Journal of Alzheimer’s Disease 85 (2022) 55–58 55

DOI 10.3233/JAD-215234
IOS Press

Short Communication

When My Child Has Alzheimer’s Disease

Gustavo L. Franklina,∗ , Alex T. Meirab , Maira Tonidandel Barbosac,d ,
Hélio A.G. Teivee and Paulo Caramellic
a Departamento de Clı́nica Médica, Escola de Medicina da Pontifı́cia Universidade Católica do Paraná, Curitiba

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(PR), Brazil
b Departamento de Medicina Interna, Universidade Federal da Paraı́ba, João Pessoa (PB), Brazil
c Departamento de Clı́nica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo
Horizonte (MG), Brazil
d Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte (MG), Brazil

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e Universidade Federal do Paraná, Serviço de Neurologia, Departamento de Medicina Interna, Curitiba (PR),

Brazil

Accepted 5 October 2021

Pre-press 8 November 2021
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Abstract. The significant increment in life expectancy, associated to the existence of high-performing older adults, and the
appropriate diagnosis of early dementias, lead to an uncommon scenario, of healthy parents accompanying their children
with Alzheimer’s disease or another dementia to medical consultations. Here, we reported three peculiar clinical vignettes
of patients diagnosed with a dementia, who were accompanied by healthy parents. This is a modern situation that tends to
become more frequent, and must be properly discussed, since multidisciplinary care and specific training are necessary.
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Keywords: Alzheimer’s disease, dementia, diagnosis, early-onset dementia, management

INTRODUCTION contrasts with the daily clinical suspicion, that is usu-

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ally higher when there is a clear family history.

Early-onset Alzheimer’s disease (EOAD) is
defined as the diagnosis of Alzheimer’s disease (AD)
in patients who present symptoms before the age of
65 years. EOAD comprises about 5% of cases of AD,
and, in comparison to late-onset AD, may present
different clinical characteristics, such as more aggres-
sive course, less memory impairment, and greater
involvement of other cognitive domains on presenta-
tion, commonly leading to frequent delay in diagnosis
[1]. Although there is also greater genetic predisposi-
tion, sporadic EOAD (sEOAD) is still more common
than familial EOAD (fEOAD). This fact, however,
∗ Correspondence to: Gustavo L. Franklin, MD, PhD, Rua Gen-
eral Carneiro 1103/102, Centro, Curitiba, PR, 80060-150, Brazil.
E-mail: gustavolf 88@hotmail.com.
On the other hand, a new concept has emerged,
that is of SuperAgers or high-performing older adults
(HPOA), that are defined as individuals aged 80 years
or older with memory abilities similar or superior to
middle-aged subjects [2, 3]. The existence of HPOA,
and the appropriate diagnosis of early dementias,
lead to scenarios that are still rare, but which tend
to become more frequent, which is the situation of
healthy parents having their children diagnosed with
dementia. The family impact generated by the decon-
struction of the natural idea that “the children will
grow up and take care of their parents in their old
age” is evident and must be well understood by health
professionals, so that integrated care and adequate
support can be provided.
In order to illustrate this new situation, we present
below two characteristic clinical vignettes describing

ISSN 1387-2877/$35.00 © 2022 – IOS Press. All rights reserved.

56 G.L. Franklin et al. / When My Child Has Alzheimer’s Disease

uncommon EOAD scenarios and one more case in
which a classical AD may also present an unusual, but
very modern circumstance, of a cognitively healthy
father with a child with AD.
CLINICAL VIGNETTE 1: “HOW CAN MY
DAUGHTER HAVE DEMENTIA IF I
HAVEN’T?”
A very lucid 94-year-old mother, a Japanese
descendant, brought her 67-year-old daughter for an
assessment to determine why she had been having
to memory complaints, the patient had behavioral
changes, which, although incipient, were causing
great distress to his parents. The patient did not meet
diagnostic criteria for another cause of dementia, and
cerebrospinal fluid AD biomarkers confirmed the pre-
vious diagnosis.
The patient was married and had two children, who
were the first to identify the symptoms. However, they
doubted somebody could have AD before the age of
60. In this case, there were no major conflicts regard-
ing the patient having an illness without his parents
having, since the real family history was unknown.

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However, the patient’s condition was a huge burden
memory decline and difficulty performing some daily
for this family, and they raised an interesting ques-
tasks in the past three years. In the initial investi-
tion: is it possible for a son to reach senility before
gation, the patient scored 20 points out of a total
the parents?
of 30 points in the Mini-Mental State Examina-
tion (MMSE). She also presented signs of executive
dysfunction and mild behavioral changes, causing a
major impact on her functional autonomy and on
her quality of life. The patient had hypertension
and insulin-dependent diabetes mellitus. Diagnostic
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CLINICAL VIGNETTE 3: “MY
DAUGHTER NEEDS YOUR EVALUATION:
HER MEMORY HAS BEEN VERY BAD!”
workup indicated clinical diagnosis of probable AD
A very pleasant 99-year-old man (Mr. F), a wid-
dementia at a mild to moderate stage.
owed retired driver with one year of schooling, was
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The patient had three grown-up children and a
brought by a great-grandson to a geriatric consulta-
husband, but the family had not suspected the diag-
tion. The great-grandson told him that he was going
nosis of AD earlier, since they had never experienced
to pick him up at the end of the assessment when they
this situation with any close family member and also
were to call each other by cell phone.
because of a natural reluctance to consider the pos-
Mr. F was clearheaded and fully independent
sibility of someone having dementia if her parents
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for instrumental and basic activities of daily living

had not.
and was alone at the consultation. We conducted a
The patient’s father died due to complications after
global geriatric assessment, including a brief cog-
a stroke, at the age of 72. He had hypertension,
nitive evaluation. His MMSE score was normal for
diabetes, and dyslipidemia. The patient’s mother
the education-adjusted cutoff score for cognitive
was bilingual with Japanese as her main language,
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impairment. Geriatric Depression Scale score was

although she speaks Portuguese fluently. She has
hypertension and diabetes mellitus, controlled with
oral medication. Despite her age, she had no cogni-
tive complaints. The question that the mother brought
to us is certainly a philosophical challenge for every
clinician who treats people with dementia: “But how
can my daughter have dementia if I haven’t?”
CLINICAL VIGNETTE 2: “IS IT POSSIBLE
FOR A SON TO REACH SENILITY
BEFORE THE PARENTS?”
A 57-year-old man, diagnosed one year before with
early-onset AD was accompanied to the outpatient
clinic by his family, including his children, and by
his healthy adoptive parents in their 80s. The parents
did not have any neurological complaints. In addition
0, indicating absence of depressive symptoms. Upon
receiving his final report and our compliments on his
health, Mr. F asked us to schedule an appointment for
one of his daughters (Mrs. C) to administer the same
tests we performed on him: “She is the one who needs
this consultation, doctor.”
After a few months, Mrs. C, aged 75 years and
with eight years of schooling, came to the outpatient
clinic accompanied by her father, Mr. F, already aged
100 years, and by one of her six children. Global
geriatric assessment and ancillary tests confirmed the
diagnosis of mild dementia due to a clinically com-
patible AD.
Mr. F, who is still in good health, is a very suc-
cessful centenarian. He finds it surprising and quite
unexpected to have a daughter “so young with AD”
(as he describes), but he is happy to know that she
 G.L. Franklin et al. / When My Child Has Alzheimer’s Disease
is “well taken care of by the family and the medical
team”. Mr. F has a very interesting and uncommon
Brazilian name, “Felizardo”, which in Portuguese
means very lucky and happy.
DISCUSSION
The cases presented illustrate a modern phe-
nomenon of parents who have their children
diagnosed with dementia. Among several factors
associated with the genesis of this situation, are
the recognition and proper diagnosis of people with
dementia who would otherwise be misdiagnosed with
a psychiatric disorder; the presence of environmental
and epigenetic factors that add risk factors to geneti-
cally predisposed people; in addition to the existence
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of parents, called high-performing older adults. With
the significant increment in life expectancy expe-
rienced by most countries in the last decades, the
absolute number of people who reach advanced ages
and still maintain good cognitive functioning and
autonomy is also of note. Higher education, absence
of cardiovascular risk factors, physical activity, and
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also genetic factors as the absence of the apolipopro-
tein epsilon4 allele, may be protective factors of
cognitive decline, and may be also related to HPOA
[2–4]. In addition, epigenetic factors, transcriptional
regulations, and gene-environment interactions could
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offer a plausible explanation of why close relatives
may not develop the disease or may present with the
condition at such variable ages [5, 6].
The prevalence of dementia increases exponen-
tially after the age of 65 years, usually doubling its
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rate at each five-year interval [7]. Hence, it is indeed
much more common to see daughters and sons bring-
ing their parents with cognitive changes to clinical
consultation. The situation of a father bringing a child
for consultation with cognitive complaints, usually
age-related, seems a contradiction, and an inversion
of the natural order of life. Moreover, the incidence
of EOAD has increased nowadays, and although the
etiology and genetic basis remain poorly understood,
patients with EOAD are commonly excluded from
observational and therapeutic studies.
In the usual circle of life, parents take care of
their children until they become fully independent.
Later on, it is the children’s turn to deliver care to
their parents when they become fragile or when they
present some illness that affects their functional inde-
pendence. It is still not usual for a parent to look after a
middle-age or older child affected by dementia. This
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situation represents an inversion of what is consid-
ered “normal” during the life cycle and is certainly a
major challenge for parents, demanding capabilities
of understanding, acceptance, and coping.
The professional approach of an early dementia
may have some peculiarities. First, early diagno-
sis should be sought in an attempt to reduce initial
family burden. Also, clinicians must clearly commu-
nicate the diagnosis, the perspective of evolution, and
the therapeutic possibilities, avoiding vague terms
or medical language. Still, it is important to under-
stand the family context, to know if the parents are
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the main caregivers, since despite the relatively pre-
served cognitive function, parents may have physical
limitations, due to their age, such as frailty syndrome,
among other age-related diseases. There is a need for
closeness to other family members, and, frequently,
caseworkers. Finally, there are legal implications of
having an elderly caregiver that must be taken into
account.
In this way, although the term senility, as men-
tioned by one of the parents, may have a broad
definition [8], it is crucial that healthcare profession-
als seek to educate the community that dementia is
not a natural part of aging. In addition, specific train-
ing of the multidisciplinary team may be necessary
to manage and deliver the best possible care within
this new scenario, that may appear more frequently
in the near future.
CONCLUSION
The situation of healthy parents, having their chil-
dren diagnosed with AD or other dementia, has
a relevant practical implication in society today.
The proper care may be more difficult and prepar-
ing healthy professionals to properly recognize and
understand how to manage this condition is of
extremely importance, since it tends to be more fre-
quent with the natural aging of the population.
DISCLOSURE STATEMENT
Authors’ disclosures available online (https://
www.j-alz.com/manuscript-disclosures/21-5234r1).
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