Patterns of sick leave and unemployment prior to a diagnosis of young onset Alzheimer's disease

Abstract

INTRODUCTION

Early symptoms in young onset Alzheimer's disease (YOAD) may be misinterpreted, causing delayed diagnosis. This population-based study aimed to map adverse occupational events preceding YOAD diagnosis as potential prodromal signs.

METHODS

In a register-based, incidence density matched nested case-control study, we examined unemployment and long-term sick leave among individuals diagnosed with YOAD in Danish memory clinics between 2016 and 2022 compared to controls over a 13-year period. Conditional logistic regression produced incidence rate ratios (IRRs).

RESULTS

The study included 2434 cases and 12,170 controls. YOAD patients had higher rates of adverse occupational events, particularly long-term sick leave, starting from 8 years before diagnosis (IRR 1.40, 95% confidence interval [CI] 1.07–1.84) and increasing to an IRR of 29.59 (95% CI 18.97–46.13) in the year before diagnosis.

DISCUSSION

Adverse occupational events may serve as warning signs of YOAD. Timely diagnosis could facilitate restructuring the remaining working life to accommodate cognitive deficits or in seeking a disability pension.

HIGHLIGHTS

• This is a retrospective, nested case-control study of young onset Alzheimer's disease (YOAD).
• Unemployment rates rise significantly 5 years before the YOAD diagnosis.
• Long-term sick leave rates rise significantly 8 years before the YOAD diagnosis.
• This emphasizes the importance of occupational history in the timely diagnosis of YOAD.
• Findings suggest the need for earlier YOAD diagnosis for work–life management.