When dementia strikes young adults

Many people don’t care too much if an octogenarian forgets the best route to their favorite store, can’t remember a friend’s name, or dents their car when trying to park it on a busy city street. Even healthy brains become less efficient with age, and memory, sensory perceptions, and physical abilities become less reliable.

But what if the person in question is not over eighty, but is in their mid-thirties, mid-forties, or mid-fifties and forgets how to get home from their own street corner? That is much more worrying. Although most of the 5.3 million Americans living with Alzheimer’s disease or some other form of dementia are over the age of 65, about 200,000 are under the age of 65 and develop serious cognitive and memory problems long before they reach age. the expected.

“Dementia praecox is a very discouraging diagnosis, because it affects people who are in their prime,” wrote David S. Knopman, a neurologist at the Mayo Clinic in Rochester, Minnesota, in a July 2021 article published in JAMA Neurology, a peer-reviewed medical journal. Many of those affected are in their 40s or 50s, mid-career, perhaps starting a family, and definitely not planning to retire.

Dementia in young adults is traumatic and difficult for family members to accept, and many doctors do not identify it or even suspect that it may be the underlying cause of some symptoms.

“It’s very common for young patients to complain of blackouts, which are usually benign,” Knopman told me. “It is difficult to know when they are not attributable to stress, depression or anxiety, or are the result of normal aging. Not even neurologists frequently see patients with dementia praecox.”

However, recent studies indicate that the problem is much more common than doctors know. An analysis of 74 studies conducted in the Netherlands indicates that, globally, up to 3.9 million people under the age of 65 may be affected. The results of the analysis, published in September by JAMA Neurology, revealed that for every 100,000 people aged 30 to 64, 119 had early dementia.

Knopman’s accompanying article called dementia in young people “an underappreciated problem.” Its diagnosis is often delayed and “also little is known” about its management, he wrote.

The different causes of early dementia

The Dutch study found that Alzheimer’s disease was generally the most common cause of early dementia. But when symptoms occurred before age 50, early Alzheimer’s was a less likely explanation than two other causes: vascular dementia and frontotemporal dementia.

Vascular dementia is the result of a blockage or injury to blood vessels within the brain that impairs circulation and does not allow the brain to get the necessary oxygen and nutrients. In addition to memory problems, its most common symptoms are confusion, difficulty concentrating and organizing ideas or tasks, and slower reasoning.

In frontotemporal dementia, parts of the brain behind the forehead and ears shrink, leading to dramatic personality changes, socially inappropriate or impulsive behavior, and emotional indifference. As usual, motor and memory problems develop later in the course of the disease. According to the Mayo Clinic, frontotemporal dementia almost always begins between ages 40 and 65 and may be misdiagnosed as a psychiatric problem.

Lewy body dementia is another cause of dementia in young adults. It is associated with abnormal deposits of a protein called alpha-synuclein in the brain, which affect brain chemistry and cause motor, cognitive, and behavioral problems. Most of the symptoms are similar to those seen in other types of dementia, and some of its symptoms, such as hallucinations, can resemble schizophrenia. but the deterioration of brain functions appears much faster. Knopman commented that a characteristic symptom of Lewy body dementia is the presence of violent dreams and the attempt to stage them.

Alzheimer’s disease remains the most common cause of dementia in both younger and older adults. There is an inherited form of the disease that almost always manifests at younger ages, but those cases account for less than 10 percent of dementia praecox. Although genetic factors may increase the risk, most cases of Alzheimer’s occur sporadically and for unknown reasons.

It is common for people with Alzheimer’s to have a buildup of abnormal substances (tau and amyloid beta proteins) in the brain. Initial symptoms include memory impairment, language problems, difficulty concentrating and completing tasks, making poor decisions, and a visual or spatial impairment resulting in problems with orientation and driving. An MRI of the brain may show a loss of neurons and a decreased ability to metabolize glucose, which is characteristic of a degenerative brain disease.

Perhaps the factor most attributed to an increased risk of developing dementia praecox is undergoing frequent blows to the head, like those suffered by professional boxers, soccer and football players, or sometimes Army veterans.

When neurons are lost or damaged, there is nothing to do. So, at the moment, the best protection is to avoid head injuries.

Nowadays, many parents try to discourage youth from playing sports such as football, in which frequent blows to the head are common. However, consistent and proper helmet use and not heading the ball when playing soccer can reduce the risk of head injury. Knopman mentioned that he is less concerned about elementary school kids who play those sports; Those who played major league football or became professional boxers are at much higher risk of developing dementia at a young age as a result of constant head banging.

For older adults, the same inflammatory factors linked to atherosclerosis—clogged and hardening of the arteries leading to the heart—can also affect blood vessels leading to the brain. The general inflammation in the body that is associated with diabetes and heart disease can cause changes in the brain that favor the development of dementia.

Diagnosis of dementia praecox

According to Knopmann, Accurately diagnosing early dementia can be difficult and takes time, and this should start with taking a detailed medical history. “If doctors don’t ask the right questions, the family may miss some very significant symptom, like violent dreams.”

A full cognitive assessment of the person’s memory and language difficulties is essential. he asserted. Does the individual not remember the words or say “white” instead of “black”? Neuropsychological tests can detect subtle problems with memory, visual, cognitive, and performance functions.

A brain scan to rule out the possibility that it is a tumor that is causing these cognitive symptoms in the person. A lumbar puncture and an analysis of the cerebrospinal fluid can reveal the presence of elevated levels of the proteins tau and beta amyloid in the brain. An MRI can detect the shrinkage of some specific parts of the brain. A positron emission tomography (PET) scan can also reveal abnormal sugar uptake patterns in various parts of the brain that can help distinguish between Alzheimer’s disease, Lewy body dementia, and frontotemporal dementia. “Different degenerative brain diseases have specific patterns of glucose uptake,” Knopman explained.

As with older dementia cases, it is essential to keep younger dementia patients safe. They no longer have to drive, operate dangerous equipment such as the stove, or be left alone. Everyone should wear an identification tag at all times so that others are aware of their illness.

Obtaining the diagnosis is the first of the unique challenges posed by dementia in people between the ages of thirty and fifty-something. (I)