World Alzheimer's Day 2023: What Is Early Onset Alzheimer's Disease? Know Symptoms And More

Early onset Alzheimer's disease is a form of dementia that affects individuals under the age of 65. About 5% to 6% of people with Alzheimer's disease develop symptoms before this age. Most of these people develop symptoms of the disease when they are between 30 and 60 years old. It is a debilitating condition that not only impacts the afflicted person but also places a significant burden on their families and caregivers. It is a formidable challenge, impacting individuals in the prime of their lives.

Early-onset Alzheimer's disease is caused by a complex interplay of genetic and environmental factors. A significant number of cases are linked to well-characterized genetic mutations. Young-onset Alzheimer's can result from mutations in one of three genes (APP, PSEN1, or PSEN2), which can potentially be passed on to other family members. Having a parent or grandmother who has been diagnosed with early-onset Alzheimer's can be an indicator of one of these gene alterations. These three genes are found in fewer than 1% of all Alzheimer's patients but in approximately 11% of young-onset Alzheimer's patients. It is possible to develop early-onset Alzheimer's disease due to factors other than changes in these three genes.

In this condition, the accumulation of two proteins is thought to harm nerve cells. Plaques are made up of fragments of one protein, beta-amyloid. Tangles are twisted fibers of another protein, tau. These impair nerve cell activity and communication. Initially, these plaques and tangles harm the brain's memory centers. They eventually damage additional parts of the brain.

The clinical manifestations of early-onset Alzheimer's disease are similar to those of late-onset Alzheimer's. Early symptoms include forgetting important things, particularly newly learned information. Repeating oneself, losing track of time, trouble finding the right word, misplacing things, poor judgment, withdrawal from work and social situations, and changes in personality are other early symptoms. As the disease progresses, the patient may have severe mood swings and behavior changes, deepening confusion about time, place, and life events. They may become suspicious of friends, family, and caregivers. In advanced stages, they may also have trouble speaking, swallowing, and walking.

A comprehensive assessment is imperative, involving a thorough medical history followed by a systemic, neurological, and cognitive assessment. Imaging techniques such as MRI and PET scans, along with biomarker studies, play a crucial role in confirming the diagnosis and ruling out other potential causes of cognitive impairment.

Various treatment approaches aim to alleviate symptoms and enhance quality of life. Pharmacological interventions that target neurotransmitter imbalances can provide modest relief. Non-pharmacological interventions, such as cognitive stimulation therapy and regular physical exercise, have shown promise in maintaining cognitive function and promoting overall well-being.

Additionally, creating a supportive and structured environment, along with providing education and resources for caregivers, are vital components of the overall management plan. Support groups and counseling can offer much-needed emotional support for both patients and their families.

The progression of early-onset Alzheimer's varies from person to person, but it generally follows a relentless trajectory. These individuals typically experience a more rapid decline compared to those with late-onset Alzheimer's. Factors such as genetic background, overall health, and access to care can influence the rate of progression.

Advances in neuroimaging techniques, biomarker discovery, and genetic studies hold promise for earlier detection and targeted therapeutic interventions. As our understanding of the underlying mechanisms deepens, it is hoped that more effective treatments and potentially disease-modifying interventions will emerge.

(Lt Gen (Dr) CS Narayanan, VSM, Head, Neurology at HCMCT Manipal Hospitals, Dwarka)

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