Dementia: The ‘subtle indications’ of dementia that can emerge almost two decades before

Steve Thompson recalls signs of his early-onset dementia

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Research conducted by academics in Chicago in the US, found that a test of memory and thinking can reveal differences in people who go on to have Alzheimer’s disease (AD) up to 18 years before diagnosis. Based on these tests, a lower score on a cognitive test was associated with an 85 per cent greater risk of future dementia. It suggests that the development of AD could begin many years earlier than expected before symptoms are recognised.

Commenting on the study, Dr Doug Brown, director of research and development at Alzheimer’s Society, said: “Dementia often causes changes in the brain years before the symptoms become apparent.

“This study shows that there may be subtle indications of AD in thinking and memory as many as 18 years before a formal diagnosis could take place.

“This could mean there is a long window of opportunity for treatment in which we could one day halt or slow dementia.

“Although these tests cannot accurately predict who will develop dementia, they could potentially be used to identify people at higher risk.”

The report, which was published in Neurology journal in 2015, considered the results of 2,125 participants.

At the start of the process – in 1993 – none of the participants had clinical AD.

However, 442 of those people (or 21 percent) had developed the disease 18 years later.

The study explains: “Lower composite cognitive test scores were associated with the development of Alzheimer’s disease dementia over the duration of the study.

“These associations were consistently larger among European Americans than among African Americans.

“Performance on individual cognitive tests of episodic memory, executive function, and global cognition also significantly predicted the development of AD dementia, with associations exhibiting a similar trend over 18 years.”

It concludes: “Our findings suggest that cognitive impairment may manifest in the preclinical phase of AD dementia substantially earlier than previously established.”

“Our results indicate that performance on a brief cognitive battery and on the cognitive domains measured by individual tests in the battery differs substantially between those who will subsequently develop clinically evident AD dementia and those who will not up to 18 years before diagnosis in a biracial population sample.

“If, as widely hypothesised, evidence of AD dementia pathophysiology precedes cognitive impairment in preclinical AD dementia, these results imply a very long duration for the prodromal phase of clinical manifestation of AD dementia, one that may span decades.”

The Alzheimer’s Society lists common symptoms of dementia as:

  • Memory loss
  • Confusion and needing help with daily tasks
  • Problems with language and understanding
  • Changes in behaviour.

These will get “worse over time” and are different from “normal” signs of ageing.

It says: “When a person has dementia, this worsening in mental abilities is much more serious than the normal changes that people experience as they get older.

“The changes may be small to start with, but become more noticeable.

“For a health professional to diagnose dementia, a person’s symptoms must be significantly affecting their daily life.

“This means having difficulties with completing daily tasks about the house, in the community or at work.”

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