Dementia and Alzheimer's in young people
" Dementia " – is a collection of symptoms that indicate impairment of higher brain functions (problems with memory, language, initiative, recognition, perception, judgment), behavioral changes, and functional decline. There are many diseases that cause dementia. The most well-known and common of these is Alzheimer's disease.
According to European Union data, there are approximately 6000 people in Israel with dementia between the ages of 30 and 65.
Symptoms at a young age
The vast majority of people diagnosed with Alzheimer's disease and other dementias are in their eighth and ninth decades of life. But about one in 20 people diagnosed with Alzheimer's disease and other dementias are younger than 50 years old and sometimes younger. Younger patients with dementia do not necessarily suffer from memory problems, about half of them complain as their first symptom of personality changes, apathy, mood swings, difficulty speaking and retrieving words or understanding language, unexplained vision problems or visual hallucinations, trouble using their hands or walking, sleep disturbances and even epileptic seizures.
Rate of disease progression and time to death
The rate of progression of dementia in young people is different from that in older people. The time from the onset of symptoms to significant functional difficulty can be as fast as a year or two, or as slow as 15-20 years. The rate of progression can be deceptive and raise suspicion that it is a stroke, an acute brain disease.
Delay in diagnosis
Accurate diagnosis of dementia in young people requires complex tests to interpret, such as cognitive tests, brain MRI, spinal fluid tests, or brain mapping (isotopes). Combining findings between the tests requires an expert in the field of dementia. The combination of young age, atypical symptoms, and complex tests poses a diagnostic challenge at a young age and causes a delay in diagnosis and treatment of several years.
List of diagnostic memory clinics
Impact on the family unit
Unlike adults, the disease in young people has consequences for the family unit. The disease strikes them while they are still in the workforce, earning a living and raising families. Living alongside young patients causes severe tension at home, and affects daily decision-making.
Genetics and family
People with dementia diagnosed at a young age often report other family members with dementia, sometimes several family members in each generation. In these cases, it is suspected that it is a genetic/hereditary disease, a genetic mutation that causes dementia.
Dementia-causing mutations can manifest differently within the same family, for example, a mental health disorder, Parkinson's disease, stroke, or other brain disease that precedes the onset of dementia by several years. Dementia may also appear at different ages in the same family, up to 30 years apart.
If there is a high suspicion of familial dementia, it is recommended to contact a genetic counselor from a health insurance company or hospital. Genetic counseling with an expert in the field must take place before the test itself, and this is desirable so that the patient and his family can make essential decisions - confidentiality, health insurance, sharing information between family members, anxieties and fears about the results. In most cases, the test itself is not included in the drug basket and can cost between hundreds and thousands of shekels.
The value in identifying a mutation is usually not for the dementia patient but for their children for future fertility and pregnancy needs. In rare cases, patients may be eligible for a drug trial targeting a genetic mutation. Most patients and their families will ultimately decide not to undergo genetic testing.