person has. Often someone will have a greater amount of one type of dementia than another. In such cases, we talk about this type being ‘predominant’.

 

Mild Cognitive Impairment

Mild cognitive impairment (MCI) is a condition in which someone has minor problems with cognition - their mental abilities such as memory or thinking. In MCI these difficulties are worse than would normally be expected for a healthy person of their age. However, the symptoms are not severe enough to interfere significantly with daily life, and so are not defined as dementia. It is estimated that between 5 and 20% of people aged over 65 have MCI. It is not a type of dementia, but a person with MCI is more likely to go on to develop dementia. Many people who are diagnosed with MCI use this as an opportunity to change their lifestyle for the better. There is a lot that someone can do to help reduce their chances of MCI progressing to dementia.

The term MCI describes a set of symptoms, rather than a specific disease. A person with MCI has mild problems with one or more of the following:

  • memory - for example, forgetting recent events or repeating the same question
  • reasoning, planning or problem-solving - for example, struggling with thinking things through
  • attention - for example, being very easily distracted
  • language - for example, taking much longer than usual to find the right word for something
  • visual depth perception - for example, struggling to interpret an object in three dimensions, judge distances or navigate stairs.

These symptoms may have been noticed by the individual, or by those who know them. For a person with MCI, these changes may cause them to experience minor problems or need a little help with more demanding daily tasks (for example paying bills, managing medication, driving). However, MCI does not cause major problems with everyday living. If there is a significant impact on everyday activities, this may suggest dementia.

 

Most healthy people experience a gradual decline in mental abilities as part of ageing. In someone with MCI, however, the decline in mental abilities is greater than in normal ageing. For example, it's common in normal ageing to have to pause to remember directions or to forget words occasionally, but it's not normal to become lost in familiar places or to forget the names of close family members. If the person with MCI has seen a doctor and taken tests of mental abilities, their problems will also be shown by a low test score or by falling test scores over time. This decline in mental abilities is often caused by an underlying illness.

The main benefit of diagnosing MCI is that it helps to identify people who are at increased risk of developing dementia. They can then be offered information, advice and support. They can also be kept under review and if they do develop dementia, they should have this diagnosed sooner. Anyone who is worried about their memory, or has any of the symptoms listed above, should see their GP. A thorough assessment might clear up any anxiety about the cause of symptoms. It may also lead to diagnosis of conditions (such as depression, high blood pressure or poor vision) that can be treated.

 

Alcohol related dementia

Alcohol-related 'dementia' is a type of alcohol-related brain damage (ARBD). If a person has alcohol-related ‘dementia’ they will struggle with day-to-day tasks. This is because of the damage to their brain, caused by regularly drinking too much alcohol over many years.  The person may have memory loss and difficulty thinking things through. They may have problems with more complex tasks, such as managing their finances. The symptoms may cause problems with daily life. For example, the person may no longer be able to cook a meal.

Symptoms include difficulties with:

  • staying focused on a task without becoming distracted
  • solving problems, planning and organising
  • setting goals, making judgements and making decisions
  • being motivated to do tasks or activities (even essential ones like eating or drinking) controlling their emotions – they may become irritable or have outbursts
  • understanding how other people are thinking or feeling (their behaviour may seem insensitive or uncaring).

The symptoms of alcohol-related ‘dementia’ can change a lot from person to person. If a person with the condition has a brain scan, it will often show that some areas of the brain have shrunk much more than others. Alcohol particularly affects the frontal lobes of the brain.

Unlike Alzheimer’s disease or vascular dementia, alcohol-related ‘dementia’ is not certain to get worse over time. With the right treatment and support, there is often a good chance that it will stop getting worse or improve. For example, if the person stops drinking alcohol, takes high doses of thiamine and starts eating a balanced diet. However, if the person keeps drinking alcohol and doesn’t eat well, alcohol-related ‘dementia’ is very likely to get worse.

It is not easy to help a person with alcohol addiction to stop drinking. However, it can be even more challenging when the person has alcohol-related ‘dementia’. Problems with thinking and reasoning (caused by dementia) can prevent a person from understanding that they need to stop drinking. They may also find it very difficult to stay motivated if they do stop drinking, because losing motivation is a symptom of dementia.

The first part of treatment usually lasts up to several weeks. It aims to stop the person drinking alcohol and make their health more stable. Most people with alcohol-related ‘dementia’ will need to stay in hospital for this. Alcohol withdrawal usually causes a person to have delirium, which can make them easily distracted and confused, disorientated, and prone to mood swings. They may also experience intense sweating, anxiety and a high heart rate. They may become agitated or hallucinate. They may be treated with drugs that mimic the effect of alcohol on the brain to reduce withdrawal symptoms. These drugs can be safely reduced slowly. The person will also be given fluids and salts, and high doses of thiamine (vitamin B1) by injection.

As well as medication, the person will need a lot of non-drug support. This often includes counselling or ‘talking therapies’ that help them to stay alcohol-free. They may also be encouraged to attend self-help groups once they are out of hospital. Some of the common symptoms of alcohol-related ‘dementia’ may make it harder for a person to take part in an alcohol treatment programme. These symptoms can include denial, lack of insight and being impulsive. The person may struggle to stay focused during therapy sessions.

 

Young onset dementia

When a person develops dementia before the age of 65, this is known as ‘young-onset dementia’.

There are important differences in how dementia affects younger people. These include the following:

  • A wider range of diseases cause young-onset dementia.
  • A younger person is much more likely to have a rarer form of dementia.
  • Younger people with dementia are less likely to have memory loss as one of their first symptoms.
  • Young-onset dementia is more likely to cause problems with movement, walking, co-ordination or balance.
  • Young-onset dementia is more likely to be inherited (passed on through genes) – this affects up to 10% of younger people with dementia.
  • Many younger people with dementia don’t have any other serious or long-term health conditions.

Someone who is diagnosed under the age of 65 needs to adjust to living with a long-term condition as a younger person. They might be concerned about the effects this will have on their family, relationships, finances and daily life. They may also be worried that any children or siblings will have a higher risk of developing dementia.

Younger people with dementia experience a range of challenges, which are often different to those that older people face. Younger people are less likely to experience memory loss as one of their early symptoms and may experience problems with behaviour, vision or language first.

 

They are also likely to have varied aspects to their lives that will be affected in different ways by dementia. This includes:

  • their relationships, including with their children (if they have them)
  • their finances
  • employment (if they’re working) and daily activities
  • driving (if they drive)
  • their hobbies and interests.

All of these can make it hard for a younger person to adjust to a diagnosis. Dementia can also be harder for younger people because it usually comes at a time in their life when it is least expected. However, there is support available and planning ahead can make a big difference.

Dementia at any age can have a big impact on relationships. However, for younger people there are particular challenges that can affect their relationships with partners, family, friends and work colleagues. Dementia can mean lots of changes to a younger person’s plans for the  future as they adapt to living with the condition. This can be difficult to  come to terms with for both the person and their family. Dementia at any age can lead to questions about how roles in relationships will change. For younger people with dementia, this can be more challenging due to their commitments. For example, they may have a mortgage, young children and household duties they share with a partner or friend.

After their diagnosis, younger people with dementia and their families may find that friends and other family members don’t stay in touch or provide the support they need. This can be for different reasons. Dementia in a younger person is unexpected, so friends and family may not understand what the person and those close to them are going through. Giving people information, such as this page, can help them to understand and come to terms with things. A partner or children of the person with dementia may end up providing more and more care for the person over time. This can be difficult to adapt to and can lead to a big change in the relationship.

Children

Younger people with dementia are more likely to have dependent children, and dementia can have a huge impact on them and their family relationships. It can be hard to explain to children what the diagnosis means and how it might impact the family. It’s important to try and be honest with children, listen to their concerns and feelings and make time to answer any questions they have.

Children can find it difficult to come to terms with a parent having dementia. The person with dementia may feel guilty about the impact their diagnosis has on their children. It can also affect the relationships between other members of the family. There can be difficulties balancing the needs of the person with dementia, their children and other family members. For example, it can be a challenge to support children emotionally and help them cope with the changes in a parent. It can be particularly hard for the parent without dementia or other family members who will need to provide more support for the family, while also trying to meet the needs of the person with dementia. If the person has (or thinks they have) a genetic form of dementia, that can have a huge impact on their relationship with their children. They and their children may have questions about genetic testing and whether they should have it. The person may feel guilty about putting their children at risk. Children may be angry or unsure how to process this information. It’s really important that the family have access to appropriate support and counselling to deal with this.