Young-onset dementia: how to beat cognitive decline

We tend to associate dementia with old age. But a new study warns a growing number are being diagnosed with the disease in mid-life.  We look at science-backed ways to protect our brain

For many cases of young onset dementia, the cause is still unclear and individual risk is likely due to a complex interaction of genes, lifestyle environment and age.

Dementia is a disease most often associated with growing old, the consequence of progressive decline in cognitive ability that gradually causes problems with memory, thinking and problem-solving. But new research published in the Journal of Dementia Care warns that it can also strike much earlier, in mid-life.

“In the study we have exposed a hidden population of people living with young onset dementia that has not previously been recognised,” says Dr Janet Carter, associate professor of mental health neuroscience at University College London and lead author of the new paper. “This number is likely to be the tip of the iceberg.”

Figures released by the Alzheimer’s Society of Ireland (ASI) show that there are approximately 4,066 people living with ‘young onset’ dementia, defined as the development of symptoms, including memory and behaviour problems usually between 30 to 65 years of age. The new findings, which explode the myth that cognitive decline occurs only with ageing, show a rising number of people in their 40s, 50s and 60s are being diagnosed with the condition. For many cases of young onset dementia, the cause is still unclear and individual risk is likely due to a complex interaction of genes, lifestyle environment and age.

But there’s much that can be done to reduce your risk of developing mid-life dementia.

What are the warning signs?

Unlike dementia in later life, it is less common for memory loss to be an early symptom in younger people and the majority of younger adults who report memory problems do not have the condition. “Usually, younger people first present with non-memory problems, such as language or visual symptoms, and impaired thinking and planning skills,” says Carter. “Behavioural changes with impairment or loss of speech and sometimes inappropriate social behaviour are other signs.”

Too often these symptoms are dismissed as stress or depression and anxiety, or wrongly attributed to other causes including menopause, physical health problems and relationship issues in early consultations. If you notice signs in yourself or someone else seek help as early as possible is the advice of the ASI.

Do you need a genetic test?

For a very small number of people with young onset dementia, a genetic mutation passed down through generations is the cause of some rare types of Alzheimer’s or frontotemporal dementia. With so-called ‘familial’ Alzheimer’s, for example, a faulty gene that results in an abnormal build-up of a protein called amyloid in the brain that causes the clumps or ‘plaques’ characteristic feature of Alzheimer’s disease, is passed down directly from a parent who has the condition.

Research shows that people who carry a faulty gene will develop Alzheimer’s disease, and their children have a 50% chance of inheriting the gene from them. If there is a pattern of Alzheimer’s affecting every generation at a young age in your family, then genetic testing in the form of a blood test to confirm a gene mutation may be available.

According to the ASI, you should talk to your doctor about genetic counselling to find out if it is appropriate for you.

Get a consistent seven hours of sleep a night

If mid-life stresses are causing you to miss out on valuable sleep, it could take its toll in the long term. Last year a study in Nature Communications of almost 8,000 people in Britain, ranging in age from 50 to 70s, assessed how many hours they slept per night on six occasions between 1985 and 2016. Some of the participants wore accelerometers to objectively measure sleep time.

“Results showed that people in their 50s and 60s getting six hours of sleep or less were at greater risk of developing dementia later in life,” Carter says. “Compared to those getting normal sleep, defined as seven hours, those getting less rest each night were 30% more likely to be diagnosed with dementia.”

It suggests that short sleep duration during midlife could increase the risk of developing dementia later in life, Carter says, “although more research is needed to confirm and understand the reasons”.

Genetic factors and lack of sleep are understood to be factors in early-onset dementia

Keep your waistline in check

Weight gain and obesity are known risk factors for some types of dementia and people who carry excess weight in middle age have an increased risk of developing the condition, according to research from a long-running British study in the International Journal of Epidemiology that followed 6,000 people aged over 50 for an average of 11 years.

Men and women who were obese and had a high waist circumference showed a 28% increased risk of dementia.

Being overweight also raises the risk of Type 2 diabetes, another known risk factor for brain disease. A recent study of 10,000 participants with a follow-up of 32 years, published in JAMA, showed that those with younger onset type 2 diabetes were younger at onset of dementia if they developed it.

Power walk for 2.5 hours a week

Exercising regularly is important for dementia prevention and poor cardiovascular health has been shown to damage blood flow to the brain increasing the risk for the condition. A nine-year study involving 649,605 people presented in February to the American Academy of Neurology conference by researchers at Washington VA Medical Centre showed that people with the highest levels of cardiorespiratory fitness were 33% less likely to develop Alzheimer’s disease than those who were less fit. The researchers recommended a brisk walk most days, “for a total of two and a half hours or more per week” to achieve a protective fitness effect for people middle-aged and older.

“The idea that you can reduce your risk for Alzheimer’s disease by simply increasing your activity is very promising, especially since there are no adequate treatments to prevent or stop the progression of the disease,” said Edward Zamrini, adjunct professor of clinical research at George Washington University and the lead author on the paper.

Eat healthily and consider a supplement

A diet rich in fruit, vegetables and cereals, and low in red meat and sugar while keeping alcohol within recommended limits of no more than 14 units a week could help reduce dementia risks according to the ASI. While no supplement provides protection against dementia, researchers from Wake Forest University School of Medicine in North Carolina recently reported that three years of multivitamin supplementation roughly translated to a 60% – or about 1.8 years - slowing of cognitive decline. They compared the effects of taking a 500mg daily cocoa extract supplement, rich in beneficial compounds called flavanols, or a daily multivitamin-mineral supplement that provided several nutrients needed to support normal brain function.

“Our study showed that although cocoa extract did not affect cognition, daily multivitamin-mineral supplementation resulted in statistically significant cognitive improvement,” says Laura D Baker, professor of gerontology and geriatric medicine at Wake Forest. “This is the first evidence of cognitive benefit in a large longer-term study of multivitamin supplementation in older adults,” Baker says “It’s too early to recommend daily multivitamin supplementation to prevent cognitive decline” but if you want to leave nothing to chance you might consider taking one.

• Centrum Silver 50+ was the supplement provided for trial participants but look for any supplement with a long list vitamins and minerals, and lutein, important for healthy vision and brain function.