Tag: Harvard Health Letter

If you’re in your 80s or 70s and you’ve noticed that you’re having some memory loss, it might be reasonable to be concerned that you could be developing Alzheimer’s disease or another form of dementia. But what if you’re in your 60s, 50s, or 40s… surely those ages would be too young for Alzheimer’s disease or dementia, right?

About 10% of Alzheimer’s disease is young onset, starting before age 65

Not necessarily. Of the more that 55 million people living with dementia worldwide, approximately 60% to 70% of them have Alzheimer’s disease. And of those 33 to 38.5 million people with Alzheimer’s disease, memory loss or other symptoms began before age 65 in 10% of them. Alzheimer’s is, in fact, the most common cause of young onset dementia. A recent study from the Netherlands found that of those with a known classification of their young onset dementia, 55% had Alzheimer’s disease, 11% vascular dementia, 3% frontotemporal dementia, 3% Parkinson’s disease dementia, 2% dementia with Lewy bodies, and 2% primary progressive aphasia.

Young onset dementia is uncommon

To be clear, young onset dementia (by definition starting prior to age 65, and sometimes called early onset dementia) is uncommon. One study in Norway found that young onset dementia occurred in 163 out of every 100,000 individuals; that’s in less than 0.5% of the population. So, if you’re younger than 65 and you’ve noticed some trouble with your memory, you have a 99.5% chance of there being a cause other than dementia. (Whew!)

There are a few exceptions to this statement. Because they have an extra copy of the chromosome that carries the gene for the amyloid found in Alzheimer’s plaques, more than half of people with Down syndrome develop Alzheimer’s disease, typically in their 40s and 50s. Other genetic abnormalities that run in families can also cause Alzheimer’s disease to start in people’s 50s, 40s, or even 30s — but you would know if you are at risk because one of your parents would have had young onset Alzheimer’s disease.

How does young onset Alzheimer’s disease differ from late onset disease?

The first thing that should be clearly stated is that, just as no two people are the same, no two individuals with Alzheimer’s disease show the same symptoms, even if the disease started at the same age. Nevertheless, there are some differences between young onset and late onset Alzheimer’s disease.

People with typical, late onset Alzheimer’s disease starting at age 65 or older show the combination of changes in thinking and memory due to Alzheimer’s disease plus those changes that are part of normal aging. The parts of the brain that change the most in normal aging are the frontal lobes. The frontal lobes are responsible for many different cognitive functions, including working memory — the ability to keep information in one’s head and manipulate it — and insight into the problems that one is having.

This means that, in relation to cognitive function, people with young onset Alzheimer’s disease may show relatively isolated problems with their episodic memory — the ability to form new memories to remember the recent episodes of their lives. People with late onset Alzheimer’s disease show problems with episodic memory, working memory, and insight. So, you would imagine that life is tougher for those with late onset Alzheimer’s disease, right?

Depression and anxiety are more common in young onset Alzheimer’s disease

People with late onset Alzheimer’s disease do show more impairment, on average, in their cognition and daily function than those with young onset Alzheimer’s disease, at least when the disease starts. However, because their insight is also impaired, those with late onset disease don’t notice these difficulties that much. Most of my patients with late onset Alzheimer’s disease will tell me either that their memory problems are quite mild, or that they don’t have any memory problems at all!

By contrast, because they have more insight, patients with young onset Alzheimer’s disease are often depressed about their situation and anxious about the future, a finding that was recently confirmed by a group of researchers in Canada. And as if having Alzheimer’s disease at a young age wasn’t enough to cause depression and anxiety, recent evidence suggests that in those with young onset Alzheimer’s disease, the pathology progresses more quickly.

Another tragic aspect of young onset Alzheimer’s disease is that, by affecting individuals in the prime of life, it tends to disrupt families more than late onset disease. Teenage and young adult children are no longer able to look to their parent for guidance. Individuals who may be caring for children in the home now need to care for their spouse as well — perhaps in addition to caring for an aging parent and working a full-time job.

What should you do if you’re younger than 65 and having memory problems?

As I’ve discussed, if you’re younger than 65 and you’re having memory problems, it’s very unlikely to be Alzheimer’s disease. But if it is, there are resources available from the National Institute on Aging that can help.

What else could be causing memory problems at a young age? The most common cause of memory problems below age 65 is poor sleep. Other causes of young onset memory problems include perimenopause, medication side effects, depression, anxiety, illegal drugs, alcohol, cannabis, head injuries, vitamin deficiencies, thyroid disorders, chemotherapy, strokes, and other neurological disorders.

Here are some things that everyone at any age can do to improve their memory and reduce their risk of dementia:

All of us can lower the odds of unintentional shootings.

Guns hurt and kill; it’s a simple fact. And while most gun injuries and deaths are the result of an assault or suicide, unintentional injuries happen all the time, including to children and between them. In the six-year span between January 1, 2015, and December 31, 2020, there were at least 2,070 unintentional shootings by children under 18 years old, resulting in 765 deaths and 1,366 injuries, according to Everytown Research and Policy.

If you’re a parent — or even if you’re not — you can help reduce the odds of an accidental shooting in several ways.

Why is it important to talk about gun safety with children?

Children are naturally curious, and guns are ubiquitous in the media and video games that children see all the time. Many don’t really understand how dangerous guns can be, and most don’t know how to tell if a gun is loaded.

According to the Pew Research Center, three in 10 in Americans own a gun, and four in 10 live in a household with one. So it’s not surprising that 34% of children in the US live in a home with at least one firearm. While it is recommended that guns be stored locked, with ammunition locked separately, less than half of US families with both children and guns actually do this.

What steps can parents take around gun safety?

If you have a gun and you have a child in your home, please lock up the gun, and lock up the ammunition separately. And make sure that your child doesn’t know how to unlock either or both. Children know more than most adults realize.

If your child plays at the homes of other children, you need to think — and ask — about gun safety. Many people feel uncomfortable asking; they worry that asking could be seen as an invasion of privacy, or as being judgmental. But it’s not either one. It’s simple safety.

The best way to do it is to make it routine, and make it part of other questions you should ask before sending your child to someone else’s home. You might say: “Hey, I have some questions I always ask before sending my child somewhere, just being safe.” Then, you could ask things like:

• “Who will be home with them, and how do you handle supervision?”
• “Do you have a pool?” (If yes, more questions about safety and supervision are important.)
• “Does anybody smoke?” (This is particularly important if your child has asthma or other breathing issues.)
• “Do you have pets?” (This is important for allergies, if your child is afraid of animals, and to find out if there are any animals that might be aggressive.)
• “Does anyone have allergies?” (So that your child doesn’t bring any foods that might cause problems.)

There may be other questions you ask based on your situation. As for guns, the question you should ask is:

• “Do you have an unlocked gun in your home?”

If the answer is yes, you have options. You can either ask them to please lock it up (and ask more questions about supervision), or if you’re not sure the family can or will lock it up, say, “I am so sorry, but I won’t be able to send my child to your home.” Be matter-of-fact and pleasant. If it’s a playdate, you can offer to have it at your home, or to take the children somewhere else like a local park.

They may be surprised or offended, sure. But that’s a risk worth taking to protect your child’s safety, and maybe even their life.

An ad for a new eczema drug leaves some questions unanswered.

Dry, itchy, reddened skin is the hallmark of eczema. If you have eczema and have seen this ad, you may be wondering about Dupixent (dupilumab). Does this new medicine work as well as it seems to in the ad? Where does the ad hit the mark, and where could it do better?

The medicine only treats one type of eczema

While the ad uses “eczema” and “atopic dermatitis” interchangeably, these conditions aren’t exactly the same. Eczema is an umbrella term that includes:

• atopic dermatitis, which develops in people prone to asthma and environmental allergies, such as hay fever
• contact dermatitis, which is an allergic reaction to a substance touching the skin, such as soaps, scented products, or poison ivy
• skin inflammation that accompanies leg swelling.

Atopic dermatitis is the only skin condition for which Dupixent is approved.

The pitch

Every ad is a sales pitch, whether it uses real people or paid actors. Here we see real people banging on drums in a band, playing piano or trombone, and baking in the kitchen. A voiceover says “With less eczema, you can show more skin. So, roll up those sleeves and help heal your skin from within with Dupixent.” The pitch? People with eczema may be embarrassed by it and try to hide it — and effective treatment means you need not keep your skin covered.

We next hear this is “the first treatment of its kind that continuously treats moderate to severe eczema, or atopic dermatitis, even between flare-ups.” The viewer sees an outstretched arm with a red rash that clears up over a second or two. Of course, that’s not what happens in real life; it can take weeks to see improvement.

More perplexingly, the voiceover tells us that the drug “…is a biologic, and not a cream or steroid.” Perhaps you’re wondering what a “biologic” medicine is. Hold that question for further explanation below. “Many people taking Dupixent saw clear or almost clear skin and had significantly less itch. That’s a difference you can feel.“

Side effects, warnings, and a tagline

The warnings may raise eyebrows. “Don’t use if you’re allergic to Dupixent. Serious allergic reactions can occur, including anaphylaxis, which is severe. Tell your doctor about new or worsening eye problems such as eye pain or vision changes, or parasitic infection. If you take asthma medicines, don’t change or stop them without talking to your doctor.“

Quickly, though, the ad moves on to a glowing tagline: “So help heal your skin from within” and recommends talking to “your eczema specialist” about Dupixent. That may be difficult: most people with eczema see their primary care physician for it, not a dermatologist.

What the ad gets right

It’s true that people with eczema may try to hide it and that effective therapy may be liberating, allowing them to worry less about others seeing their skin. Dupixent is, indeed, neither a cream nor a steroid, which are older, common treatments for eczema. And, yes, Dupixent is the first treatment of its kind for eczema. It blocks a chemical called interleukin 4 (IL-4), which is thought to play an important role in this skin disease.

What else should you consider if you have atopic dermatitis?

• How is it usually treated? Mild cases of atopic dermatitis may respond to skin moisturizers or medicated creams, gels, or ointments, some of which contain steroids. But this may not be effective for more severe eczema.
• What’s a biologic? These medicines are made in a living system such as a microorganism, human or animal cells, or plant cells. They are often antibodies that block a substance in the body thought to cause or contribute to a disease. Because biologics are usually large molecules that would be destroyed during digestion if taken in pill form, they are generally available only by injection. Dupixent is injected every two weeks.
• Why are eye problems, parasites, and asthma mentioned in the warnings? Eye inflammation was a side effect of the medicine in studies leading to approval. IL-4 is considered a key part of our immune defense against parasitic infections, and a few study participants developed parasitic infections. As for asthma, Dupixent is an approved asthma treatment when combined with other medicines. So, if you had asthma and it improved while you treated your atopic dermatitis, you might be tempted to cut back on your other medicines — but that’s not safe without medical supervision.
• What about cost? Biologics are expensive. This yearly price tag for this medicine is about $40,000 a year. Even when covered by health insurance, copays and deductibles can make it a costly treatment.
• Does it work? Text appearing on the screen says 37% of adults and 24% of teenagers saw major improvement after four months of treatment, compared with less than 10% of people not taking Dupixent. That may seem great if you’re in the minority of people who dramatically improved. Or it might seem like modest success for a systemic treatment with significant risk of side effects and a large price tag.

The bottom line

Drug ads exist to sell a product. They should never be your primary source of health and treatment information. For that, look to your own health care providers and other reliable sources of information like the FDA or NIH. Their primary interest is providing accurate information and promoting public health and medication safety, not convincing you to use a particular drug.