Recent research advances in young-onset dementia

Data-driven discovery of midlife cardiometabolic profile associated with incident early-onset and late-onset dementia

BACKGROUND

Cardiometabolic risk factors have been associated with the risk of late-onset dementia. However, evidence regarding early-onset dementia was inconsistent, and the impact of clustered cardiometabolic risk factors was unclear. We aimed to investigate the associations of cardiometabolic profiles with incident early-onset and late-onset dementia.

METHODS

Among 289 494 UK Biobank participants, cluster analysis was built on 12 common cardiometabolic markers. Analyses were performed on those aged <65 years at baseline (n = 249 870) for early-onset dementia and those ≥65 at the end of follow-up (n = 191 213) for late-onset dementia.

RESULTS

During a median follow-up of 14.1 years, 279 early-onset dementia cases and 3167 late-onset dementia cases were documented. Among the five clusters of cardiometabolic profiles identified (cluster 1 [obesity-dyslipidemia pattern], cluster 2 [high blood pressure pattern], cluster 3 [high liver enzymes pattern], cluster 4 [inflammation pattern] and cluster 5 [relatively healthy pattern]), cluster 3 was significantly associated with higher risks of both early-onset and late-onset dementia; however, the risk estimate for early-onset dementia (hazard ratio 2.58, 95% CI 1.61-4.14) was larger than that for late-onset dementia (1.36, 1.09-1.71). Cluster 4 was associated with a higher risk of late-onset dementia (hazard ratio 1.39, 95% CI 1.13-1.72). No significant interactions were observed between cardiometabolic clusters and apolipoprotein E ε4 genotype.

CONCLUSIONS

Cardiometabolic patterns characterised by relatively high liver enzyme levels or systemic inflammation were associated with increased risks of early-onset and late-onset dementia. Identification of high-risk subgroups according to distinct cardiometabolic patterns might help develop more precise strategies for dementia prevention regardless of apolipoprotein E (APOE) ε4 status.

Antarctic bryophyte Sanionia uncinata (HEDW.) Loeske, Amblystegiaceae, antimicrobial, antioxidant, cytotoxic, and acetylcholinesterase activities

Sanionia uncinata, or Sickle-leaved-Hook-moss, is a cosmopolitan pleurocarpous moss composing the Antarctic Peninsulae biodiversity, primordially forming dense mats over rocks. The species was collected in 24 different spots located at King George Island and was processed to obtain 24 ethanolic extracts (ADS#) by a serial-24h-maceration, which were prospected for antimicrobial, cytotoxic, antioxidant, and acetylcholinesterase (AChE) inhibition activities by using in vitro tests. Alien material was removed from the non-sterilized plant samples before being submitted for extraction. It was observed that extracts collected in different spots showed different biological activities. Extracts ADS04(10.66±0,17mm) and ADS14(11.37±0,11mm) were active against Staphylococcus aureus, according to the diffusion in bioautography assay. They showed significant antioxidant activity and inhibited AChE; the cytotoxicity observed to the human breast cancer cells MCF-7 and MDA-MB-231 were higher than in normal cell line MCF-10A. ADS04 was 7.62 times more cytotoxic to MCF-7, and ADS14 was 2.03 times more cytotoxic to MDA-MB-231 than to MCF-10A. The extracts showed similar cytotoxicity between PC-3, a human prostate cancer cell line, and MCF-10A. Sanionia uncinata extracts are a vital potential source of biologically active compounds, particularly ADS04 and ADS14, including further prospection on eventual bryophyte's endophytic fungi.

Neuropathological Heterogeneity of Dementia Due to Combined Pathology in Aged Patients: Clinicopathological Findings in the Vallecas Alzheimer's Reina Sofía Cohort

Background/Objectives: Clinicopathological research in late-life dementia has focused recently on combined neurodegenerative and vascular conditions underlying the high phenotypic heterogeneity of patients. The Vallecas Alzheimer's Reina Sofía (VARS) cohort (n > 550), and particularly the series of associated brain donations (VARSpath cohort) are presented here. The aim of this study is to contribute to research in dementia with a well-characterized cohort from a single center. Methods: A total of 167 patients with complete neuropathological work-ups were analyzed here. The cohort is characterized by a high female predominance (79%), advanced age at death (88 yrs.), and a high frequency of ApoE-e4 haplotype (43%). Results: The main neuropathological diagnosis was Alzheimer's disease (79.6%), followed by vascular dementia (10.2%) and Lewy body dementia (6%). Overall, intermediate-to-high cerebrovascular disease was observed in 38.9%, Lewy body pathology in 57.5%, LATE (TDP-43 pathology) in 70.7%, ARTAG in 53%, and argyrophilic grain disease in 12% of the patients. More than one pathology with a clinically relevant burden of disease was present in 71.1% of the brains, and a selection of premortem neuropsychological and functional scores showed significant correlation with the number of co-pathologies identified in postmortem brains. Conclusions: The VARS cohort, with thorough clinical follow-up, regular blood sampling, 3-Tesla MR, and a high rate of postmortem brain donation, can provide essential multidisciplinary data in the rising age of modifying therapies and biomarkers for Alzheimer's disease and related dementias.

Understanding Family Resilience in Young-Onset Dementia: A Multiple Case Study

AIM

Through the lens of family resilience, exploring the experiences of families in adapting to young-onset dementia.

DESIGN

Qualitative multiple case study.

METHODS

This study examined the family as a single unit of analysis, focusing on a triad including a person with young-onset dementia, their spouse and their adult child. Three family triads were included. Data collection took place between April 20 and July 4, 2023, in South Korea. Data analysis involved a two-stage process, consisting of a directed content analysis based on the family resilience framework within cases, followed by a cross-case analysis to identify themes and unique patterns across cases.

RESULTS

The study identified six key themes: (1) Stressors due to a young-onset dementia diagnosis, (2) perception of the young-onset dementia diagnosis, (3) degree of emotional connection, (4) coping approach to young-onset dementia, (5) availability and utilisation of external resources and (6) patterns of adaptation. Furthermore, our research uncovered the interplay between themes, and how adaptations patterns of families formed either resilient or non-resilient.

CONCLUSION

Our triadic approach uncovered hidden family dynamics, emphasising family-centred care. This study provides insights into unique challenges and diverse adaptation processes, suggesting tailored interventions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study emphasises the importance of family-centred care in young-onset dementia, recognising all family members as crucial clients. Also, we suggest that healthcare professionals should develop tailored treatment plans that reflect the unique needs of each family.

IMPACT

This study presents the unique experiences of young-onset dementia families, laying the foundation for developing effective support strategies that reflect these insights. Additionally, we emphasise the utilisation of external resources and their existence, providing a comprehensive research direction.

REPORTING METHOD

Our research follows the EQUATOR guidelines, specifically adhering to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Global burden of young-onset Alzheimer's disease and other dementias: a secondary analysis of the global burden of disease study, 2019

The aging of the world population has led to an increase in the epidemiology and burden of Alzheimer's disease and other dementias.

Objective

To describe the global burden of young-onset Alzheimer's disease and other dementias by world region and income through a secondary analysis of the Global Burden of Disease Study 2019.

Methods

This is a descriptive cross-sectional ecological study. Data by sex and five-year age groups from 40 to 64 years were extracted from the Global Burden of Disease Study results tool. We performed a descriptive analysis of prevalence, incidence, deaths, disability-adjusted life years, years of life lost, and years lived with disability.

Results

In 2019, young-onset Alzheimer's disease and other dementias presented a prevalence of 2.67 cases and an incidence of 0.44 per 1,000 inhabitants globally. It carried a significant burden, resulting in 1.16 disability-adjusted life years per 1,000 inhabitants, primarily due to years of life lost, and to a lesser extent due to years lived with disability. East Asia & the Pacific, Latin America & the Caribbean, and North America are the most affected regions. Burden rates are consistently higher among women; no gradient was observed by country income. Smoking was the most relevant risk factor, presenting a broad difference by country income level.

Conclusion

The global burden of young-onset Alzheimer's disease and other dementias may reshape healthcare requirements and the societal impact of dementias, and its understanding is relevant to inform decisions related to service offerings and research agendas.

Dementia in Australia: Clinical recommendations post-diagnosis

The delivery of a dementia diagnosis, the information provided, and the practical advice and support arranged can have a long-lasting impact on patients and their families and deserves attention equal to that given to the assessment and investigation process. Patients and their families need a constructive yet sensitive conversation about the nature and cause of their difficulties, communicated in plain language, and tailored to their main concerns and needs. This conversation should lead to the provision of high-quality, easily accessible information. Following this, clinicians may wish to consider broaching the following dementia topics: (1) pharmacological and non-pharmacological interventions, (2) connection and integration with relevant organisations, (3, 4) application for formal support services and engagement with support teams, (5) safety in the home, (6, 7) financial planning, guardianship and legal matters, (8) driving eligibility, (9) support and education resources to family carers and (10) research initiatives and genetic information. Addressing these topics will contribute to improved disease management, which is likely to improve the dementia journey for the patient, their carer(s), and family.

Navigating the Journey of Living with Young-Onset Dementia: Experiences of Spousal Caregivers

Background

Young-onset dementia (YOD) refers to dementia occurring before the age of 65, with Alzheimer's disease being the most common form, posing distinct challenges for spousal caregivers.

Objective

This study aims to investigate the unique experiences of spousal caregivers of persons with YOD in China, where dementia-specific community care services and primary healthcare professionals are relatively lacking, in order to inform the tailored support services development.

Methods

This qualitative-design study utilized semi-structured interviews with 11 spousal caregivers of persons with YOD dwelling in the community. Traditional content analysis was employed to analyze the interview data.

Results

Limited dementia-specific healthcare professionals and low public awareness made diagnosing and accepting YOD a prolonged and challenging journey. Spousal caregivers faced skepticism when seeking diagnosis, exacerbating their burden and emotional stress. Disparities in healthcare professionals and insufficient collaboration between institutions worsened the situation. YOD significantly impacted family dynamics and led to changes in emotional communication within the family. The stigma surrounding YOD raised concerns among spousal caregivers about their children's future in marriage and career, emphasizing genetic risks.

Conclusions

In settings where dementia-specific community care services and primary healthcare professionals are limited and unevenly distributed, integrating support services at both the primary and community levels is crucial for families dealing with YOD in the community. Additionally, raising public awareness about YOD can foster a more understanding and supportive environment, addressing challenges related to stigma faced by affected families, contributing to increased investment in supporting resources, and encouraging individuals to seek help early on.

Interventions for Persons with Young-Onset Dementia and Their Families: A Scoping Review

Background

Dementia occurring before age 65 is known as young-onset dementia (YOD), with Alzheimer's disease being the most common type. YOD poses unique challenges for persons and families, impacting their working-age years and family responsibilities. Person-centered interventions and services are essential to improve their quality of life and social engagement.

Objective

This study aims to synthesize non-pharmacological interventions for persons with YOD and their families to inform future targeted interventions.

Methods

We conducted a systematic literature search across four databases: PubMed, PsycINFO, Scopus, and CINAHL. The included articles were carefully screened, categorized, and synthesized by following Arksey and O'Malley's five stages framework.

Results

We included 20 studies reported in 24 papers, with 11 studies (14 papers) on persons with YOD and nine studies (10 papers) on families. Quantitative intervention results vary, but qualitative interviews show positive feedback. Stakeholders provided positive evaluations, stating these interventions provided a sense of normalcy, facilitated communication among families, enhanced the independence of persons with YOD, and improved the families' caregiving self-efficacy, thereby reducing care burden and psychological distress. The heterogeneity among the studies posed integration challenges.

Conclusions

Interventions for YOD can improve the quality of life for both persons with YOD and their families. More extensive intervention studies are urgently needed, especially in developing countries, with a focus on family-centered and life course perspectives. In future intervention research design, a more extensive incorporation of stakeholder involvement is essential for successful implementation. Moreover, the integration of new technologies shows promise as a potential avenue for intervention advancement.

Incidence of young-onset dementia in Italy: The Brescia register study

INTRODUCTION

The goal of the present work was to assess the incidence of dementia with onset before the age of 65 years (i.e., young-onset dementia [YOD]) and define the frequencies of young-onset Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD), and dementia with Lewy bodies (DLB) in the general population.

METHODS

The study was conducted from January 1, 2019 to December 31, 2019 in Brescia province (population: 1,268,455). During the study period, all new YOD cases (incident YOD) were counted, and all patients' records reviewed. The incidence was standardized to the Italian general population in 2019.

RESULTS

A total of 29 YOD patients were diagnosed. The age-sex standardized incidence rate was 4.58 (95% confidence interval, 3.07-6.58) per 100,000 person-years. No difference in incidence rate between YOD due to AD or FTLD (P = 0.83) and between sexes (P = 0.81) was observed. YOD incidence increased with age, reaching its peak after 60 years.

DISCUSSION

Presenting neurodegenerative YOD phenotypes encompasses both AD and FTLD. Improved knowledge on YOD epidemiology is essential to adequately plan and organize health services.