A disease associated with old age, but which can also affect young adults.
The Alzheimer ‘s disease, a neurodegenerative disorder devastating to the life of the sufferer and those around him, is most often seen in old age. However, it’s not always like that. Although it is not as common, it can appear before the age of 65 and even during early adulthood. In fact, the first presentation of the disease is described in the case of a 55-year-old woman.
There are some reasons to believe that Alzheimer’s disease that occurs in old age and that manifests in adulthood, although they share many characteristics, could in fact be variants of the same clinical entity. In what form does this disease appear and how can we detect it in time, then?
Characteristics of Alzheimer’s disease
The objective of the article is not to make an exhaustive definition of the classic presentation of Alzheimer’s, but it is necessary to refresh the memory and remember which are the most characteristic symptoms of Alzheimer’s disease.
Alzheimer’s in old age
The most common clinical presentation is episodic memory loss, which is accompanied by a progressive deterioration of other cognitive domains such as voluntary movements or the ability to produce and understand language. This definition is not rigid, since many other cases present a focal alteration of only one of the domains without memory impairment. For this reason, when we talk about Alzheimer’s disease we are talking about a very heterogeneous set of presentations that all have the same cause.
At the brain level, we observe the formation of senile plaques and neurofibrillary tangles. Plaques are nothing more than deposits of peptides that form with aging. It is common to have these plaques even in healthy adults, but we found a greater number of them in patients with Alzheimer’s disease. Neurofibrillary tangles, on the other hand, are hyperphosphorized conglomerates of tau protein. Its presence in the brain is also predictive of neurocognitive disorder.
Alzheimer’s in young adulthood
About 4% of Alzheimer’s patients are diagnosed before the age of 65. The most common form of Alzheimer’s in young age is not through memory loss, but through non-amnesic syndromes. For example, visuospatial dysfunctions, apraxias, anomias, etc. Thus, we will find that executive, visuospatial and motor functions are usually affected in these patients, confusing the diagnosis with other disorders.
At the brain level, like their larger analogues, these patients also have a greater number of senile plaques and neurofibrillary tangles. However, its location is different. In young adults who develop Alzheimer’s disease, the hippocampus is preserved and free from involvement by these deposits. Remember that the hippocampus is a cardinal point in the acquisition and retrieval of memory. This finding largely explains the difference in presentations, why memory is affected from the very beginning in older adults and why this is rare in young people with Alzheimer’s.
Neuropathology shows that there is a higher density and a more diffuse distribution of the typical signs of Alzheimer’s. Structural neuroimaging studies show that the cortex is more affected than in elderly patients and also more diffusely, especially affecting the neocortex.
Taking all this evidence into account, it is possible to affirm that although both manifestations fall under the label of Alzheimer’s disease because they meet the same diagnostic criteria, the pathological processes suffered by young people are different from those found in older patients. Lesions are distributed differently, so we could be talking about two variants of the same disease, not just a criterion of temporality.
Causes of Alzheimer’s in young people
In Alzheimer’s disease that occurs in old age, the disease occurs due to the formation of natural deposits. The older the patient, the more likely they are to have so many deposits of waste that their cognitive abilities begin to decline. Likewise, the lifestyle of each one may or may not protect the formation of these deposits present in the disease.
However, in normal young patients there is no time for these deposits to form. No normal process justifies such a density and pathological distribution in the brain. This is why many of the Alzheimer’s cases that begin at an early age occur due to mutations in genes that allow protein deposits to accumulate and senile plaques to form.
Instances of Alzheimer’s due to genetically transmitted mutations are rare. It is believed that most cases occur by acquisition, or because the genes involved do not do their job optimally. It seems more the product of a cluster of genetic factors and lifestyles that produce oxidative stress than of a specific gene or marker. Naturally, those people who come from families with a strong history of Alzheimer’s at a young age, if they wish, can undergo a test where a marker of the presence of said genetic mutation or not can be found and know if they will develop the disease.
Treatment and prognosis
The treatment of Alzheimer’s in young people is the same as that prescribed to the elderly, with the advantage that they can perform more therapeutic activities than the latter. It is very important to maintain activities of daily living for as long as possible and not stop doing them because of having been diagnosed. Autonomy and activities allow the individual to retain their cognitive abilities for much longer and the decline is more gradual.
Cognitive stimulation through activities that use brain functions is a good protector against the progression of the disease. It is impossible to get rid of or stop it, so the goal is to preserve the greatest autonomy and quality of life possible for the longest period of time. It might be a good idea to make plans about how to manage life later when you begin to depend more on others and are unable to carry issues such as your own finances, legal procedures, the will or your own will towards certain medical procedures to which it could be submitted one later.
The prognosis for Alzheimer’s at an early age is unfavorable. These people deteriorate more quickly than the elderly and the cognitive decline is more marked and evident. However, it is important to always focus on the skills that the patient retains and that he can still take advantage of and use for as long as possible.