Cases of early-onset dementia will rise sharply over the next 25 years, but the increase will be uneven across the provinces, according to projections by the Alzheimer Society of Canada. The acceleration will occur mainly in Alberta, British Columbia and Ontario, but should be less marked in Quebec.

Age is the most important risk factor for neurocognitive disorders. The various forms of dementia and Alzheimer's disease appear mainly after the age of 65. They affect a third of people over 85.

When they develop in people aged 60 and under, we speak of early-onset dementia. Dr Robert Jr Laforce, a neurologist at the Enfant-Jésus Hospital of the Centre hospitalier universitaire (CHU) de Québec, treats patients who are barely in their thirties.

“Early-onset cases often progress more rapidly,” he explains in an interview with the Insurance Portal. 

Canadian projections to 2050  

In Canada, says the Alzheimer Society report, little research has been done on the number of people living with early-onset neurocognitive disorders. The landmark study estimated their number at around 28,000 in 2020 and predicts it will rise to 40,000 by 2050, but this increase will be uneven across the provinces, as this table shows:

Genes could account for 25-30% of early-onset cases.

“As a medical specialist, as soon as you see a young patient, you have to think about the genetic aspect and see if there are other affected family members,” says Dr. Laforce.

The most famous case in Quebec is that of Sandra Demontigny, a woman in her mid-forties with Alzheimer's, which she inherited genetically. At least two of her four children are certain to inherit the gene. Their mother has already indicated that she will seek medical assistance in dying once the disease has reached a certain stage.

Effects of early-onset dementia at work  

“In the collective unconscious, there's still a view that the person with Alzheimer's is 85, incontinent and in a long-term care facility. But he's also a 58-year-old at work who forgets important things,” points out Dr. Laforce.

The effects of an early diagnosis of dementia are powerful for its victims. Many of them are in the workforce and have family responsibilities. At his Memory Clinic, he says he sees architects, teachers and even practicing doctors who suffer from dementia.

He makes no secret of the fact that early onset of dementia generally marks the end of a career.

“99.9% of the time,” he explains. “By the time we see the first signs in the clinic, it's often been 10 years since people have noticed any changes. We tell them, 'Enjoy life. If you've always wanted to see Italy, go ahead, because you don't have many years left.’” From the time a person consults the Memory Clinic, we're talking about 4 to 5 years in the best cases of cognitive health, but it's often less.”

Disability insurance then becomes crucial for these people. Those who are insured will turn to their insurer to obtain the benefits provided for in their policy.

“However,” observes Dr. Laforce, “we see people who have insurance for moderate and/or severe dementia, but not for mild dementia.” People diagnosed with mild dementia may not be entitled to benefits because their policy did not provide for it. The disease may greatly affect their financial security, reducing their retirement savings or pension plan.

Symptoms of early-onset dementia  

How can you tell if someone under 60 is suffering from early-onset dementia?

“If they have significant forgetfulness,” he points out: “The person doesn’t remember yesterday's discussion, so they'll repeat themselves in their day-to-day speech.”

“When memory changes have a functional impact – for example, the person got lost while driving the car – that's a sign that you absolutely must consult.”

New drugs available... but not in Canada 

For individuals in the moderate and advanced stages, there is no cure or way back.

However, there is hope of remission for those aged 60 and under. The United States, the European Union, China, Japan and the United Kingdom have approved two drugs that modify the course of Alzheimer's: Lecanemab and Donanemab.

“We're talking about a 35% reduction in symptoms,” says Dr. Laforce. “They've been used in the U.S. for a year and a half. When prescribed to people just starting the disease, they can save five months of cognitive health, which is significant for the patients who benefit from them.”

The problem? They're not available here, because Health Canada still hasn't completed its own analyses.

Extending quality of life and career 

Nevertheless, he encourages people with worrying signs to seek early advice, so that those with early-onset dementia can prolong their cognitive health, quality of life and careers.

He returned from a conference in Philadelphia in the summer of 2024 very energized. New drugs will help stop amyloid, a protein that accumulates in the brain and causes dementia.

“I don't think we'll be able to stop Alzheimer's disease,” he says. “It will always be part of normal aging. But we're going to be better at recognizing it early and stabilizing people as soon as they show the first signs.”