Young onset dementia

Abstract

Young onset dementia (YOD), where symptoms of dementia have an onset before the age of 65, has become more prominent due to the population increase from the Baby Boomer generation. This clinical perspective examines key issues in the assessment, diagnosis and management of YOD. Challenges in the assessment and diagnosis of YOD are partly due to the diverse range of types of YOD, where degenerative dementias are less common and secondary dementias more common than in late onset dementia. Early symptoms are broad and include depression, behavioural change, neurological disorders, systemic disorders and mild cognitive impairment (MCI). Perceived diagnostic delay may result in frustration and distress in people with YOD and their families. Chronic depression and MCI are associated with longer time to diagnosis, and in these situations, clinicians need to establish appropriate review processes and communicate clearly. A diagnosis of YOD may have marked consequences for a younger person, including early retirement, financial impacts and the psychological challenge of coming to grips with cognitive decline. Partners, children and other supporters often have unmet needs, feel burdened by care and are at high risk of physical and emotional consequences. Concerns about the heritability of dementia may add to family distress. Recent community service developments in Australia for YOD are outlined and the challenges of residential care described.

An Australian community jury to consider case‐finding for dementia: Differences between informed community preferences and general practice guidelines

“…However, there are also limitations. Lowering the age range in the RACGP guidelines from 65 to 50 years, which reflects current diagnostic concerns of younger‐onset dementia and aligns with other screening health practices in Australia, may be a limitation because it does not reflect current guideline recommendations. However, although the jurors initially thought this age “too young” their final recommendations to the RACGP included eliminating the age criterion altogether.…”

“…Our primary outcome was community juror recommendation for the question, “Should the health system encourage GPs to practice “case‐finding” of dementia in people older than 50?” We deliberately lowered the age range from the guidelines to over 50 years to reflect both Australian public experiences of other health practices such as cancer screening programmes (eg, government sponsored bowel and breast cancer screening commence at age 50 in Australia), and bone density checks, etc. that heighten awareness of individual health concerns, and to reflect that younger‐onset dementia (although rare) is increasingly recognized as a potential problem confronting practitioners . We also assessed changes in participant comprehension/knowledge of dementia, attitudes towards dementia, whether they had engaged in an informed decision, and explored consistency of participant's own intentions to test for dementia.…”

Psychotropic drug use in community-dwelling people with young-onset dementia: two-year course and determinants

“…Depression or depressive symptoms are common in people with young-onset dementia, with prevalence rates of 65%, and sometimes they are one of the earliest symptoms of dementia (Draper & Withall, 2016;Rosness, Barca, & Engedal, 2010). This likely explains why approximately one in three people used antidepressants at baseline.…”

An Overview of Primary Dementias as Clinicopathological Entities

“…7 Primary dementias which present as RPDs are more likely to be young onset and often have long tract signs, white matter changes, myoclonus, and behavioral changes. 20 For Alzheimer-related RPDs, the presence of amyloid pathology in cerebrospinal fluid (CSF) or on positron-emission tomography (PET) imaging can help establish the diagnosis, especially in the younger patients. For Lewy body disease, a careful history, evidence of neuroleptic sensitivity, and in some cases dopamine transporter imaging will help.…”