Focus On Mixed-Etiology Dementias (MED) Research

Focus On Mixed-Etiology Dementias (MED) Research

Photo of elderly couple holding red, yellow, green and blue balloons.

NINDS Program Description

Autopsy studies looking at the brains of people who had dementia suggest that a majority of those age 80 and older probably had “mixed dementia,” caused by both AD-related neurodegenerative processes and vascular disease-related processes. In a person with mixed dementia, it may not be clear exactly how many of a person’s symptoms are due to AD or another type of dementia. Researchers are still working to understand how underlying disease processes in mixed dementia influence each other. It is not clear, for example, if symptoms are likely to be worse when a person has brain changes reflecting multiple types of dementia. Nor do we know if a person with multiple dementias can benefit from treating one type, for example, when a person with AD controls high blood pressure and other vascular disease risk factors.

The NINDS supports a number of projects covering all aspects of MED research.  Some of our bigger initiatives are listed here:

The Consortium for Detecting Cognitive Impairment, Including Dementia

DetectCID is leading the effort to improve the quality of patient evaluations for detecting cognitive impairment in everyday clinical settings. The collaborative network of research programs that also performs cross-site validation of paradigms including tools and protocols, with an overall goal of increasing the frequency and improving the quality of patient evaluations for detecting cognitive impairment in primary care and other everyday clinical settings, as well as community screenings. Up to half of the funded consortium research focuses on paradigms specifically designed to address barriers to detecting cognitive impairment associated with health disparities. The Consortium consists of research teams at UCSF, Albert Einstein College of Medicine, and Northwestern University, with the University of California, San Francisco acting as the Cross-Consortium Coordinating Team (CCCT). 

  • Mixed-etiology dementias can also be referred to as Multiple-etiology dementias, Mixed-etiology dementias, or Dementia-multifactorial.
  • Mixed-etiology dementia symptoms may be identical to those of Alzheimer’s disease or another type of dementia
  • Majority of all dementia cases (age 65+) are mixed dementias, mainly Alzheimer’s pathology mixed with cerebrovascular disease and/or Lewy bodies (JAMA. 2012 May 2; 307(17): 1798–1800, Neurology. 2007 Dec 11;69(24):2197-204.)

NIH Estimates of Funding for Various Research, Condition, and Disease Categories

Research/Disease Areas* FY 2016
(Actual)

FY 2017
(Actual)

FY 2018
(Actual)
FY 2019
Estimated
Alzheimer's Disease Including
Alzheimer's Disease Related
Dementias (AD/ADRD)
$986 $1,423 $1,911 $2,468

*Dollars in millions and rounded

Proceedings & Outcomes

MED and the National Plan to Address Alzheimer’s Disease

The 2016 Alzheimer’s Disease-Related Dementias (ADRD) Summit was hosted by the National Institute of Neurological Disorders and Stroke (NINDS) in collaboration with the National Institute on Aging (NIA). The 2016 ADRD Summit was mandated by the National Plan to address Alzheimer’s Disease as a follow-up to the 2013 ADRD Summit. The Summit set research priorities for MED research, including:

Focus Area 1: Improved Diagnostic Skills in the Community

1. Detect cognitive impairment when patient or relative voices a concern to health care providers.

2. Improving differential diagnosis of symptomatic cognitive impairment.

3. Increase training of health professionals to meet the expanding demand for cognitive impairment and dementia diagnosis and care, as well as the critical challenges of and need for human-based research.

4. Develop diagnostics/biomarkers in asymptomatic individuals.

Focus Area 2: Basic and Clinical Research in Interactions between Dementia Pathophysiologies

5. Promote basic and clinical research in multi-etiology dementia.

Focus Area 3: Determining the Role for Screening for Cognitive Dysfunction

6. Determining the value of screening for clinically relevant cognitive impairment in the absence of a cognitive complaint.