This Could Be Your First Sign of Dementia Years Before Diagnosis, Study Says


Dementia may be all too common in old age, but that doesn't mean it's part of normal aging. To the contrary, experts say that when it comes to cognitive impairment, the goal is to spot it early and to act fast using a combination of medication, therapies, lifestyle changes, and more. However, for many dementia patients that opportunity has come and gone—and the statistics are likely to become more grim over time. While the Centers for Disease Control and Prevention (CDC) says that over five million Americans suffered from dementia in 2014, the organization projects that over 14 million will suffer from its symptoms by 2060 as the population over 65 continues to increase.

An Inability to Hear Speech in a Crowd Linked With Dementia Later in Life

Unfortunately, certain types of dementia can go unrecognized for years or decades before symptoms become apparent. In fact, a 2021 report from the Alzheimer's Association says that certain types of dementia "begin 20 years or more before symptoms arise. It starts with changes in the brain that are unnoticeable to the person affected," the organization adds.

That's exactly why it's so essential to spot the signs as they do arise—and why one group of researchers at the University of Cambridge is sounding the alarm about a symptom they say might very well be your first. Read on to find out which sign of dementia may tip you off to a problem years before a diagnosis, and how to get the help you need if you notice it.

Increased apathy can be among the first signs of dementia.


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According to the recent study, increased apathy—or a lack of motivation, interest, or investment—is positively associated with frontotemporal dementia (FTD) and some of its worst outcomes. These include "functional decline, decreased quality of life, loss of independence, and poorer survival," according to Maura Malpetti, a co-author of the study and a postdoctoral researcher in the Department of Clinical Neurosciences at Cambridge.

Importantly, these are all factors that can sometimes be improved with medical, therapeutic, and lifestyle interventions if discovered early on. The researchers behind the study say their findings could help predict the onset of FTD several years before other symptoms begin, creating a "window of opportunity" to intervene during the disease's earliest stages.

All too often, behavior changes are dismissed or overlooked.

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According to the Cambridge researchers, FTD is associated with significant alterations in behavior. Personality changes may include increased impulsivity, socially inappropriate behavior, language changes, or the development of compulsive or repetitive habits. Far too often, these signs of dementia are mistakenly attributed not brain degeneration, but to depression, laziness, or a lack of social skills. For many patients, this undermines and delays diagnosis.

However, James Rowe, MD, PhD, a professor from the Department of Clinical Neurosciences at Cambridge and a joint senior author on the study, points out that when behavior changes like apathy are recognized, they can predict FTD full decades prior to the emergence of other symptoms. "Treating dementia is a challenge, but the sooner we can diagnose the disease, the greater our window of opportunity to try and intervene and slow or stop its progress," Rowe said.

If you suspect a problem, a doctor can assess your genetic risk for FTD.
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The researchers behind the study point out that roughly one third of patients with frontotemporal dementia have a family history of FTD. In fact, when the researchers compared 304 study participants with a genetic predisposition to FTD and 296 of their family members without that same predisposition, they discovered that those with the faulty genes displayed more apathy than those without. Using "apathy, memory tests and MRI scans of the brain," the researchers determined that those with genetic mutations experienced accelerating apathy as they approached "the estimated age of onset of symptoms," despite all participants being unaware of their genetic status.

If you suspect a problem and would like to know more about your personal risk of FTD, you can speak with a genetic counselor about being tested for a genetic mutation. "Knowing if a person has a genetic mutation provides helpful information for their families, their physician, and for potential clinical trials," explains the FTD Disorders Registry. "For those who do not show signs of disease, this knowledge can predict the likely possibility that they will develop the disease," the organization adds.

The greater the apathy, the greater the cognitive problems ahead.
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Not only did the Cambridge researchers show that apathy can be among dementia's first symptoms, they also established that the level of apathy corresponded with the severity of the dementia down the road. "At the start, even though the participants with a genetic mutation felt well and had no symptoms, they were showing greater levels of apathy," Rogier Kievit, PhD, a Cambridge neuroscientist said via press release. "The amount of apathy predicted cognitive problems in the years ahead," said Kievit.

Concerned about developing dementia? Talk to your doctor if you notice a change in your own behavior or that of a loved one.

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