It is the memory-robbing disease that people fear the most as they age – and it is even more tragic when it strikes early.
One of those affected is Birds Of A Feather star Pauline Quirke, 65, whose husband revealed this week that she had been diagnosed with young-onset dementia in 2021 and would now be retiring from her TV work.
And the actress is far from alone. The majority of people with dementia are diagnosed after the age of 65, beyond which point the risk of developing the disease then roughly doubles every five years.
But official figures suggest the number of people who start having symptoms far earlier, like Pauline, is increasing.
The charity Dementia UK estimates there are more than 70,800 people under the age of 65 living with young onset disease, a rise of 69 per cent since 2014.
A more recent report last year in The Lancet suggests the number of people being diagnosed globally with a form of early-onset dementia is ‘accelerating’.
It found, particularly in high-income countries, that the number of people under 65 with the disease has more than doubled in the past 30 years.
The cause is, for around one per cent of people, linked to inheriting rare genes. Carrying just one APP, PSEN1 or PSEN2 gene makes developing Alzheimer’s before the age of 65 very likely.
One of those affected is Birds Of A Feather star Pauline Quirke, 65
Other genes increase the risk: for example, carrying one copy of the APOE4 gene doubles or triples the chance of Alzheimer’s, and makes it more likely it will develop seven to ten years earlier than for most other people.
But scientists have uncovered an array of other modifiable risk factors which are linked to the way we live our lives.
The Lancet Commission report published last year revealed a list of 14 issues which have either a direct or indirect effect on the brain and can contribute to your own risk of the disease.
It isn’t clear yet whether some of these are more important than others when it comes to the early development of dementia.
Experts say, however, that it is ‘logical’ that the earlier you are exposed to these risk factors – and the longer you are affected by them – the greater the accumulation of damage to the brain, and the earlier you could end up with dementia symptoms.
‘If you develop, say, type 2 diabetes and hypertension earlier in life and don’t manage it, you’ll cause damage to your heart and to the vascular system that feeds your brain sooner,’ Robert Howard, professor of old age psychiatry at University College London, says.
‘That could well contribute to getting vascular dementia earlier, and may drive the processes which cause Alzheimer’s. But it’s a complex disease, with lots of possible risk factors working together – there’s no one thing that causes you to develop it earlier in life.’
Crucially, tackling these risk factors means you can reduce your risk.
Pauline’s husband Steve Sheen revealed this week that she had been diagnosed with young-onset dementia in 2021 and would now be retiring from her TV work
Dr Scott Chiesa, at University College London’s Institute of Cardiovascular Science, adds: ‘We think there’s a very good chance that reducing exposure to risk factors can have an impact on dementia – whether that’s early disease or making it less likely you’ll develop it later on.’
So could you be at risk of young onset disease – and, if so, what can you do about it? Here is what you need to know…
Still smoke? It’s never too late to quit
Around two per cent of all dementia cases may be linked to smoking – and it may particularly contribute to younger onset dementia in men, research has found.
But kicking the habit can eliminate that risk.
One big study of millions of people found that while smokers have a 30 per cent increased risk of dementia, former smokers do not. It means it’s never too late to quit.
Even those who kick the habit at 60 can expect to gain an extra three years of life expectancy.
Get help if you have a problem with alcohol
The research is clear: drinking more than 21 units a week is associated with an 18 per cent increased risk of dementia, and a lower volume of grey matter in the brain, compared with people drinking fewer than 14 units.
But the biggest risk for early-onset disease is having an alcohol use disorder – being dependent on alcohol, or being unable to stop drinking when you start.
A study published in the Journal of the American Medical Association (JAMA), one of the first to look specifically at risk factors for young-onset dementia, ironically found that those drinking heavily or moderately were less likely to develop dementia early than those who didn’t drink at all, or who had a diagnosed dependence on alcohol.
That’s because people who have stopped drinking may have had a problem with alcohol in the past – and those still drinking moderately are also generally still socialising, which can help stave off the disease.
So if you do believe you have a problem with alcohol, speak to your GP or contact Alcoholics Anonymous for advice and support.
Regardless of how much you drink, cutting down may reverse your risk. In studies, most people who chose to skip a few glasses a week improved their cognition – even if they were having problems with their thinking and memory – and reduced their overall risk of dementia later on.
Meet up with friends (or enemies)
Social contact – whether that’s a coffee with a friend or just a trip to the shops – is very important for keeping the brain engaged and active.
The JAMA study found those who only visited friends or family once a month or less were much more likely to have early-onset dementia compared to those who were in touch more often.
Overall, research shows people who are isolated increase their risk of dementia by 60 per cent. Being unmarried, or widowed, is also known to be a significant factor.
The reasons are unclear, but it is thought to be linked to the brain being less stimulated, which means it is less resilient to ageing.
But getting involved in social activities of any sort may help. You don’t even have to like who you’re with – any human contact is protective.
If you struggle with your hearing, wear a hearing aid
Younger adults are less likely to need a hearing aid – but if your hearing does get worse, make sure you get it tested.
For every 10dB drop in hearing ability, our dementia risk increases by up to 24 per cent.
And hearing loss may be even more closely related to early onset dementia than later-life dementia, some studies suggest.
It’s unclear why, but scientists believe it deprives the brain of crucial sensory stimulation and makes us less sociable and more isolated. Studies show the brain gets smaller in the temporal lobes – which are related to memory – if hearing loss isn’t corrected.
New research suggests using hearing aids reduces the risk of cognitive decline by 19 per cent and dementia by 17 per cent.
Most high street opticians and pharmacies offer hearing tests – and they’re usually free.
Get help if you’re depressed
Depression is a risk factor for dementia at any age – but it may be even more closely related to young onset dementia, research has found.
The good news is that treating it will reduce that risk.
One big UK study found those who took antidepressants or had therapy were around a quarter less likely to develop dementia than those who didn’t treat it. The effects are even greater – a 38 per cent reduction in risk – for those who had both.
Lose those extra pounds, especially if you’re a woman
Nearly two-thirds of adults in the UK are overweight or obese and the overwhelming evidence shows excess weight increases your risk of dementia.
A recent Lancet report suggested having a high BMI was a big factor driving rates of early-onset disease, particularly for women.
But you don’t need to lose significant amounts of weight to reap the benefits – studies show even losing 2kg is enough to see an improvement in your thinking six months later.
There are early signs, too, that weight-loss jabs such as Wegovy may also improve cognitive impairment and reduce dementia risk.
Keep blood pressure low
One in ten people in the UK are estimated to be living with type 2 diabetes, with one million unaware they’re at risk.
The condition is caused by excess body fat which drives up sugar levels in the blood, leading to damage to the tiny network of blood vessels in the brain.
The earlier you develop it, the more damage it causes and the higher your risk of dementia – and some research suggests having high blood sugar particularly a risk for young-onset dementia if you’re a man.
It isn’t clear if treatment can reduce your risk once you have diabetes. One recent study did find people with diabetes who took Ozempic saw their risk of Alzheimer’s reduce by between 40 and 70 per cent compared to those taking other anti-diabetic medication.
But the best way to protect yourself is to maintain a healthy weight and avoid type 2 in the first place.
Get your blood pressure checked
One in three people in the UK have high blood pressure – and around half of them don’t even know it because it has no symptoms.
But it can cause heart attacks and strokes and can damage the tiny blood vessels which supply the brain – making it a risk for dementia.
Large research studies have shown that if it’s high in midlife –between 40 and 65 – your risk of dementia rises significantly.
But reviews of the evidence have found blood pressure lowering drugs reduce the risk of both dementia and cognitive impairment.
Aim to keep your systolic blood pressure – the top of two readings – below 130mmHg from age 40 onwards.
Reduce your cholesterol
Around seven per cent of dementia cases are thought to be linked to high cholesterol – and some studies have found high levels of ‘bad’ cholesterol, known as LDL, are linked with young onset Alzheimer’s disease.
Over 30 million adults have the condition, which causes fat to build up in the blood and arteries and often goes undiagnosed because it has no symptoms.
It is linked with some of our deadliest diseases – heart attacks, strokes and, it was announced last year, dementia.
But it is easy to resolve. A healthy, balanced diet with fewer saturated fats can help, as can exercise. If this fails, statins are highly effective at reducing cholesterol.
This will reduce your risk of heart disease as well as dementia.
Ask your GP for a cholesterol test and repeat it at least once a year.
Stay active
What’s good for the heart is good for the brain, experts say. And any form of exercise can reduce your risk of dementia by 20 per cent – while also improving blood flow, reducing blood pressure, reducing inflammation and even enhancing our brain’s plasticity.
Even small amounts count, whether it’s walking, gardening or swimming. But doing it outside may be even more beneficial as studies have linked low levels of vitamin D – the ‘sunshine’ vitamin which our bodies create from UV light on our skin – has been associated with an increased risk of young onset dementia.
Evidence suggests the reduction in risk is greatest for people who don’t exercise but who start doing some.
There may even be an effect which is specific to dementia and not just related to heart health. Early studies suggest irisin, a molecule released during exercise, may protect our brains.
Avoid busy roads
The more you are exposed to air pollution – such as traffic fumes and smoke from wood burning stoves – the higher your risk will be.
There’s evidence that the tiny particles they contain can enter the brain, but it’s still unclear how much is too much.
There is some speculation that magnetite, a form of iron which is released into the air by burning fuel, might be involved in the development of Alzheimer’s.
Anti-pollution masks, worn by some cyclists, won’t have much of an effect unless they’re tight-fitting. But walking on side streets rather than the main road will make a huge difference.
Air quality maps online can tell you which streets are the most polluted.
Cycling? Wear a helmet
Even mild knocks to the head can be deadly many decades later.
A UK study just last month found sports-related concussions could make people more prone to neurological diseases including dementia.
But any bash to the head from a fall to a car accident increases the risk of dementia. And that effect builds up. The more knocks you have, the worse your risk.
One Scottish study found former football players were more than three times at risk, and it was highest for defenders who tend to head the ball more.
Former England and West Bromwich Albion footballer Jeff Astle developed dementia in his mid-forties and died in 2002 at the age of 59.
So the advice is to wear a helmet while cycling and avoid heading footballs.
Sort out your vision
Struggling with your vision is linked with dementia.
Those who fail to correct their vision in later mid-life increase their risk of dementia by 47 per cent, studies have shown.
The evidence suggests those who have cataracts removed – a simple operation to replace the cloudy lens of the eye with an artificial one – significantly reduce their risk of the brain disease compared to those who did not.
And while it’s unclear whether updating your glasses prescription makes a difference, experts say it makes logical sense to do so.
