If you’re in your 70s or 80s, and you’ve noticed that you’re experiencing some forgetfulness, it may be reasonable to be concerned about memory loss that may or may not be dementia. But what if you’re in your 60s, 50s, 40s, or 30s … surely those ages would be too young for Alzheimer’s disease or dementia, right?
Although dementia usually develops in people aged 65 years and older, young-onset dementia (also called early-onset dementia) occurs in people younger than age 65. Here’s what we know about young-onset dementia:
- About 5 percent to 6 percent of people with Alzheimer’s disease develop symptoms before age 65.
- Most people with young-onset Alzheimer’s develop symptoms of the disease when they are between 30 and 60 years old.
- Experts don’t fully know why some people get the disease at a younger age than others do.
- 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 grandparent who developed young-onset Alzheimer’s can be a clue suggesting one of these gene changes. Genetic testing for these mutations is available, but anyone who’s considering it should pursue genetic counseling — to examine the pros and cons before getting tested.
- Together, these three genes are present in less than 1 percent of all people with Alzheimer’s but in about 11 percent of people with young-onset Alzheimer’s. If you have a genetic mutation in one of those three genes, you may develop Alzheimer’s before age 65.
- A family history of Alzheimer’s disease does not necessarily mean that there is a gene mutation present in an individual or family. A lack of family history also doesn’t mean that someone won’t develop young-onset Alzheimer’s disease; it is possible to develop young-onset Alzheimer’s disease from causes other than changes in these three genes.
- Of those with a known classification of young-onset dementia, 55 percent had Alzheimer’s disease, 11 percent vascular dementia, 3 percent frontotemporal dementia, 3 percent Parkinson’s disease dementia, 2 percent dementia with Lewy bodies, and 2 percent primary progressive aphasia.
- Symptoms of dementia are similar no matter what age they start, though not everyone experiences the same set of symptoms. Symptoms can include memory loss that interferes with daily life; confusion; difficulty performing familiar tasks; repetitive behavior; withdrawing from friends and family; poor judgement; changes in behavior; and/or language problems.
What 15 Factors Are Linked to a Higher Risk of Young-Onset Dementia?
A recent study published in December 2023 in JAMA Neurology has identified 15 factors linked to a higher risk of young-onset dementia. For the study, researchers examined detailed genetic and medical information for roughly 356,000 adults who were 55 years old on average and had no history of dementia. During an average follow-up period of nearly a decade, 485 people were diagnosed with young-onset dementia — dementia onset in people under 65. The researchers compared participants who did and did not develop young-onset dementia to identify possible risk factors. The study found the following 15 traits or conditions increased the risk of developing dementia before 65:
- A genetic predisposition to dementia can increase the risk of this condition developing before age 65 — a risk factor that’s impossible to change. Genetic risk factors were associated with a 27 percent to 87 percent greater risk.
- Because they have an extra copy of the chromosome that carries the gene for the amyloid found in Alzheimer’s plaques, more than half of people with Down syndrome develop Alzheimer’s disease, typically in their 40s and 50s.
- Other genetic abnormalities that run in families can also cause Alzheimer’s disease to start in people’s 50s, 40s, or even 30s — but you would likely know if you are at risk because one of your parents would have had young-onset Alzheimer’s disease.
- Being diagnosed with alcohol use disorder (AUD) has been associated with damage to several parts of the brain, including the frontal lobes, which leads to trouble with executive function and working memory.
- No alcohol use is also a risk factor because people may stop drinking when they develop memory loss (also known as the “healthy drinker effect” in dementia).
- Social isolation, which researchers defined as visiting family or friends no more than once a month, was associated with a 53 percent higher risk of young-onset dementia. Researchers found that individuals with fewer social interactions may not use their brains enough to keep them healthy.
- Vitamin D deficiency was associated with a 59 percent increased risk. Not getting enough vitamin D can lead to more viral infections. A number of studies suggest that certain viral infections increase your risk of dementia.
- High C-reactive protein is a sign of inflammation. This risk factor could be either a contributing cause or a result of impending dementia.
- Lower handgrip strength is a sign of frailty, which is often associated with dementia.
- Less formal education: Cognitive reserve can be described as our capacity to think, improvise, and problem-solve even as our brains change with age. Having less formal education may affect your familiarity with the items on the pencil-and-paper cognitive tests that are used to diagnose dementia.
- Lower socioeconomic status may be related to lower-quality education.
- Hearing impairment was tied to a 56 percent greater risk
- Type 2 diabetes was linked to a 65 percent greater risk.
- Having diabetes if you’re a man can lead to dementia in many different ways. Researchers suggest that it is because middle-aged men are more likely to have a diabetes-related ministrokes than middle-aged women, which can lead to vascular dementia.
- Heart disease was tied to a 61 percent higher risk
- Depression was associated with a more than tripled risk of young-onset dementia.
- Orthostatic hypotension (when blood pressure drops after standing up after sitting or lying down) can lead to brain damage and dementia. It can also be a result of some types of dementia, such as Parkinson’s disease dementia and dementia with Lewy bodies.
- Stroke, which can be caused by modifiable risk factors such as excessive drinking, poorly controlled blood sugar, or untreated hypertension — was associated with twice the odds of young-onset dementia.
What Else Could Be Causing Memory Problems at a Young Age?
The most common cause of memory problems below age 65 is poor sleep. Other causes of young-onset memory problems include perimenopause, medication side effects, depression, anxiety, illegal drugs, alcohol, cannabis, head injuries, vitamin deficiencies, thyroid disorders, chemotherapy, strokes, and other neurological disorders.
What Can You Do to Prevent Young-Onset Dementia?
Prioritizing your health can reduce several risk factors for young-onset dementia. In fact, there are a lot of things people can do to help reduce their risk of getting dementia in their forties or fifties. Taking these steps can reduce your risk for developing dementia before age 65:
- Participate in social activities.
- Sleep well.
- Perform aerobic exercise.
- Avoid alcohol, cannabis, and drugs.
- Manage and treat depression.
- Eat Mediterranean-style meals.
- Pursue cognitively stimulating activities, listen to music, practice mindfulness, and keep a positive mental attitude.
- Seek opportunities to socialize with others regularly.
- Make sure that you’re getting enough vitamin D.
- Make sure you are hearing well, and use hearing aids if you are not.
- Maintain a healthy body weight, and work with your doctor to reduce your risk of strokes, heart disease, and diabetes.
If You Have Young-Onset Dementia
A diagnosis of young-onset dementia is obviously devastating for the individual and their family. You will face unique challenges when it comes to family, work, finances, and future care. The Alzheimer’s Association offers an excellent resource for what to do if you have been diagnosed with early-onset Alzheimer’s disease or if you’re a caregiver for someone who has.
Do You or a Loved One Have Dementia? — the Time to Plan Is Now!
Persons with Alzheimer’s and other forms of dementia and their families face special legal and financial needs; if dementia affects you or a loved one, please reach out to make an appointment:
Northern Virginia Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
District of Columbia Elder Law: 202-587-2797
About Evan H Farr, CELA, CAP
