" I see [a faster decline] frequently in people with vascular dementia. When patients ask me, “How long before this progresses to the next stage?” I’d be like, “It depends when the next stroke happens.”
We know that a lot of people with so-called Alzheimer’s disease actually have mixed dementia. It’s not just the neurofibrillary tangles and the amyloid plaques that are causing the nerve cells to die, but a lot of people have small strokes that can cause change pretty abruptly.
But if it’s pure Alzheimer’s disease, you don’t expect these abrupt changes. In fact, one of the characteristic symptoms of Alzheimer’s disease is this slow smoldering progression.
The other thing is that hospitalizations are bad for people with dementia. If you have someone with mild dementia, and they get an infection or they get a hip fracture, god forbid and they end up in a hospital, then it’s been shown that when they get out of the hospital, they may not be able to get back to their previous baseline. That’s another reason why someone will progress more rapidly than expected. "