Psychosocial Stress as a Potential Risk Factor for Young Onset Dementia

Background: Young onset dementia, with onset prior to 65 years, is an enigmatic condition when it occurs in the absence of gene mutations and recognized risk factors. The aim of this study is to determine if self-reported psychosocial stressors might be implicated. Methods: For over 25 years we have been prospectively evaluating the neurobiology of YOD. Patients are diagnosed using published criteria. The presence of self-reported psychosocial stressors was investigated by direct enquiry from patient, spouse and family, and had to be stable at six months to be recorded as psychosocial stressors. This study incorporates 221 participants. Patients and their families were asked standardized questions developed by the senior author. The same questions were asked by the cognitive raters. A stress was rated as a stressor if confirmed by both neurologist and cognitive rater and at follow-up visit. Results: Of the 131 individuals with sporadic young onset Alzheimer’s disease, 59.5% had psychosocial stressors compared to 3% of old onset AD (p < 0.001), and 50% of the 46 individuals with sporadic behavioral variant frontotemporal dementia had psychosocial stressors in comparison to 3.3% of old onset (p < 0.00001). Only 2% of age-matched controls without dementia reported psychosocial stressors. Conclusions: Our findings suggest that psychosocial stressors may be a risk factor for YOD and point to early intervention. The results also suggest that the physico-chemical properties of the physiological reactions to psychosocial stress activate neurodegenerative pathways.