In everyday dementia care, a single diagnostic label rarely explains everything a person is experiencing. While Alzheimer’s disease is the most widely recognized cause of dementia, many people, particularly in later life, have more than one brain change contributing to their cognitive, behavioral, and functional changes. The National Institute on Aging notes that it is common for people to have mixed dementia, meaning a combination of two or more types of dementia (National Institute on Aging, 2023). Autopsy-based research also shows that multiple brain pathologies frequently co-occur in older adults (Brenowitz et al., 2017).
Why non‑Alzheimer’s dementias and mixed pathology matter
Non‑Alzheimer’s dementias—especially Lewy body dementia (LBD), vascular cognitive impairment and dementia (VCID), and frontotemporal dementia (FTD)—can present differently, progress differently, and respond differently to medications and care approaches. Mixed pathology can further blur “classic” patterns. For care teams and care partners, this complexity matters because it changes how we interpret changes in behavior, sleep, movement, communication, and safety needs. Dementia‑capable care therefore relies on two parallel skills: (1) recognizing common patterns across dementia types, and (2) tailoring person‑centered support to the individual’s current abilities, preferences, and sources of distress.
A person‑centered lens: focus on patterns and support needs
A person‑centered approach does not require perfect diagnostic certainty. It requires careful observation, compassionate interpretation, and proactive planning. Instead of viewing changes as “problem behaviors,” dementia‑capable teams treat them as communication—often signaling pain, fear, confusion, sensory changes, sleep disruption, overstimulation, unmet needs, or environmental mismatch. This is especially important in non‑Alzheimer’s dementias where perception, attention, judgment, language, or movement may be affected early.
Lewy body dementia: attention, perception, sleep, and movement together
Lewy body dementia (LBD) is a brain disorder associated with abnormal deposits of alpha‑synuclein (Lewy bodies) and can affect thinking, movement, sleep, mood, and autonomic body functions (National Institute on Aging, 2025a). Common clinical features include fluctuating attention/alertness, recurrent visual hallucinations, REM sleep behavior disorder, and parkinsonism (McKeith et al., 2017; Alzheimer’s Association, n.d.-a). Alzheimer’s.gov also notes that visual hallucinations can occur early (Alzheimer’s.gov, n.d.-a).
Care implications in LBD (person‑centered, safety‑focused)
- Fluctuations are real: the person may have “good” and “hard” hours that change within a day. Adjust expectations, timing, and demands accordingly (McKeith et al., 2017).
- Perceptual experiences can be distressing. Calm reassurance, validation, and environmental adjustments (lighting, reducing shadows/clutter) often help.
- Movement changes raise fall risk. Strength‑based mobility support, footwear, pacing, and environmental safety planning should be routine.
- Medication decisions require extra caution. The National Institute on Aging cautions that some people with LBD may have severe reactions to antipsychotic medications; clinicians should guide any medication changes (National Institute on Aging, 2025b).
Vascular contributions: when blood flow and brain health intersect
Vascular dementia (and the broader category of vascular cognitive impairment and dementia, VCID) results from conditions that disrupt blood flow and oxygen delivery to the brain, damaging vessels and brain tissue. The National Institute on Aging describes vascular dementia as caused by different conditions that interrupt blood flow and oxygen supply to the brain (National Institute on Aging, 2021). Vascular contributions may occur alone or alongside other neurodegenerative changes, including Alzheimer’s-related changes (Alzheimer’s Association, n.d.-b).
Common patterns that shape person‑centered plans
- Changes in processing speed, attention, and executive function (planning, sequencing) may be more prominent than early memory loss.
- Some people experience stepwise changes following strokes; others have gradual change associated with small vessel disease.
- Fatigue and “cognitive load” can be significant—simplifying tasks and offering supportive cueing may reduce distress.
Mixed Alzheimer’s‑vascular pathology is frequently highlighted in the literature, and overlap appears common in older age groups (Attems & Jellinger, 2014). This reinforces a practical care message: even when Alzheimer’s is present, vascular factors may meaningfully influence daily function, gait, falls risk, and resilience during illness.
Frontotemporal dementia: when behavior or language changes lead
Frontotemporal dementia (FTD) is a group of disorders affecting the frontal and temporal lobes, often leading to early changes in personality, social behavior, judgment, or language. Alzheimer’s.gov describes two major presentations: behavioral variant FTD (bvFTD), which involves changes in behavior, emotions, and judgment, and primary progressive aphasia (PPA), which involves progressive changes in communication (Alzheimer’s.gov, n.d.-c). Specialty centers also note that many people living with bvFTD have reduced insight into these changes (UCSF Memory and Aging Center, n.d.).
Person‑centered care considerations in FTD
- Assume capacity is uneven: someone may speak clearly yet struggle with judgment, social rules, impulse control, or safety awareness.
- Use structure as support: predictable routines, clear boundaries, and simplified choices can reduce overwhelm and distress.
- Treat communication changes as a support need, not “noncompliance.” Offer visual cues, short prompts, and alternative communication tools as appropriate.
- Coach care partners: FTD‑related changes can be misinterpreted as intentional or “attitude.” Education reduces conflict and increases compassion.
Mixed pathology: the “rule” in later life, not the exception
Mixed dementia refers to brain changes from more than one cause of dementia occurring together. The National Institute on Aging emphasizes that mixed dementia is common (National Institute on Aging, 2023; National Institute on Aging, 2022). The Alzheimer’s Association similarly explains that mixed dementia involves more than one type of brain change at the same time (Alzheimer’s Association, n.d.-c).
Autopsy studies help explain why real‑world presentations can be complex. Brenowitz and colleagues (2017) describe mixed neuropathologies as common in older adults, and other reviews highlight substantial overlap between vascular and Alzheimer’s-related changes in advanced age (Attems & Jellinger, 2014).
What dementia‑capable teams can do today
Regardless of diagnostic label, dementia‑capable care improves when teams consistently:
- Look for patterns (fluctuations, sleep disruption, language‑first changes, stepwise decline, gait changes) and document them clearly for the clinical team.
- Use person‑centered communication: offer choices, support autonomy, and validate emotions—especially during distress.
- Treat the environment as part of the care plan (lighting, noise, signage, predictable routines, meaningful engagement).
- Support care partners with education, coping strategies, and anticipatory guidance.
- Escalate appropriately: sudden change, new confusion, new falls, or abrupt functional decline warrants medical evaluation for delirium, infection, medication effects, or stroke.
How NCCDP can help
Non‑Alzheimer’s dementias and mixed pathology increase the need for standardized training, shared language, and practical, person‑centered skill development across roles. NCCDP can help organizations strengthen dementia‑capable care in several ways:
1) Build a strong foundation in Alzheimer’s and related dementias
The Alzheimer’s Disease & Dementia Care (ADDC) Seminar provides foundational education for individuals pursuing dementia care excellence and is a key step for those seeking CDP certification (National Council of Certified Dementia Practitioners, n.d.-a).
2) Standardize competencies with recognized credentials
NCCDP offers a range of dementia care certifications that are open to health care professionals, frontline staff, educators, and other roles supporting dementia care (National Council of Certified Dementia Practitioners, n.d.-b). Credentials help organizations set clear expectations and support workforce development.
3) Scale quality through internal trainer capacity
Dementia‑capable systems require consistent onboarding and reinforcement—not one‑time education. NCCDP’s Certified Alzheimer’s Disease and Dementia Care Trainer® (CADDCT) pathway helps organizations build internal training capacity at scale (National Council of Certified Dementia Practitioners, n.d.-c).
4) Strengthen systems‑level excellence with MCEN
For communities and organizations committed to best‑in‑class memory care standards, NCCDP’s Memory Care Excellence Network (MCEN) is designed to recognize and support organization‑wide improvement in resident outcomes and staff competence (National Council of Certified Dementia Practitioners, n.d.-d).
Conclusion
Greater emphasis on Lewy body dementia, vascular contributions, frontotemporal dementia, and mixed etiologies reflects a core truth: dementia is often clinically heterogeneous, especially in later life. Dementia‑capable teams respond by focusing on patterns, supporting safety and dignity, reducing distress through person‑centered approaches, and equipping care partners with practical skills. When education is paired with consistent systems and coaching, organizations are better positioned to deliver reliable, compassionate care—regardless of which pathologies are present.
References:
Alzheimer’s Association. (n.d.-a). Dementia with Lewy bodies (DLB). https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies
Alzheimer’s Association. (n.d.-b). Vascular dementia. https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia
Alzheimer’s Association. (n.d.-c). Mixed dementia. https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/mixed-dementia
Alzheimer’s.gov. (n.d.-a). What is Lewy body dementia? https://www.alzheimers.gov/alzheimers-dementias/lewy-body-dementia
Alzheimer’s.gov. (n.d.-c). What is frontotemporal dementia? https://www.alzheimers.gov/alzheimers-dementias/frontotemporal-dementia
Attems, J., & Jellinger, K. A. (2014). The overlap between vascular disease and Alzheimer’s disease—Lessons from pathology. BMC Medicine, 12, 206. https://pmc.ncbi.nlm.nih.gov/articles/PMC4226890/
Brenowitz, W. D., Hubbard, R. A., Keene, C. D., Hawes, S. E., & Crane, P. K. (2017). Mixed neuropathologies and estimated rates of clinical progression in a large autopsy sample. Alzheimer’s & Dementia, 13(6), 654–662. https://alz-journals.onlinelibrary.wiley.com/doi/10.1016/j.jalz.2016.09.015
McKeith, I. G., Boeve, B. F., Dickson, D. W., et al. (2017). Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology, 89(1), 88–100. https://www.neurology.org/doi/10.1212/WNL.0000000000004058
National Council of Certified Dementia Practitioners. (n.d.-a). Alzheimer’s Disease & Dementia Care (ADDC) Seminar. https://www.nccdp.org/seminars/addc-seminar/
National Council of Certified Dementia Practitioners. (n.d.-b). Dementia care certifications. https://www.nccdp.org/certifications/
National Council of Certified Dementia Practitioners. (n.d.-c). Certified Alzheimer’s Disease and Dementia Care Trainer® (CADDCT). https://www.nccdp.org/train/
National Council of Certified Dementia Practitioners. (n.d.-d). NCCDP’s Memory Care Excellence Network. https://www.nccdp.org/certifications/nccdps-memory-care-excellence-network/
National Institute on Aging. (2021, November 1). Vascular dementia: Causes, symptoms, and treatments. https://www.nia.nih.gov/health/vascular-dementia/vascular-dementia-causes-symptoms-and-treatments
National Institute on Aging. (2022, December 8). What is dementia? Symptoms, types, and diagnosis. https://www.nia.nih.gov/health/alzheimers-and-dementia/what-dementia-symptoms-types-and-diagnosis
National Institute on Aging. (2023, April 5). Alzheimer’s disease fact sheet. https://www.nia.nih.gov/health/alzheimers-and-dementia/alzheimers-disease-fact-sheet
National Institute on Aging. (2025a, January 27). Lewy body dementia: Causes, symptoms, and diagnosis. https://www.nia.nih.gov/health/lewy-body-dementia/lewy-body-dementia-causes-symptoms-and-diagnosis
National Institute on Aging. (2025b, January 27). How is Lewy body dementia treated and managed? https://www.nia.nih.gov/health/lewy-body-dementia/how-lewy-body-dementia-treated-and-managed
UCSF Memory and Aging Center. (n.d.). Behavioral variant frontotemporal dementia. https://memory.ucsf.edu/dementia/ftd/behavioral-variant-frontotemporal-dementia
