Alzheimer Disease and Other Dementias: The Looming Brain Drain

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There’s no getting away from it: Baby boomers—members of the generation born from 1946 through 1964—are not young anymore. Many have reached (or will soon reach) retirement age, and even the youngest will celebrate their 50th birthdays this year. With this graying of the United States comes an ever-more-pressing need for an improved understanding of Alzheimer disease and other dementias that plague the elderly, as well as for an enhanced tool set for diagnosing and treating these conditions.

Norman L. Foster, MD, is a professor of neurology at the University of Utah School of Medicine in Salt Lake City. Foster, who also serves as director of the university’s Center for Alzheimer’s Care, Imaging & Research and as senior investigator at the Brain Institute at the University of Utah, concedes that progress is being made on the Alzheimer-disease/dementia diagnosis and research fronts. He notes, “The prevalence of these conditions and the cost of care warrant so much more,” however.

Statistics paint a grim picture of the incidence and effects of Alzheimer disease and other dementias alike. According to the Alzheimer’s Association 1, an estimated 5.2 million US patients currently have Alzheimer disease. This population includes approximately 200,000 individuals under age 65 who have been diagnosed with younger-onset Alzheimer disease.

The report also indicates that the US Alzheimer-disease/dementia population will see explosive growth, in the near future, as baby boomers continue to age. Barring effective means of preventing or arresting these conditions, the number of people 65 or more years old who have Alzheimer disease might more than triple, reaching 16 million; of these patients, 7 million will be 85 or older. Alzheimer disease is the number-six cause of death in the United States and the fifth most frequent cause of death for those 65 and older, killing more than prostate cancer and breast cancer combined.

While incidence rates for death from other major diseases (including cancer) decreased between 2000 and 2010 (the last year for which figures are available), the rate of death caused by Alzheimer disease trended upward by 68% Equally staggering are the potential costs of addressing Alzheimer disease/dementia, which have been projected to rise sharply as the number of US residents 65 or older doubles (to 72 million) over the next 20 years.

Deeming Alzheimer disease “the most expensive condition in the nation,” the Alzheimer’s Association report pegs the current cost of Alzheimer-disease/dementia care at $214 billion per year, including $113 billion borne by Medicare, $37 billion by Medicaid, $36 billion by patients/families, and $28 billion by insurers and uncompensated providers. By many estimates, Foster observes, US Alzheimer-disease/dementia care will, in 2050, carry a price tag of $1.2 trillion per year (in today’s dollars).

Foster notes that more of the financial burden connected with Alzheimer disease/dementia is also falling onto the shoulders of patients and their families, in part because of a growing preference among all parties for home-care programs or assisted-living facilities over nursing homes. “Home care often means lost wages for the adult caregiver,” he says, “and while assisted-living facilities are cheaper than nursing homes, not all states will pay for patients to move to one.”

Foster says that Utah ranks among exceptions to the rule; it picks up the assisted-living tab for about 60% to 70% of Alzheimer-disease/dementia patients who would otherwise be required to reside in nursing homes in order to receive state-funded care. Michigan offers a similar program under which individuals with Alzheimer disease or other dementias can, in certain instances, bypass nursing-home care and be waived into assisted-living facilities instead, with their expenses covered by Medicaid. The catch, Foster says, is that the state limits the number of available Medicaid waivers to about 2,500 per year; those usually have been spoken for, each year, by the end of February.

New Angles

Recent research has brought to light entirely new perspectives on Alzheimer disease and other forms of dementia. Clifford Jack, MD, PhD, is a professor of radiology and noted Alzheimer-disease researcher at the Mayo Clinic (Rochester, Minnesota). He says that research increasingly validates the theory that biomarkers become abnormal before clinical symptoms of Alzheimer disease/dementia develop.

“This has been a revelation for the field—for