What Are The Risk Factors
We do not know fully the risk factors for developing young onset dementia. For many people, it just seems to develop. In a proportion of younger people, there is a familial link. Individuals who have at least one close relative with dementia have a two to four times greater risk of developing dementia before the age of 65, most commonly Alzheimers disease. The effect is stronger for those where the close relative had young onset dementia.
A second major risk factor is Downs syndrome. Up to three-quarters of people with Downs syndrome over the age of 50 will develop dementia . This problem is increasingly evident as people with Downs syndrome are living longer now.
In addition, people from black and minority ethnic groups under the age of 65 years seem more likely to be diagnosed with dementia.
Study Shows Link Between Alzheimers And Heart Disease
Recently, researchers discovered that Alzheimers is caused by amyloid beta proteins building up in the spaces between brain cells. While this causes noticeable symptoms in the brain first, this same protein plaque can build up around the heart.
This was discovered in a study that examined 22 patients with Alzheimers and 35 patients without, all of whom were 78 or 79 years old. The goal was to analyze the stiffness present in the hearts left ventricle the thickest chamber of the heart responsible for transporting blood throughout the body.
During the study, published in the Journal of the American College of Cardiology, researchers discovered that those with Alzheimers had a thicker left ventricle than those without Alzheimers. This thickness was caused by the same plaque protein buildup that was building in the Alzheimers patients brains. The thickness can lead to various cardiovascular issues if and when the left ventricle becomes too thick to successfully pump blood through the body. As a result, this puts Alzheimers patients at a higher risk of heart attack and stroke.
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Health Environmental And Lifestyle Factors
Research suggests that a host of factors beyond genetics may play a role in the development and course of Alzheimers. There is a great deal of interest, for example, in the relationship between cognitive decline and vascular conditions such as heart disease, stroke, and high blood pressure, as well as conditions such as diabetes and obesity. Ongoing research will help us understand whether and how reducing risk factors for these conditions may also reduce the risk of Alzheimers.
A nutritious diet, physical activity, social engagement, and mentally stimulating pursuits have all been associated with helping people stay healthy as they age. These factors might also help reduce the risk of cognitive decline and Alzheimers. Researchers are testing some of these possibilities in clinical trials.
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Use And Costs Of Health Care And Long
Among Medicare beneficiaries with Alzheimer’s or other dementias, black/African Americans had the highest Medicare payments per person per year, while whites had the lowest payments . The largest difference in payments was for hospital care, with black/African Americans incurring 1.7 times as much in hospital care costs as whites .
- Created from unpublished data from the National 5% Sample Medicare Fee-for-Service Beneficiaries for 2014.
In a study of Medicaid beneficiaries with a diagnosis of Alzheimer’s dementia that included both Medicaid and Medicare claims data, researchers found significant differences in the costs of care by race/ethnicity. These results demonstrated that black/African Americans had significantly higher costs of care than whites or Hispanics/Latinos, primarily due to more inpatient care and more comorbidities. These differences may be attributable to later-stage diagnosis, which may lead to higher levels of disability while receiving care delays in accessing timely primary care lack of care coordination duplication of services across providers or inequities in access to care. However, more research is needed to understand the reasons for this health care disparity.
What Are The Symptoms Of Early
For most people with early-onset Alzheimer disease, the symptoms closely mirror those of other forms of Alzheimer disease.
Withdrawal from work and social situations
Changes in mood and personality
Severe mood swings and behavior changes
Deepening confusion about time, place, and life events
Suspicions about friends, family, or caregivers
Trouble speaking, swallowing, or walking
Severe memory loss
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Medicines To Treat Challenging Behaviour
In the later stages of dementia, a significant number of people will develop what’s known as behavioural and psychological symptoms of dementia .
The symptoms of BPSD can include:
- increased agitation
- delusions and hallucinations
These changes in behaviour can be very distressing for both the person with Alzheimer’s disease and their carer.
If coping strategies do not work, a consultant psychiatrist can prescribe risperidone or haloperidol, antipsychotic medicines, for those showing persistent aggression or extreme distress.
These are the only medicines licensed for people with moderate to severe Alzheimer’s disease where there’s a risk of harm to themselves or others.
Risperidone should be used at the lowest dose and for the shortest time possible as it has serious side effects. Haloperidol should only be used if other treatments have not helped.
Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety.
Sometimes other medications may be recommended to treat specific symptoms in BPSD, but these will be prescribed “off-label” .
It’s acceptable for a doctor to do this, but they must provide a reason for using these medications in these circumstances.
Reasons Rate Of Alzheimers Disease Increases With Age
When talking about the average age for Alzheimers, it is important to discuss the reasons the illness increases with age.
Healthy brains clear out amyloid-beta regularly. This ability tends to slow down as people grow older.
A study from The Washington University School of Medicine shows that for people in their 30s a healthy brain will clear amyloid-beta every 4 hours.
When a person is 80 the brain may take at least 10 hours to complete the job. This may explain the relationship between Alzheimers and age.
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Key Points About Early
Alzheimer disease commonly affects older people, but early-onset Alzheimer disease can affect people in their 30s or 40s.
It affects memory, thinking, and behavior.
Although there is no known cure, early diagnosis and treatment can lead to better quality of life.
Stay healthy with a good diet and regular exercise.
Avoid alcohol and other substances that may affect memory, thinking, and behavior.
Differences Between Women And Men In The Prevalence And Risk Of Alzheimer’s And Other Dementias
More women than men have Alzheimer’s or other dementias. Almost two-thirds of Americans with Alzheimer’s are women., Of the 5.8 million people age 65 and older with Alzheimer’s in the United States, 3.6 million are women and 2.2 million are men., Based on estimates from ADAMS, among people age 71 and older, 16% of women have Alzheimer’s or other dementias compared with 11% of men.
The prevailing reason that has been stated for the higher prevalence of Alzheimer’s and other dementias in women is that women live longer than men on average, and older age is the greatest risk factor for Alzheimer’s.- But when it comes to differences in the actual risk of developing Alzheimer’s or other dementias for men and women of the same age, findings have been mixed. Most studies of incidence in the United States have found no significant difference between men and women in the proportion who develop Alzheimer’s or other dementias at any given age., , – However, some European studies have reported a higher incidence among women at older ages,, and one study from the United Kingdom reported higher incidence for men. Differences in the risk of dementia between men and women may therefore depend on age and/or geographic region.,
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Diagnosis Of Dementia Due To Alzheimers Disease
- Obtaining a medical and family history from the individual, including psychiatric history and history of cognitive and behavioral changes.
- Asking a family member to provide input about changes in thinking skills and behavior.
- Conducting problem-solving, memory and other cognitive tests, as well as physical and neurologic examinations.
- Having the individual undergo blood tests and brain imaging to rule out other potential causes of dementia symptoms, such as a tumor or certain vitamin deficiencies.
- In some circumstances, using PET imaging of the brain to find out if the individual has high levels of beta-amyloid, a hallmark of Alzheimers normal levels would suggest Alzheimers is not the cause of dementia.
- In some circumstances, using lumbar puncture to determine the levels of beta-amyloid and certain types of tau in CSF normal levels would suggest Alzheimers is not the cause of dementia.
Brain Changes Associated With Alzheimer’s Disease
A healthy adult brain has about 100 billion neurons, each with long, branching extensions. These extensions enable individual neurons to form connections with other neurons. At such connections, called synapses, information flows in tiny bursts of chemicals that are released by one neuron and detected by another neuron. The brain contains about 100 trillion synapses. They allow signals to travel rapidly through the brain’s neuronal circuits, creating the cellular basis of memories, thoughts, sensations, emotions, movements and skills.
The accumulation of the protein fragment beta-amyloid outside neurons and the accumulation of an abnormal form of the protein tau inside neurons are two of several brain changes associated with Alzheimer’s.
Plaques and smaller accumulations of beta-amyloid called oligomers may contribute to the damage and death of neurons by interfering with neuron-to-neuron communication at synapses. Tau tangles block the transport of nutrients and other essential molecules inside neurons. Although the complete sequence of events is unclear, beta-amyloid may begin accumulating before abnormal tau, and increasing beta-amyloid accumulation is associated with subsequent increases in tau.,
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Interventions To Reduce Racial And Ethnic Disparities
Although there is extensive evidence documenting disparities among different racial and ethnic groups with Alzheimer’s disease, there are few studies evaluating interventions to address disparities in this population. Almost all interventions designed to explicitly address racial and ethnic disparities focus on cultural competency on the part of the health care provider and/or health system. Interventions not specific to the Alzheimer’s disease population include care coordination, care management, community health workers, and culturally tailored education interventions .
Cultural competency is especially important in the health care setting, where barriers to communication and access to quality care can result in delayed diagnosis, inappropriate treatment, or worse. Cultural competence involves both awareness and knowledge about other cultures and skill in relating to people of other cultures. Cultural competence requires acknowledging that culture and ethnicity guide and affect behavior, and that all people are cultural beings .
A culturally competent health care environment includes the following characteristics : a culturally diverse staff that reflects the communities served bilingual staff or interpreters for the clients’ languages culture-specific and language-specific training for providers and signs and materials in the clients’ languages that are sensitive to cultural norms.
Outreach to Minority Communities
Common Forms Of Dementia
There are many different forms of dementia. Alzheimers disease is the most common form and may contribute to 6070% of cases. Other major forms include vascular dementia, dementia with Lewy bodies , and a group of diseases that contribute to frontotemporal dementia . The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
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Is There Treatment Available
At present there is no cure for Alzheimer’s disease. However, one group of drugs called cholinergeric drugs appears to be providing some temporary improvement in cognitive functioning for some people with mild to moderate Alzheimer’s disease.
Drugs can also be prescribed for secondary symptoms such as restlessness or depression or to help the person with dementia sleep better.
Community support is available for the person with Alzheimer’s disease, their families and carers. This support can make a positive difference to managing dementia. Dementia Australia provides support, information and counselling for people affected by dementia. Dementia Australia also aims to provide up-to-date information about drug treatments.
For more information contact the National Dementia Helpline on 1800 100 500.
For a range of books and videos contact our Library.
For advice, common sense approaches and practical strategies on the issues most commonly raised about dementia, read our Help Sheets.
Reminiscence And Life Story Work
Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.
Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.
These approaches are sometimes combined. Evidence shows they can improve mood and wellbeing.
Find out how to live well with dementia and more useful information in the NHS Dementia Guide.
Page last reviewed: 05 July 2021 Next review due: 05 July 2024
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Prevalence Of Alzheimer’s Disease
The pooled data of population-based studies in Europe suggests that the age-standardized prevalence in people 65+ years old is 6.4 % for dementia and 4.4 % for AD. In the US, the study of a national representative sample of people aged > 70 years yielded a prevalence for AD of 9.7 %. Worldwide, the global prevalence of dementia was estimated to be 3.9 % in people aged 60+ years, with the regional prevalence being 1.6 % in Africa, 4.0 % in China and Western Pacific regions, 4.6 % in Latin America, 5.4 % in Western Europe, and 6.4 % in North America. More than 25 million people in the world are currently affected by dementia, most suffering from AD, with around 5 million new cases occurring every year.- The number of people with dementia is anticipated to double every 20 years. Despite different inclusion criteria, several meta-analyses and nationwide surveys have yielded roughly similar age-specific prevalence of AD across regions .,,, The age-specific prevalence of AD almost doubles every 5 years after aged 65. Among developed nations, approximately 1 in 10 older people is affected by some degree of dementia, whereas more than one third of very old people may have dementia-related symptoms and signs., There is a similar pattern of dementia subtypes across the world, with AD and vascular dementia, the two most common forms of dementia, accounting for 50 % to 70 % and 15 % to 25 %, respectively, of all dementia cases.
Incidence Of Alzheimer’s Disease
The pooled incidence rate of AD among people 65+ years of age in Europe was 19.4 per 1000 person-years. The pooled data from two large-scale community-based studies of people aged 65+ years in the US Seattle and Baltimore, areas yielded an incidence rate for AD of 15.0 per 1000 person-years., The incidence rate of AD increases almost exponentially with increasing age until 85 years of age .,-
Age-specific incidence of Alzheimer’s disease across continents and countries. *, incidence of all types of dementia
There appears to have been some geographic variations in the incidence of AD. The pooled data of eight European studies suggested a geographical dissociation across Europe, with higher incidence rates being found among the oldest-old people of north-western countries than among southern countries. The incidence rates of AD were reported to be slightly lower in North America than in Europe. Differences in methodology , rather than real different regional distributions of the disease, may be partly responsible for the geographic variations. The study using identical methods in UK found no evidence of variation in dementia incidence among five areas in England and Wales. Studies have confirmed that AD incidence in developing countries is generally lower than in North America and Europe. For example, the incidence rate of AD among people aged 65+ years was 7.7 per 1 000 person-years in Brazil and 3.2 per 1 000 person-years in India.,
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What Assistance With Everyday Activities Do People With Dementia Receive
People with dementia living in the community may receive assistance from a range of providers depending on their needs.Notably, the bulk of care was provided by informal carers , with informal care being the only care received for many of the activities. For example, of those needing help with reading and writing, 89.2% received only informal assistance with the activities. Similarly, of those needing assistance with meal preparation, this need was only met by informal sources for 81.1% of the people affected.
Risk Factors To Consider
Although AD isnt an expected part of advancing age, youre at increased risk as you get older. More than 32 percent of people over age 85 have Alzheimers.
You may also have an increased risk of developing AD if a parent, sibling, or child has the disease. If more than one family member has AD, your risk increases.
The exact cause of early onset AD hasnt been fully determined. Many researchers believe that this disease develops as the result of multiple factors rather than one specific cause.
Researchers have discovered rare genes that may directly cause or contribute to AD. These genes may be carried from one generation to the next within a family. Carrying this gene can result in adults younger than age 65 developing symptoms much earlier than expected.
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Figure : Mortality Rates Due To Dementia And Alzheimers Disease Were Highest In Those Of The White Ethnic Background Aged Over 65 Years
Age standardised mortality rate for deaths due to dementia and Alzheimer’s disease by ethnic group, aged 65 years and over, England and Wales, 2019
In this section mortality data have been linked to Census data. The study population included all usual residents coded to an ethnic group in 2011 and not known to have died before 1 January 2019. Those enumerated in 2011 answering the “Intention to stay” question, because they had entered the UK in the year before the 2011 Census took place, were excluded from the analyses because of their high propensity to have left the UK before the analysis period under investigation.