Early-Onset Alzheimer’s: What Are the Signs?

An upsurge in recent decades in the incidence of dementia among younger individuals is raising concerns.

Early-onset dementia—defined as dementia that develops before the age of 65—is on the rise, robbing more and more people in their prime of their most productive years and placing a huge burden on society.

The neurological condition, which is associated with Alzheimer’s disease (AD) in up to 58 percent of cases, is increasingly diagnosed in people in their 40s, 50s, and even their 30s. Dementias are beginning a decade earlier than they were in early 1990, according to the first major study to track the rise in early-onset dementia incidence published in July 2015 in the journal Surgical Neurology International. In the U.S., an estimated 250,000 of the more than 5 million Americans suffering from dementia at any given time have early-onset dementia.

“In many cases the symptoms of early-onset dementia differ from those of late-onset dementia, as well as according to the type of dementia involved,” says Tapsi Dayanand, MBBS, a geriatric psychiatrist at Massachusetts General Hospital (MGH) and an instructor in psychiatry at Harvard Medical School. “For example, dementia that begins in later life tends to progress more slowly than early-onset dementia. Younger adults in the beginning stages of frontotemporal dementia—the second most common cause of early-onset dementia—tend to have fewer problems with learning and memory than individuals with early-onset AD, and a higher incidence of problems with behavior and personality.

WHAT YOU CAN DO

Worried about memory issues? Here’s where to go for help:

Alzheimer’s Association
225 N Michigan Ave, Fl. 17, Chicago, IL 60601
Tel: 1-800-272-3900
www.alz.org

Alzheimer’s Foundation of America
322 8th Ave., 7th Fl., New York, NY 10001
Tel: 1-866-232-8484
www.alzfnd.org

Alzheimer’s Disease Education and Referral (ADEAR) Center
PO Box 8250 Silver Spring, MD 20907
Tel: 1-800-438-4380
www.nia.nih.gov/alzheimers

“Diagnosis is more complicated in these younger patients, but it is very important. Knowing what symptoms to look for and seeking a professional assessment is essential. In many cases, the symptoms may reflect other potential causes of serious changes in cognition and behavior, such as depression or hypothyroidism, that can be successfully treated.”

Symptoms of Early-Onset AD

Although the signs of early-onset AD are similar to symptoms of AD in people over 65 years of age, they may be more easily overlooked because they are rarer in younger individuals.

Symptoms of early-onset AD as outlined by the Alzheimer’s Association include:

  • Memory loss that disrupts daily life, especially affecting short-term memory
  • Challenges in planning, solving problems, organizing, and multi-tasking
  • Difficulty completing familiar tasks at home, at work, or at leisure
  • Confusion with time or place
  • Trouble understanding visual images and spatial relationships
  • New problems with words in speaking or writing
  • Misplacing things and losing the ability to retrace steps
  • Decreased insight or poor judgment
  • Withdrawal from work or social activities, apathy
  • Changes in mood and personality, including depression, anxiety, and irritability

“A family history of AD is a characteristic of 60 percent of people with early-onset AD,” Dr. Dayanand says.

Other Early-Onset Dementias

People with frontotemporal dementia and other non-AD forms of early-onset dementia often display certain symptoms—such as behavioral and psychological problems—earlier than those with early-onset AD do. They also are more likely to show signs of other notable changes early in the course of their disease process, including:

Problems with language, including decreased vocabulary, and difficulty reading and understanding the speech of others

Problems with concentration, such as having difficulty following a conversation or the story line of a television drama

Problems with math, such as figuring out how much change they are owed while shopping.

“Many healthy older adults occasionally experience some of these symptoms, but their symptoms are unusual and temporary,” says Dr. Dayanand. “However, if you or a loved one is experiencing one or more of these symptoms with increasing frequency, if the symptoms represent a major change in the ability to function, and if the symptoms appear to be getting worse, it’s time to get a professional assessment.”

Diagnosis

Many physical and psychological disorders can lead to symptoms similar to those of early-onset dementias, so seeking the opinion of a doctor who specializes in dementia is an essential first step for people worried about possible dementia. The diagnostic process probably will involve a medical checkup to look for possible physical or psychological causes of these cognitive changes, such as depression, the effects of medications, excessive alcohol use, thyroid problems, and other factors.

Once physical problems have been eliminated as a possible source of the symptoms, specialists usually recommend cognitive testing to assess memory and other cognitive abilities. Analysis of the spinal fluid for AD biomarkers, or brain imaging, such as CT scans and MRIs to search for abnormalities in the brain, such as tumors or signs of stroke, may also be ordered

One imaging technique in particular may soon make it easier to identify early-onset AD. Research published in the January 2017 issue of Alzheimer’s Research & Therapy describes promising results using a novel imaging agent called (18F) flutemetamol in combination with positron emission tomography (PET) scanning to identify toxic beta-amyloid accumulations in the brain, an indication of AD. The new technique resulted in a change of diagnosis in 19 percent of the 211 patients with early-onset dementia who participated in the research, confidence in the diagnosis rose dramatically, and patient management was changed in 37 percent of the patients.

Treatments

Since effective treatments for early-onset dementias are lacking, emphasis is placed on addressing memory and cognitive symptoms with the medication memantine, cholinesterase inhibitor medications such as donepezil, rivastigmine, and galantamine, or a combination of the two types of medication. Psychological and behavioral symptoms are addressed with antidepressants, anti-anxiety medications, and in some instances, antipsychotic medications. Problems with sleep, which can aggravate cognitive and mood symptoms, are addressed with the neutraceutical sleep medication melatonin and lifestyle changes.

“Current treatments aim at slowing the progress of the disease and making the patient more comfortable,” says Dr. Dayanand. “We encourage patients and their families to adopt a brain-healthy lifestyle with a nourishing, low-fat diet, regular exercise, at least seven hours of sleep at night, and careful management of health conditions like high blood pressure, diabetes, and cardiovascular disease, which can add to cognitive decline.

“It’s also advisable to get a social worker involved to help ease the burden on caregivers. They can provide support and advice on employment issues, obtaining disability, and other matters.” (Also, see What You Can Do for a list of support groups.)

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