Patricia Farrell's COLUMN

Early-onset Alzheimer’s and Its Misdiagnosis Tragedies

Who is in danger of early-onset Alzheimer’s and why

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“I don’t know who this man is and he keeps getting into bed with me,” the woman said in a noticeably frightened voice. “I keep telling him my husband will be coming home,” she said, “but he won’t leave.”

The man was her husband, and the woman was experiencing Early-onset or Young-onset Alzheimer’s, a neurological disorder that can affect younger persons in their 30s, 40s, or 50s. Seen less frequently in clinical practice, it can be misdiagnosed and is of great concern.

One current theory is that this type of Alzheimer’s may be familial, but a similar form is found in those with Down Syndrome. Estimates suggest that 50 percent or more of people with Down syndrome will develop dementia due to Alzheimer’s disease as they age.

Younger Alzheimer’s patients may face stigmas and stereotypes about the disease. Due to their young age, people with young-onset Alzheimer’s may find that others do not believe they have the disease or question the diagnosis. It’s also not uncommon to be told your symptoms may be related to stress, menopause, or depression.

People with young-onset Alzheimer’s may lose relationships or jobs as a consequence of this misunderstanding instead of being identified as medically ill or disabled.

The woman, in this case, was in her mid-50s, attractive, well-groomed, and was from a socially prominent family with considerable financial resources. Beginning a year or two before her clinical assessment at an Alzheimer’s clinic, she had persuaded her husband that thieves were coming into their home. She began to have insomnia because of her fear and became socially isolated.

Triple security systems were installed, but she still insisted they were in danger and should keep a gun in their bedroom. Then, she began to suspect that her husband wasn’t her husband at all.

It was time for more certain clinical measures. The diagnosis was Early-onset Alzheimer’s, but since no records were available, a familial connection couldn’t be made.

Although it is Early-Onset Alzheimer’s Disease (EOAD), there are several differences in symptoms that increase the likelihood of misdiagnosis.

Individuals with early-onset Alzheimer’s demonstrate more often atypical presentations than those with late-onset Alzheimer’s disease. Many of those with early-onset don’t have significant memory loss initially — the classic hallmark symptom of Alzheimer’s.

Their disease progression does not begin with symptoms of forgetfulness. Some of these individuals present with visual symptoms — inability to see the full picture giving them in essence a “tunnel vision”, impaired depth perception or inability to recognize faces — or impaired speech/difficulty coming up with words in conversation.

But, according to some studies, early-onset Alzheimer’s disease also progresses much faster than late-onset.

Photo by Viktor Talashuk on Unsplash

Why Early-onset Alzheimer’s?

Most types of early-onset Alzheimer’s disease are the same, but there are a few small distinctions:

Common Alzheimer’s disease. The majority of people with early-onset Alzheimer’s disease have the common form of Alzheimer’s disease. The disease will progress in roughly the same way as it does in older people with Alzheimer’s disease.

Genetic Alzheimer’s disease. This form is extremely rare. A few hundred people have genes that directly contribute to Alzheimer’s disease. These people begin showing symptoms of the disease in their 30s, 40s, or 50s.

Although much is still to be discovered about both types of Alzheimer’s, one study of nuns in the Midwest has provided some interesting insights. The researchers noted that mood and education might play significant roles in any dementia.

One interesting aspect of the lives of the nuns was that they maintained a lifestyle of continuous learning. One nun made it her chore to learn a new language every year, if possible.

A pattern of emotional expression that accentuates positive
affect undoubtedly has behavioral correlates that could enhance or
disrupt the positive effects on physiology and health
.”

One nun in the study had physiological evidence at her death that defied the theories about how Alzheimer’s develops in any patient.

Sister Mary, the gold standard for the Nun Study, was a remarkable woman who had high cognitive test scores before her death at 101 years of age. What is more remarkable is that she maintained this high status despite having abundant neurofibrillary tangles and senile plaques, the classic lesions of Alzheimer’s disease.

Education, too, may play a significant role in the development of Alzheimer’s (AD). As noted in recent work in neurology, “protective environmental factors, like increased education, may promote brain resistance against β-amyloid pathology in both sporadic and autosomal dominant AD.” The accumulation of amyloid is believed to promote the development of memory impairment. Is learning one of the keys to prevention?

Is Prevention Possible?

The theories about the development of AD have centered around genetics, the tau proteinbeta-amyloid plaques, and tangles, and now diet is being considered.

Not all studies have shown a link between eating well and a boost in cognition. Overall, the evidence suggests, but does not prove, that following a Mediterranean or similar diet might help reduce the risk for Alzheimer’s dementia or slow cognitive decline.

The dietary theory is based on the fact that certain foods like fish may provide anti-inflammatory and antioxidant properties that protect the brain. These foods, then, could inhibit the development of beta-amyloid deposits and promote the maintenance of normal brain functioning.

The jury is still out on both Early-Onset Alzheimer’s and the form in older patients, but a number of both environmental and genetic factors are in play.

Resources:

  1. Early-Onset Alzheimer’s Disease: A Resource List
  2. Living with Alzheimer’s: For Younger-Onset Alzheimer’s
  3. Education may be protective for people with gene for familial early-onset Alzheimer’s

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Pat Farrell PhDhttps://medium.com/@drpatfarrell
I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

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DR PATRICIA FARRELL

Medika Editor: Mental Health

I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

Patricia also acts in an editorial capacity for Medika's mental health articles, providing invaluable input on a wide range of mental health issues.

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