Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct-Dec;11(4):364-370.
doi: 10.1590/1980-57642016dn11-040005.

Mixed dementia: A review of the evidence

Nilton Custodio  1   2 , Rosa Montesinos  1   3 , David Lira  1   2 , Eder Herrera-Pérez  1   4   5 , Yadira Bardales  1   6 , Lucía Valeriano-Lorenzo  1   7
Affiliations

Mixed dementia: A review of the evidence

Nilton Custodio et al. Dement Neuropsychol. 2017 Oct-Dec.

Abstract
in English, Portuguese

Mixed dementia is the coexistence of Alzheimer's disease and cerebrovascular disease (CVD) in the same demented patient. Currently, its diagnosis and treatment remains a challenge for practitioners. To provide an overview of the epidemiology, pathogenesis, natural history, diagnosis, and therapy of Mixed Vascular-Alzheimer Dementia (MVAD). The literature was reviewed for articles published between 1990-2016 by using the keywords linked to MVAD. Neuropathological studies indicate that MVAD is a very common pathological finding in the elderly with a prevalence about of 22%. The distinction between Alzheimer's dementia and vascular dementia (VD) is complex because their clinical presentation can overlap. There are international criteria for the MVAD diagnosis. The pharmacologic therapy shows modest clinical benefits that are similar among all drugs used in patients with Alzheimer's dementia and VD. The non-pharmacologic therapy includes the rigorous management of cardiovascular risk factors (especially hypertension) and the promotion of a healthy diet. The diagnosis and treatment of MVAD cannot be improved without further studies. Currently available medications provide only modest clinical benefits once a patient has developed MVAD. In subjects at risk, the antihypertensive therapy and healthy diet should be recommend for preventing or slowing the progression of MVAD.

Demência mista é denominação usual para a coexistência da doença de Alzheimer e doença cerebrovascular (DCV) no mesmo paciente demente. Atualmente, seu diagnóstico e tratamento continuam sendo um desafio. Fornecer uma visão geral da epidemiologia, patogênese, história natural, diagnóstico e terapia da Demência Mista Alzheimer-Vascular (DMAV). Foi realizada revisão da literatura buscando por artigos publicados entre 1990 e 2016 usando palavras-chave relacionadas ao DMAV. Estudos neuropatológicos indicam que DMAV é um achado patológico muito comum em idosos, com uma prevalência de cerca de 22%. A distinção entre demência de Alzheimer e demência vascular (DV) é complexa porque suas apresentações clínicas podem se sobrepor. Existem critérios internacionais para o diagnóstico DMAV. A terapia farmacológica mostra benefícios clínicos modestos que são semelhantes para todos os medicamentos utilizados em pacientes com demência de Alzheimer e DV. A terapia não-farmacológica inclui o manejo rigoroso dos fatores de risco cardiovascular (especialmente a hipertensão) e a promoção de uma dieta saudável. O diagnóstico e o tratamento do DMAV não podem ser melhorados sem outros estudos. Os medicamentos atualmente disponíveis fornecem apenas benefícios clínicos modestos, depois que DMAV instalou-se. Em indivíduos em risco, a terapia anti-hipertensiva e uma dieta saudável devem ser recomendadas para prevenir ou retardar a progressão da DMAV.

Keywords: Alzheimer's disease; cerebrovascular disease; mixed dementia; vascular dementia.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors report no conflicts of interest.

References

    1. Gorelick PB, Scuteri A, Black SE, arli C, Greenberg SM, Iaola C, et al. Vascular Contributions to Cognitive Impairment and Dementia. Stroke. 2011;42(9):2672–2713. - PMC - PubMed
    1. Zekry D, Hauw J-J, Gold G. Mixed dementia epidemiology, diagnosis, and treatment. J Am Geriatr Soc. 2002;50(8):1431–1438. - PubMed
    1. Chui HC, Ramirez-Gomez L. Clinical and imaging features of mixed Alzheimer and vascular pathologies. Alzheimers Res Ther. 2015;7:21–21. - PMC - PubMed
    1. Hanyu H. Diagnosis and treatment of mixed dementia. Brain Nerve. 2012;64(9):1047–1055. - PubMed
    1. Lim A, Tsuang D, Kukull W, Nochlin D, Leverenz J, McCormick W, et al. Clinico-neuropathological correlation of Alzheimer’s disease in a community-based case series. J Am Geriatr Soc. 1999;47(5):564–569. - PubMed