Taimur Zaman, MD

Alzheimer’s disease doesn’t always wait for old age. When it appears earlier, striking someone in mid-life, it can be especially devastating. The trouble is, the difference between ordinary memory lapses and something more serious isn’t always clear.

It’s that uncertainty that brings people in their 40s and 50s to the office of Taimur Zaman, MD, a neurologist with Jefferson Health in West Berlin.

“Younger professionals come in worried because their memory isn’t as sharp as it used to be,” says Zaman. “Most of the time it isn’t Alzheimer’s, but when it is, it’s a different disease than what we usually see in older adults.”

Early onset vs. early stage (they’re not the same)

Alzheimer’s disease is a progressive brain disorder that slowly destroys memory and thinking skills. When symptoms appear before age 65, it’s considered early onset – which is different from early-stage – dementia.

“People sometimes hear about early-stage dementia and think that means the same thing as early-onset dementia, but they’re very different,” says Richard Stefanacci, DO, Medical Director of Inspira Living Independently for Elders (LIFE).

“Early-stage dementia usually refers to the beginning stages of memory loss in older adults – the point when newer FDA-approved medications may be introduced to help slow progression,” he explains. “Early-onset dementia, on the other hand, has nothing to do with stage. It means symptoms are appearing decades earlier than expected, sometimes as early as the 30s or 40s.”

Richard Stefanacci, DO,

How it happens

Scientists don’t yet know exactly what causes Alzheimer’s. “We believe it’s an interplay of genetics, environment and lifestyle,” says Zaman. “With early onset, a small subset has a very strong genetic link. For the majority of cases, there isn’t much people could have done differently.”

Either way, Alzheimer’s is identified by the buildup of abnormal proteins in the brain, including amyloid plaques, that interfere with communication between brain cells and eventually cause cells to die, he says.

In older adults, those changes can unfold silently for years before symptoms appear. With early onset, the disease often moves faster, and symptoms may be different – sometimes showing up first as trouble with language, mood changes or even seizures rather than profound memory loss, says Zaman.

Finding out if you have it

Diagnosing Alzheimer’s in someone under 65 is far from straightforward. “If a 75-year-old comes in with memory loss and the family confirms it, Alzheimer’s is the number one diagnosis,” says Zaman. “But if a 40-year-old comes in with the same symptoms, the doctor is going to be much more careful. There are terrible consequences associated with that diagnosis, so we need a lot of evidence before we say it’s Alzheimer’s.”

That means ruling out other explanations first – everything from stress and sleep deprivation to stroke, head injury or metabolic problems, Zaman says. Only after that do specialists move to more advanced tests.

“We’ll do a brief office-based cognitive test, which takes about 15 minutes,” he adds. “If it’s abnormal, we can order imaging like an MRI or CT scan, along with blood work. And in some cases, we can use a PET scan or the new FDA-approved blood test to help confirm the diagnosis.”

Families sometimes assume that alarming changes like hallucinations or sudden personality shifts point to Alzheimer’s. That’s rarely the case.

“If a younger individual suddenly has those symptoms, 99% of the time it’s not dementia,” says Stefanacci. “That’s more likely a delirium, medication side effects or another serious neurologic issue. And at any age, that’s a medical emergency.”

Other types of dementia can, however, appear earlier in life and cause very different symptoms.

“With Lewy body dementia, people may have hallucinations, and with frontotemporal dementia, there can be dramatic behavioral changes,” explains Zaman. “Those conditions don’t involve the same amyloid plaques we see in Alzheimer’s, and the treatments are different. But they can also show up in younger adults.”

The toll on families

What makes early onset Alzheimer’s especially devastating is the timing. “When someone in their 40s or 50s develops dementia, the family structure can break down very quickly,” says Zaman. “They may still be raising teenagers, paying a mortgage, working full-time. If that person is the breadwinner and loses their job, the whole household is affected.”

The ripple effects are harsh. A spouse may suddenly have to cover household bills, care for children and become a full-time caregiver – all at once. And without the safety nets older patients often have, younger families face added strain.

“When a 75-year-old develops Alzheimer’s, they usually have Medicare, adult children who can pitch in and some savings,” Zaman explains. “But when it happens earlier, people may not have health insurance once they can’t work, and applying for disability can take months or even years. During that time, families are really left to struggle.”

Slowing the progressions

Treatment options for early and late onset are the same: medications that may slow the disease, not stop it.

“There are two IV therapies now approved that target amyloid deposits,” says Stefanacci. “They don’t reverse the disease, but they can delay its progression. That’s why getting diagnosed early is important.”

Other possibilities are on the horizon. “Some of the newer diabetes therapies are being studied even in people without diabetes to see if they help cognition,” Stefanacci adds. “The early results are encouraging, but we’ll need a few more years before we know.”

For families looking for options, he notes, clinical trials can offer both access to new therapies and faster evaluation than waiting months to see a specialist.

Even without new drugs, healthy habits can make a difference.

“Good sleep, controlling blood pressure, managing diabetes, exercising – those all impact cognition,” says Stefanacci. He emphasizes that it’s not just hours of sleep but the quality of deep, restorative rest that matters most.

Diagnosis is also becoming easier. Until recently, confirming Alzheimer’s required either a spinal tap or a PET scan with a tracer – procedures that were invasive and not always easy to access.

“Months ago, we didn’t have a blood test for Alzheimer’s,” says Stefanacci. “Now we do. Maybe this time next year we’ll have more effective treatments with fewer side effects. There’s reason to stay hopeful.”