Why is the disease slower to detect and diagnose?

Firstly, there is a complete lack of awareness that dementia can affect younger people. A further complication is the fact that there is no specific test for this illness.

Often medical professionals may misdiagnose people as suffering from depression and anxiety. There may be relationship difficulties. Women may be misdiagnosed and put down to menopausal symptoms. Younger people who develop early onset dementia have different symptoms than those in the older age group. Often memory decline is a primary symptom in older age groups. What is seen however in the younger age group are changes that are behavioral. These are symptoms such as apathy or irritability or even mood changes. Personality changes show by lack of empathy or inappropriateness. Problems are also seen with language such as difficulty in finding the right word. Patients often complain of problem solving and planning. A failing sense of direction and visual issues may also occur.

 

What are the types of Early Onset dementia?  

Alzheimer’s disease is the most common type and affects a third of younger people with early onset dementia. However this is a much smaller proportion than those of older age which accounts for 2/3 of all cases in that age group. People in this younger age group are often classified as Atypical. Also some show a very clear inheritance type known as Familial Alzheimer’s Disease. These cases are very rare and tend to occur below the age of 50. These mutations are found in 7% of people with younger onset dementia.

Vascular Dementia is the next most common subtype and accounts for around 15 to 20% in this group. It occurs due to significant disease within the vascular system of the brain. A rare inherited disorder known as CADASIL syndrome causing small strokes within the brain can also be included in this group.

Frontotemporal Dementia or FTD occurs when the front and side parts of the brain are affected. Around 10 to 15% of early onset dementia cases have this form. This is much higher than in older people. There are three different subtypes of this disease. The first type is called the Behavioural variant. It is characterised by prominent changes in personality, interpersonal relationships and conduct. The disease is most prominent in areas that control conduct, judgement, empathy and foresight among other abilities. Another variant is known as Primary Progressive Aphasia. Here there are problems with language skills, speaking, writing, and comprehension. The last variant are disturbances of motor function. This produces changes in muscle and motor functions without behavioural or language problems. Lastly there is a strong genetic component in FTD in about a third of all cases.

Dementia with Lewy bodies. This type is caused by a build up of tiny protein deposits called Lewy bodies. Symptoms include features of Parkinson’s Disease and can have visual hallucinations. This type is rare and only occurs between 5% and 7% of cases.

Korsakoff syndrome. This is caused by excessive alcohol abuse and lack of the vitamin Thiamine. It accounts for 10% of people with early onset dementia.

There are also very rare forms including Huntington’s disease, Parkinsons Disease and Creutzfelt Jacob disease.

It is also known that people with Down Syndrome are at a higher risk of developing Alzheimer’s disease. It is estimated that in the age group of 50 to 65 one in three will develop Alzheimer’s disease.

 What are the implications for this age group?

In my clinic, I see people who are still in gainful employment.

  • They may still have dependent children.

  • They may also have significant financial commitments such as mortgages etc

  • This age group is still physically fit and very active.

  • They are possibly driving and use a car as part of their profession.

  • The person often feels stigmatised as dementia is often considered an old person’s disease.

  • Significant relationship difficulties occur between spouse or partner with their loved one, due to the nature of the disease.Role reversal can occur as the disease worsens.

 

REVERSIBLE DEMENTIAS AND MIMICKING ILLNESSES.

There are of course other reasons for cognitive decline, mood and personality changes. There are conditions that although showing symptoms suggestive of neurodegenerative change, the symptoms can be reversed. There are also conditions that mimic dementia and are not a physical disease type.

In the reversible group, a thyroid disorder where low levels of thyroxine are present, and confirmed by a blood test, can be treated successfully with replacement therapy. The same can be said for vitamin B12 deficiency. Certain infections can cause symptoms which with the right treatment can reverse the process. Conditions diagnosed through radiological imaging such as Normal Pressure Hydrocephalus and some space occupying lesions within the brain can be detected and possibly treated with success.

Lastly a change of mood, a significant depression sometimes known as Depressive Pseudo Dementia can mimic the disease itself. Once the depression is treated the patient recovers completely.