My recent blog posting New views of Alzheimer’s disease and new approaches to treating it describes recent research relating to the disease and new understanding of what creates it. This week the Alzheimer’s Association has released a new report that describes the social consequence of the disease: 2010 Alzheimer’s Disease Facts and Figures. I cover a few highlights from that report in this blog entry, relate the facts and figures to what is known about the cause of the devastating disease, and offer an opinion of what we should do as a society about Alzheimer’s disease and senile dementia.
Facts and Figures
- About 16.2 million Americans are now deeply affected by Alzheimer’s, 5.3 million who have the disease and another 10.9 million whose lives are wrapped up in caring for those who have the disease.
“In 2009, an estimated 10.9 million family members and friends provided unpaid care for a person with Alzheimer’s disease or another dementia.” About 94 % of unpaid caregivers are family members; about 60% are women and about 60% are aged over 50. The quality of the lives of many of these unpaid caregivers is seriously impacted by their caregiver responsibilities. 40% of caregivers of Alzheimer’s disease patients report high emotional stress compared to 28% of caregivers of other older people. “Because Alzheimer’s and other dementias usually progress slowly, most caregivers spend many years in the caregiving role. At any point in time, 32 percent of family and other unpaid caregivers of people with Alzheimer’s and other dementias have been providing help for five years or longer, including 12 percent who have been providing care for 10 years or longer. An additional 43 percent have been providing care for one to four years, and 23 percent have provided care for less than a year.” (Quotes here are from the report)
- The total current economic impact of the disease is $316 billion, $172 of which is for paid care of those having the disease and $144 billion is for the effort of unpaid caregivers. (Note that these figures do not take into account another very large amount for lost economic productivity of those having the disease.)
According to the report, payments for health and long-term care services for people with Alzheimer’s will total $172 billion this year. Unpaid caregivers provided 12.5 billion hours of care in 2009, valued at $144 billion with care valued at $11.50 per hour. It is pointed out that this is more than the federal government spends on Medicare and Medicaid combined for people with Alzheimer’s and other dementias.
- More than any other disease, Alzheimer’s and other dementias are signature diseases of old age. Death rates rise precipitously with age.
Death rate per 100,000Age
45–54 0.2 0.2
55–64 2.0 2.1
65–74 18.7 20.2
75–84 139.6 175.6
85+ 667.7 848.3
Other diseases of old age do not present such a steep rise in the death rate with increasing age. “To put such age-related differences into perspective, for U.S. deaths in 2006, the differences in total mortality rates from all causes of death for those aged 65–74 and those aged 75–84 was 2.5-fold, and between the 75–84 age group and the 85 and older age group, 2.6-fold. For diseases of the heart, the differences were 2.8-fold and 3.2-fold, respectively. For all cancers, the differences were 1.7-fold and 1.3-fold respectively. The corresponding differences for Alzheimer’s were 8.7-fold and 4.8-fold. This is because Alzheimer’s is most likely caused by cell senescence of microglia, increasing cell senescence being a normal consequence of the aging process. Getting Alzheimer’s is part of normal aging. It is not necessarily caused by a bacterium or virus and does not necessarily require a gene defect although it could be triggered by such conditions.
· There is currently no treatment for the disease
“No treatment is available to slow or stop the deterioration of brain cells in Alzheimer’s disease. The U.S. Food and Drug Administration has approved five drugs that temporarily slow worsening of symptoms for about six to 12 months, on average, for about half of the individuals who take them.” Puny results for expensive drugs is all the pharmaceutical industry has been able to provide at this point.
· While the risk of death due to other diseases continues to decrease with time, the risk of death due to Alzheimer’s disease is rapidly increasing.
Between 3000 and 2006 causes of death % changes:
Alzheimer’s disease +46.1%
Prostate cancer -8.7%
Heart disease -11.1%
The report projects 500,000 new cases of Alzheimer’s will be diagnosed this year. The report estimates that almost a million new cases of Alzheimer’s will be diagnosed annually by 2050.
- Medicare costs for Alzheimer’s patients are almost three times higher than for other older people and Medicaid costs are almost nine times higher.
“Hospital: In 2004, Medicare beneficiaries aged 65 and older with Alzheimer’s and other dementias were 3.1 times more likely than other Medicare beneficiaries in the same age group to have a hospital stay. — Skilled nursing facility: In 2004, Medicare beneficiaries aged 65 and older with Alzheimer’s and other dementias were eight times more likely than other Medicare beneficiaries in the same age group to have a Medicare-covered stay in a skilled nursing facility.”
- The disease affects women more than men and blacks and Hispanics more than whites.
- Blacks are roughly twice as likely to get the disease compared to whites.
- Hispanics are roughly 1.5 times as likely to get the disease compared to whites.
- Women are more or less 1.7 times or more likely to get the disease then men, depending on the age group.
- Alzheimer disease patients are likely to have concurrent medical issues
Percentage withAlzheimer’s or OtherDementia and theCoexisting Condition
Coronary heart disease 26%
Stroke—late effects 25%
Congestive heart failure 16%
Chronic obstructive pulmonary disease 15%
Parkinson’s disease 8%
Data is for 2004 medicare beneficiaries aged 65 and older
What more can be done about Alzheimer’s disease?
I would like to see a few things shifted.
1. I think it would be beneficial to stop viewing Alzheimer’s disease as yet another disease we are seeking to cure and start viewing AD as intrinsically wrapped up with aging, one of several aging processes that gets ahead of the other aging processes in AD patients. The present find-a-specific-cure viewpoint has not worked and can’t work because AD is due to cell senescence of microglia. It is due to a process that is intrinsic to aging itself. In fact, if we could delay all other age-related diseases, then AD would get virtually everybody by age 125. In other words, curing AD and “curing aging” are likely to be part and parcel of the same thing.
2. Major shifts in AD research are in order. Efforts to find a chemical by trial-and-error that is a partial or entire cure, such as pharmaceutical companies have been pursuing for decades, are a modern form of alchemy rather than scientific research. Any research that is going to move us forward has to look at the fundamental molecular biological and genetic-genomic processes involved.
3. I suspect that current research and clinical trials aimed at reducing or eliminating tau tangles and amyloid-beta plaques in AD patients(ref) may lead to therapies that slow the progress of AD but are unlikely to produce cures because they do not address the root cause of the disease.
4. I think the research cited in the blog entry New views of Alzheimer’s disease and new approaches to treating it points its fingers at microglial cell senescence as a root cause for AD. Additional research I have reviewed since writing that blog entry confirms this conclusion. Therefore, any treatment that fundamentally addresses AD must address cell senescence and/or failure of cell replacement through stem cell differentiation. If a treatment works to significantly delay or prevent AD it is likely to work to significantly delay or prevent many other diseases and processes of aging as well. The answer may lie in a more effective form of telomerase activation(ref), in reversing epigenomic markers of aging such as DNA methylation at selected promoter sites(ref) or in manipulating the stem cell supply chain probably using induced pluripotent stem cells(ref) or embryonic stem cells(ref). Perhaps activation of the BDNF gene could be involved(ref). Those are the kinds of basic research that should be encouraged.
5. Another shift in aging and Alzheimer’s research is that there should be lots more of it. The report says “for every $25,000 the government spends on care for people with Alzheimer’s and dementia, it spends only $100 for Alzheimer research.” This is an order-of-magnitude too little.
6. Finally it is important to reiterate that a number of approaches are available to ordinary people that can usually delay onset of Alzheimer’s disease, other forms of dementia and other diseases resulting from cell senescence. These are the measures in the anti-aging firewalls in my treatise ANTI-AGING FIREWALLS THE SCIENCE AND TECHNOLOGY OF LONGEVITY. Many of my blog entries are also relevant such as Warding off Alzheimer’s Disease and things in my diet and Seven Ps of health and longevity. And a search of blog entries using the term dementia will turn up several additional relevant blog entries.