Alzheimer’s Among Younger Adults: A Growing Concern – Dr Daanish A Chhapra

As a neurologist, I am often asked whether Alzheimer’s disease affects only older adults. Though most patients we see are above 65, Alzheimer’s can strike much earlier.

Alzheimer’s disease gets classified as early-onset or young-onset. This occurs when symptoms show before the age of 65 years. Diagnosis as well as management present unique challenges within this less common form.

What makes young-onset Alzheimer’s different?

The core pathology, the accumulation of amyloid plaques and tau tangles in the brain, is similar in both early and late-onset Alzheimer’s. However, younger individuals often may show a difference in the symptom profile.

Rather than having the slow onset of forgetting we tend to ascribe to senior patients, the younger ones may be hard-pressed in the beginning with language, executive function (planning, decision-making), or visuospatial abilities (reading maps, judging distances, recognising familiar objects).

A 48-year-old individual may find themselves unable to organise the tasks necessary for the day, or a 52-year-old may find themselves lacking the words to express thoughts during conversations.

Such symptoms are quite often attributed to stress, depression, or burnout-which further delays diagnosis.

Younger patients, unlike older-diagnosed ones, tend to be employed, may run their own households, and may care for children, factors that can be severely socially and economically impactful when affected by cognitive decline.

Early warning signs to look for

While memory impairment is still a hallmark, it is not always the earliest indicator in young-onset cases. Some subtle symptoms to watch out for include:

● Difficulty with problem-solving or multitasking – Struggling to handle work-related responsibilities that previously came naturally.

● Language issues – Trouble finding words, forming coherent sentences, or following conversations.

● Disorientation – Getting lost in familiar places or confusion about time and schedules.

● Changes in behaviour or mood – Unexplained irritability, withdrawal, or loss of initiative.

● Decline in visuospatial skills – Difficulty reading, judging distances, or recognising common objects.

Often, family members notice these changes before the individual themselves does. Early recognition is key because a delayed diagnosis means delayed access to interventions that can slow progression and improve quality of life.

Why is diagnosis more complicated in younger people?

The rarity of young-onset Alzheimer’s only about 5-10% of all Alzheimer’s cases, makes it easy for healthcare providers to overlook. Symptoms resemble those of psychiatric disorders or other neurological disorders such as multiple sclerosis.

A definitive diagnosis can be reached through neuroimaging, analysis of cerebrospinal fluid, and genetic testing (in selected cases). In families with a history of early dementia, the mutations in PSEN1, PSEN2, or APP might be present, significantly increasing the risk.

Approaches to tackle young-onset Alzheimer’s:

While there is no cure that exists now, real differences can come about through quite a few strategies.

● Cholinesterase inhibitors can aid symptom control. Memantine may slow the decline. New treatments focused on amyloid and also on tau proteins seem hopeful.

● Indeed, independence can be maintained through cognitive rehabilitation using some tailored strategies that strengthen problem-solving skills, plus memory techniques with daily living activities.

● If people eat well, exercise, get enough sleep and stimulate the brain, they support brain health (such as puzzles, new skills etc).

● Younger patients are those who recognise their own decline; they commonly experience depression along with anxiety psychologically. Support groups in conjunction with counselling provide critical emotional relief.

● Roles that shift require families to change with time. Families' duties depend on caregiver education. Since many spouses or partners are still actively working plus also raising their own children while concurrently managing care, caregiver burnout is certainly especially high.

● Because younger patients can live for many years with the disease, planning for their future is important. Due to things such as advance directives and workplace adjustments, financial and legal planning become important.

Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.