What Are The Risk Factors Associated With Young-Onset Dementia?

Young-onset dementia refers to cases of dementia where symptoms appear before age 65. Dementia is a disease that affects older adults, but in rare cases, younger people can be affected. The symptoms of young dementia vary somewhat from those of older-onset dementia, but the disease is still progressive and debilitating. To understand conditions causing this form of dementia, it may be helpful to explore the symptoms of both early—and late-onset dementia and examine the determinants associated with developing dementia while young. 

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Understanding dementia

Some confusion surrounding dementia’s labels may exist in popular society. The term “dementia” is no longer clinically used, being replaced by the diagnosis of major neurocognitive disorder (MND). Similarly, the term “Alzheimer’s” was once used to refer to nearly all types of dementia. While Alzheimer’s is the most common form of dementia, accounting for 70% to 80% of all cases, it does not encompass all forms of dementia. Today, Alzheimer’s disease is formally diagnosed as “major neurocognitive disorder due to Alzheimer’s.”

Despite shifts in naming conventions, the terms “early-onset dementia” and “early-onset Alzheimer’s” are commonly used synonymously. For example, the Alzheimer’s Association still refers to the dementia that appears in those younger than 65 as early-onset Alzheimer’s, even though the organization advocates for all types of dementia patients. Those searching for information on the condition may use the two terms interchangeably. 

Symptoms of late-onset (typical) dementia 

Dementia is a significant cognitive decline affecting a person’s ability to complete standard activities of daily living. Symptoms of cognitive decline may appear earlier, but a diagnosis of dementia may not be warranted until the person begins to require assistance completing typical everyday tasks. The most common and well-known symptom of dementia is memory loss, and trouble remembering people, places, or concepts is often one of the first indicators that a person may be experiencing a major neurocognitive disorder. 

Other common signs of dementia include: 

• Difficulty keeping track of everyday objects like a purse or wallet
• Difficulty handling money 
• Challenges with meal preparation and other multi-step tasks
• Difficulty organizing schedules and remembering appointments 
• Trouble retaining newly-learned information

Those with late-onset dementia typically live about three to eight years after diagnosis. Still, the length of time a person survives following a diagnosis depends heavily on how early they receive it and what level of support is available to them. Underlying medical conditions may also affect their life expectancy. Dementia symptoms are progressive, meaning they worsen over time. They are typically organized into early, middle, and late-stage symptoms. 

In the early stages of dementia, a person may be primarily independent and require little support. In the middle stage, typically the longest, a person often requires assistance from friends, family members, and professional caregivers. Some people can remain in their homes for most of the middle stage of dementia. In the late stage, a person with dementia is often completely dependent on others for support and may be referred to hospitalization or residential treatment. 

Symptoms of early-onset (younger) dementia

While the symptoms of young-onset and late-onset dementias overlap significantly, the two conditions have unique features that differentiate how a person’s cognition may decline. The most common feature of late-onset neurocognitive disorder, memory loss, is less pronounced in those with young-onset dementia. Memory problems may still occur and worsen as the disease progresses, but memory, especially the ability to create new memories, often remains intact for extended periods. 

Younger-onset dementia can occur in those in their 30s but is more common in someone’s 40s and 50s. This condition is organized into several subtypes that define the specific clinical (delete – ‘clinician’) features of the disease. While there are many subtypes, two of the most common can produce symptoms that are substantially different from what is seen in the types of dementia that affect older people.

• Logopenic variant primary progressive aphasia: This subtype is the most common form of dementia in those under age 65. Logopenic variant dementia is defined by substantial losses in a person’s ability to use language but slower declines in other areas of cognition. Those with this variant often struggle to find words, organize sentences, and understand what is said. 
• Posterior cortical atrophy: The second most common subtype of early-onset dementia is caused by Alzheimer's-type degradation of the occipital lobe, the part of the brain that processes visual information. Those with this variant often experience visuospatial problems such as difficulty reading, finding objects, navigating surroundings, getting dressed, and driving. 

Other, less common variants of younger-onset dementia can cause problems with behavioral regulation, decision-making, impulsivity, and executive function. As with other forms of the disease, memory tends to remain relatively intact compared to traditional dementia and Alzheimer’s. 

Other differences between early and late-onset dementia 

Other features that separate symptoms of younger-onset dementia and older-onset dementia often include:

• A more aggressive course with faster degradation than what is typical in older-onset dementia
• Significantly delayed diagnosis due to the rarity of younger-onset dementia
• Greater psychosocial problems due to younger people often having a higher number of responsibilities than those over age 65 
• Lower vascular risks (such as risk of stroke), but higher likelihood of past brain injury. 

Note that other conditions can cause cognitive decline prior to age 65, such as vascular problems, traumatic brain injury, or genetic mutations like cerebral autosomal dominant arteriopathy with subcortical artifacts and leukoencephalopathy (CADASIL). 

Dementia’s risk factors

While younger-onset and older-onset dementia don’t have the same exact determinants and can vary by the type of dementia one is diagnosed with, researchers believe that several of the same determinants that apply to older-onset dementia are also relevant to younger-onset dementia. Only one factor is known to be exclusive to younger-onset dementia alone: genetic predisposition. Those with a history of familial Alzheimer’s disease are significantly more likely to develop dementia early in life. 

Other factors that may contribute to the development of dementia while relatively young include: 

• Diagnosis of an alcohol use disorder (AUD): AUD is associated with significant brain damage. When combined with poor nutrition, AUD may harm brain cells in the hippocampus, making it more challenging to form new memories. 
• Social isolation: Researchers theorize that a lack of social interaction leads to under-stimulation of the brain, making it more difficult for the brain to stay healthy. 
• Not enough vitamin D: A lack of vitamin D, often obtained by exposure to sunlight, can lead to more viral infections. Evidence suggests that certain viral infections substantially increase the risk of dementia. 
• Hearing problems: Difficulty hearing can increase the risk of dementia due to reduced brain stimulation and potentially reduced social engagement. 

Based on the risk factors listed above, it may be possible to reduce the risk of developing dementia before age 65 by limiting alcohol consumption, socializing regularly, spending time in the sun or taking a vitamin D supplement, and using hearing aids if hearing problems develop. In addition, individuals may adhere to self-care principles for mental and physical health. Eating nutritious foods, exercising regularly, and getting enough sleep may significantly reduce the risk of developing dementia. 

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Seeking support from a therapist

Those diagnosed with dementia at a young age may experience a significant emotional burden, and their inner circle of friends and family may also be impacted. If your life has been affected by younger-onset dementia, you may consider reaching out to a therapist for help in managing the emotional challenges and stress that may arise. 

If you are experiencing barriers that limit your access to in-person services, you might also consider online therapy through a platform like BetterHelp. Online therapy allows clients to meet with their therapist from home or any location with an internet connection. In addition, online therapy is often cheaper than in-person options without insurance, potentially offering more diverse therapist to work with.  

Online therapists use the same evidence-based techniques as traditional therapists. They are qualified to support clients with the same issues that would bring someone to in-person therapy and receive the same training as in-person therapists. As the popularity of online treatment continues to increase, substantial research is being conducted to ensure that online techniques work as well as their in-person counterparts. The evidence suggests that, in most cases, online therapy is as effective as in-person therapy.