Bollywood’s latest film ‘Saiyaara’, a love story between a 22-year-old girl battling early onset Alzheimer’s and an aspiring musician, may have hit the right emotional chords but its depiction of the neurodegenerative brain disorder is far from reality. Neurologists say early onset generally doesn’t happen before 40 and definitive symptoms hardly manifest in a patient in their 20s and 30s.
“Alzheimer’s Disease in your 20s is an extremely rare disorder, so rare that there may be a handful of cases in the world. Existing medical literature has nothing by way of Alzheimer’s in the 20s and shows early onset to be mostly occurring in people in their 40s. A majority of Alzheimer’s patients are 65-plus,” says Dr Shivakumar R, head and senior consultant, neurology, Manipal Hospital, Bengaluru. So the film’s depiction of early onset of Alzheimer’s is far removed from evidence-based science.
What is Alzheimer’s Disease?
It is a neuro-degenerative brain disorder that slowly destroys memory and thinking skills, and finally the ability to carry out even the simplest tasks and body functions. “It happens because of clustering of a protein called beta-amyloid, which accumulates outside of nerve cells or neurons. Then there are tangles or twisted fibres of a protein called tau, which accumulates inside neurons. These disrupt normal brain function, leading to cell death and brain shrinkage,” says Dr Shivakumar. Almost everyone develops plaques and tangles as they age. But those with Alzheimer’s Disease develop much more.
One third of all neuro-degenerative conditions happen to be young-age Alzheimer’s, according to Dr PN Renjen, senior neurologist at Apollo Hospital, Delhi.
What triggers early or young onset Alzheimer’s?
That happens when you have a strong family history of the disease-causing gene, which means it has affected family members in multiple generations. “A person can have early onset when they inherit the gene mutations from their parents. People living with Down’s syndrome also carry the risk and may manifest Alzheimer’s symptoms 10 to 20 years younger than the general population,” says Dr Shivakumar.
What are the symptoms of early-onset Alzheimer disease?
They tend to be atypical, ranging between headaches, aggressive behaviour, gait abnormalities and difficulty swallowing, not so much memory problems. “Trouble solving basic problems, such as keeping track of bills, losing track of the date or time of year, repetitive questioning, difficulty finding words, disorientation, mood disorders and behavioural oddities are also potential early signs,” says Dr Renjen.
How is early onset Alzheimer’s diagnosed?
Since doctors generally don’t look for Alzheimer’s in younger people, an accurate diagnosis may take a long time and appear confusing. “Symptoms may be incorrectly attributed to stress or mental health conditions. Besides, there could be conflicting diagnoses by different doctors. Also, the disease affects each person differently and symptoms will vary accordingly,” says Dr Renjen.
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The current diagnosis of early-onset Alzheimer disease depends on finding quite a few signs of mental decline. Then there could be cognitive tests recommended by the neuropsychologist. Tests of blood, urine and spinal fluid are followed by imaging tests such as CT and MRI scans of your brain. “Now studies are on to identify biomarkers, like proteins or other markers, that can indicate the presence of a disease,” says Dr Renjen.
A study published in Neurology suggests that beta-amyloid plaques can start accumulating in the brain as early as the 20s. This accumulation may not immediately cause noticeable symptoms but could indicate an increased risk for later-onset Alzheimer’s.
How is early-onset Alzheimer disease treated?
There is no cure but early detection means the neurologist can suggest medication to slow down disease progression. Diet, exercise, sleep, cardiovascular and diabetes treatments, antioxidants, and cognitive training are supportive therapies.
The average life expectancy after early onset diagnosis is around eight to 10 years but this can go up, depending on individual factors and the progression of the disease.
