Dr. Denise Compton Sparks

Early diagnosis critical to slowing progression of the disease

Alzheimer’s is generally thought of as a disease of people older than 65. But a small percentage, about five percent, of Alzheimer’s patients get the disease at younger ages, and it is important they be properly diagnosed for treatment to delay the progression of the disease while allowing the patient to make plans for future care.

The disease used to be called early onset Alzheimer’s. But that was confusing because some people took it to mean the early stage of Alzheimer’s at the normal ages people come down with the disease. Now the term “young onset” Alzheimer’s is preferred.

“Any person with the clinical symptoms of Alzheimer’s will go through an early stage whether they are younger or older,” said Denise Compton Sparks, PhD, a clinical psychologist and assistant professor, Donald W. Reynolds Institute on Aging at the University of Arkansas for Medical Sciences (UAMS), Little Rock.

Compton said it can be difficult for younger people to receive an accurate diagnosis for Alzheimer’s because there are many reasons for memory or cognitive problems. When a young person complains of memory problems, it’s more common for a physician to think it is caused by depression, stress, vascular disease, diabetes or sleep problems, rather than Alzheimer’s.

“Probably, also medical professionals would just really rather not think that a young person has Alzheimer’s disease,” Compton said. “And it is fairly rare among young people. So a lot of times it is assumed there is another cause. For that reason, younger people do have difficulty getting an accurate diagnosis. They are often more seriously impaired by the time they get a diagnosis. It causes them many more complications in their lives.”

By the time younger people have enough symptoms to warrant a diagnosis, they might not able to function on the job or have lost their job. They may have lost income because they no longer have the skills to handle their bills and finances. Marital problems are common because spouses don’t understand the changed behavior. And because they haven’t been diagnosed, they can’t quality for disability and other benefits.

“They really do suffer from lack of a diagnosis,” Compton said. “I do think healthcare professionals need to take patients seriously when they are making consistent complaints of memory changes, and refer them for a comprehensive evaluation.”

While there is no cure, medications used today to slow the progression of the disease work best when used early. And Compton said if people are diagnosed early, they, and their families, have more time to prepare for the future and enjoy the time they have.

Signs of the illness include a noticeable change from the way the person has usually functioned that can include difficulty remembering details of recent events, confusion about time and appointments, and a marked increase in repeating questions or stories.

Someone with high intelligence can mask the problems longer. David A.  Lipschitz, MD, executive director, Longevity Center, St. Vincent Hospital, Little Rock, said screening instruments often don’t pick up the disease in a really intelligent person.

“Many factors affect the age at and the way Alzheimer’s manifests,” Lipschitz said. “People with a great deal of education and people who remain lifelong learners have more brain resilience and can adapt much better than a person with less education who is not a lifelong learner. If you have an active intellectual life, you may develop Alzheimer’s five to ten years later than someone with less education. If you really exercise the brain, you can retard the rate at which it develops.”

Exercising the body is also extremely beneficial since that helps prevent diabetes, heart disease and elevated cholesterol that are associated with higher rates of Alzheimer’s. What is healthy for the heart is healthy for the brain, too.

“If you have high cholesterol, treat it,” Lipschitz said. “Make sure you are not overweight, and exercise. Then instead of presenting Alzheimer’s symptoms at 80, it might not be until 86. That is a huge advantage. You may die from something else before you get Alzheimer’s.”

There are a number of different causes for young onset Alzheimer’s. Lipschitz said the condition can be inherited in families that carry the mutated Presenilin gene. Presenilin-1 genes are found on chromosome 14 and the Presenilin-2 genes are found on chromosome one.

“These genes, when present, can indicate you will develop Alzheimer’s disease at an early age,” Lipschitz said. “If you have a parent who developed Alzheimer’s at age 50, your changes of developing it early are very high. The brain changes occur ten to 20 years before symptoms appear. By the time you are 40, there already abnormalities in the brain that will relentlessly progress.”

In addition, Alzheimer’s lesions can occur at an early age in Down syndrome patients and in those who have had head injuries. Dementias pugilistica, can affect boxers, football players or others who receive head injuries. It is being recognized with more frequency in former football players.

Veterans of the Iraq and Afghanistan wars who have been victims of roadside bombs are displaying the same effects, said Pham H. Liem, MD, associate chief of staff for geriatric medicine Central Arkansas Veterans Healthcare System, and a professor at the UAMS.

“There are some studies in Northeastern schools that show they have memory problems and the accumulation of beta amyloid commonly found in association with Alzheimer’s,” Liem said. “The VA is funding some research on that. It is no different from earlier findings that repeated head concussions result in a high rate of dementia and Alzheimer’s. The NFL Player’s Union pays a lot of attention to that.”

While there are no known cures for Alzheimer’s, saying there is nothing you can do is absolutely inappropriate. In addition to the suggestions above, Liem believes it is important to avoid fructose, which is common in soft drinks and other foods. (See article “Avoidance of Fructose Could Do Double Duty Preventing Diabetes and Alzheimer’s,” Nov. 2010, Medical News of Arkansas, www.arkansasmedicalnews.com, archives section) Liem describes Alzheimer’s, which involves inflammation and insulin resistance in the brain, as a Type of diabetes. A recent report on CNN news discussed a Japanese study showing Type 2 diabetes patients have twice the rate of Alzheimer’s.

“We said it last year,” Liem said.

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