Alzheimer’s disease, a neurodegenerative disorder devastating to the lives of those who suffer from it and those around them, manifests itself most frequently in old age. However, this is not always the case. Although it is not as frequent, 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 is some reason to believe that Alzheimer’s disease that occurs in old age and that manifests itself during adulthood, although they share many characteristics, could actually be variants of the same clinical entity. How does this disease appear and how can we detect it in time, then?

Characteristics of Alzheimer’s Disease

The aim of the article is not to provide an exhaustive definition of the classic presentation of Alzheimer’s, but it is necessary to refresh the memory and remember what the most characteristic symptoms of Alzheimer’s disease are.

Alzheimer’s in old age

The most common clinical presentation is the loss of episodic memory, 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 speak of 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. The plaques are nothing more than peptide deposits that are formed 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. Their presence in the brain is also a predictor of neurocognitive disorder.

Alzheimer’s in Young Adulthood

About 4% of Alzheimer’s patients are diagnosed before the age of 65 . The most frequent form of Alzheimer’s in young age is not through memory loss, but through non-amnestic syndromes. For example, visuospatial dysfunctions, apraxia, anomie, 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 older analogues, these patients also have a greater number of senile plaques and neurofibrillary tangles . However, their location is different. In young adults who develop Alzheimer’s disease, the hippocampus is preserved and free from these deposits. We should remember that the hippocampus is a cardinal point in the acquisition and recovery of memory. This finding largely explains the difference in presentations, why in older people memory is affected early on and why in young people with Alzheimer’s this is rare.

Neuropathology shows that there is a higher density and a more diffuse distribution of the typical signs of Alzheimer’s. Structural studies of neuroimaging 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 state 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. The 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 Youth

In Alzheimer’s disease of old age, the disease occurs through the formation of natural deposits. The older the patient, the more likely it is that they will have so many deposits that their cognitive abilities will begin to worsen. Also, one’s lifestyle may or may not protect the formation of such deposits present in the disease.

However, in young normal patients does not give time for these deposits to form . No normal process justifies such density and pathological distribution in the brain. This is why many of the cases of Alzheimer’s that begin at an early age occur due to mutations in the 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 a particular gene or marker. Naturally, those who come from families with a strong history of Alzheimer’s at a young age can, if they wish, undergo a test where a marker can be found for the presence of such a genetic mutation or not and know whether they will develop the disease.

Treatment and prognosis

The treatment of Alzheimer’s in young people is the same as that prescribed for older people, with the advantage that they can carry out more therapeutic activities than the latter. It is very important to maintain the activities of daily living as long as possible and not to stop doing them because of being diagnosed. Autonomy and activities allow the individual to conserve their cognitive abilities for much longer and the decline is more gradual.

Cognitive stimulation through activities that utilize brain functions is a good protector against disease progression. It is impossible to get rid of it or stop it, so the goal is to preserve as much autonomy and quality of life as possible for as long as possible. It might be a good idea to make plans on how to manage life later when one becomes more dependent on others and is unable to take matters such as one’s finances, legal paperwork, will, or one’s own will into certain medical procedures that one might be subjected to later.

The prognosis of Alzheimer’s at an early age is unfavorable . These people deteriorate more rapidly 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 can still use and pull on as long as possible.