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Characteristics of the initial symptoms of Alzheimer's disease in young patients

​Researchers from BioMaps (SHFJ) and the Department of Memory and Language Neurology (Ste Anne's Hospital) studied the early clinical signs of Alzheimer's disease (AD) reported by young patients (< 62 years old) compared to those reported in classic AD of the elderly (> 65 years old). They show that these signs are misleading and often appear in the professional context, pointing to the need to improve the early diagnosis of young AD in the workplace.

Published on 10 June 2021

Two main clinical features differentiate early-onset Alzheimer's disease (AD) from late-onset AD: the frequency of atypical phenotypes and the rapidity of clinical decline. Young AD is defined by an age of onset before 65 years. In this study, the authors sought to retrospectively characterize the initial complaint (onset of the first symptoms) and course of care of young AD patients, with or without work activity, and to compare their neuropsychological profiles at the time of diagnosis with those of elderly patients. In order to take into account the age of retirement, they focused their work on patients under 62 years old.

When the initial main complaint did not correspond to cognitive neurological symptoms such as language or memory disorders, the diagnosis made was that of burnout leading to psychiatric follow-up and this atypical profile was observed in 32% of young ADs in the cohort. Thus, in young subjects, the use of a psychiatrist before the neurological consultation was more frequent than in elderly subjects.
Regarding the other "classic" inaugural symptoms, the initial cognitive complaint in young AD subjects differed from that of elderly subjects by a lesser predominance of memory deficits (38% versus 87%) and a greater frequency of cortical symptoms (language, visuo-spatial functions, behavior).
The diagnosis of young AD was made more than 2 years after the first symptoms and at a more severe stage than in elderly patients.

In conclusion, the inaugural clinical signs of young AD can be misleading and are often identified in the professional context.
The researchers hypothesize an early dysfunction of the parietal-frontal networks responsible for a deficit of the working memory at the origin of a pseudo-burnout. Several studies have indeed demonstrated a preferential lesional involvement of the parietal cortex in young AD compared to old AD. A training effort for health and information professionals is absolutely necessary in order to improve the diagnosis of early-onset AD and allow patients to have access to specialized care and the possibility of being included in therapeutic trials.

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