Costs of Alzheimer's Disease

Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego. ______________________________________

I wanted to share with you an update on the cost estimates of AD. These are, of course, in addition to the incalculable emotional losses caused by the disease, but are quite astonishing in themselves. There is also, however, a financial cost of the disease. In 1998 and again in 2002, reports were commissioned by the Alzheimer’s Association on the costs to U.S. businesses. Both studies were shocking. “Alzheimer’s Disease: The Costs to U.S. Businesses,” authored by Ross Koppel, Ph.D., of the Social Research Corporation and the Department of Sociology at the University of Pennsylvania, found that the 2002 Alzheimer’s cost to U.S. businesses would be in excess of $61 billion.

To put that number into perspective, this amount is equal to the net profits of the top ten Fortune 500 companies and exactly double the amount that was calculated in the 1998 report. The costs to businesses to cover medical insurance and disability for workers with Alzheimer’s was $24.6 billion. The costs incurred because workers must take on the tremendous responsibilities as family caregivers was $36.5 billion due to absenteeism, productivity losses, and replacement costs.

Alzheimer's Disease will rack up more than $20 trillion in treatment costs over the next 40 years in the United States, according to a report yesterday that calls on Congress to increase funding for drug research.

The report issued by the Alzheimer's Association found that from 2010 to 2050, the cost of caring for Americans 65 and older with Alzheimer's disease will increase more than six times to $1.08 trillion per year. Currently, $172 billion a year is spent by the government, private insurance and individuals to care for people with the disease, the most common cause of dementia.

However, if a drug were discovered by 2015 that slowed disease progression, it could cut the number of people in the severe stage of Alzheimer's disease in half to 1.1 million by 2020, and 1.2 million in 2050, down from the projections of 6.5 million. The fiscal imperative for finding a cure is now blindingly clear.

Over the Counter Genetics Test for Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation

This topic has made for an active news cycle over the past week.

First, Walgreens pharmacies announced their intention to sell an over the counter gene test. The product would enable consumers to swab their cheek and send a DNA sample, via mail, to a lab where the sample would be analyzed. The lab would then report back to the consumer on whether or not the sample indicated an increased genetic predisposition to some 70 diseases and medical conditions, including Alzheimer's disease.

This widely covered story was followed by the news that the FDA had formally notified Pathway Genomics, the manufacturer of the test kit, that the FDA required more information about the product. Finally, the news cycle peaked with Walgreens' announcement that they would not stock the product until the FDA situation was clarified.

The interesting question at the heart of this matter pertains to the debate over the value of providing complex genetic information to the lay public.

Those against enabling people to learn about their genetics take the view that the public must be shielded from information that they might use to hurt themselves in some way. I disagree with those people. Frankly, they remind me of an earlier time when similar thinking suggested that religious scripture should not be translated into common languages for public consumption.

I concede that there is a risk of misinterpretation where some might learn they have increased genetic risk for Alzheimer's disease and falsely conclude they they will definitely get the disease. However, we are talking about a self-selecting population that already has some concerns about their health and has demonstrated a willingness to invest their time, money, and effort into learning more. It is clear that these people want to know.

No one is suggesting we casually thrust genetic information upon anyone who would rather not have it. Those who share my view simply suggest that there is increasing demand among a well-educated public to learn about and manage their own health in a proactive manner. It makes good sense to support them in that noble initiative.

A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Amyloid Hypothesis Evolving?

Contributed by: Dennis Fortier, President, Medical Care Corporation

A hallmark lesion of Alzheimer's disease, to the extent that it is currently understood, is the accumulation of amyloid plaques in the brain. Most experts agree that amyloid plays some central role in the disease pathology but there is little consensus about what that role might be.

New research out of the Mount Sinai School of Medicine and published in the Annals of Neurology suggests strongly that it is the free floating clumps, or oligomers, of amyloid protein that cause the brain damage and cognitive decline, and not necessarily the dense amyloid plaques that form when these oligomers aggregate.

While this finding helps to clarify the role of amyloid in a very complex process, there are still some key weaknesses in the amyloid hypothesis that must be explained. Primarily, we need to understand why some people with excessive plaque formation have no symptoms of Alzheimer's disease. If the free floating oligomers are present prior to plaque formation, then one would presume that symptoms of decline would manifest by the time the plaques are present.

Nonetheless, this scientific advance will most likely drive the ongoing focus of scientific inquiry to an earlier point in the amyloid cycle.

This is a perfect example of how the scientific process uncovers the answers to such complex problems: questions are identified, hypothesis are formed, conclusions are drawn, and the questions are modified. The process repeats and renews until the pieces of the puzzle are clearly exposed and fitted together.

Click this link to review prior discussions on the amyloid hypothesis.

Driving With Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation

As most physicians will tell you, one of the barriers preventing patients from pro-actively voicing memory concerns is the patients' fear of losing the right to drive. However, the medical system is poorly equipped to assess driving ability and the steps between discussing a cognitive concern with a doctor and losing one's driving license are not as clear or straight forward as most patients would presume.

One the one hand, we all empathize with the natural desire to remain independent and, in the USA, where public transportation is spotty at best, the right to drive is a key enabler of independence. On the other hand, driving is a judgment intensive activity and impaired drivers need to be taken off the roads for everyone's safety.

The reality is that a patient must be severely impaired before actions initiated in the medical system will result in the loss of driving privileges. The American Academy of Neurology recently updated guidelines to help their members better assess driving skills as part of delivering comprehensive care. The new guidelines can be downloaded at their site.

The principle findings of the panel that issued the guidelines were that patients and caregivers are not very reliable sources of information about the patients' driving skills nor are standard neuro-psychological tests like the Mini-Mental State Exam. One of the best indicators that the patient may no longer drive safely is if they admit to having changed driving habits to avoid challenges such as driving in unfamiliar locations or night time driving.

How Much do Brain Games Help your Brain?

Contributed by: Dennis Fortier, President, Medical Care Corporation

Following a recent study sponsored by the BBC and published in Nature Magazine, this topic has been in the news a great deal. I will share my opinion about the answer to the question posed in my headline but would like to first comment on how this story is being reported.

As I described in this post yesterday, we must all be careful in how we interpret scientific commentary. This is because scientists speak in a language of precision that should be regarded as such, and very precise comments should not be generalized. A common example is when scientists comment that a particular hypothesis or phenomenon "has not been proven" and the comment is erroneously generalized to mean that the hypothesis is false. That is not how a scientist would interpret the comment; they would understand that the hypothesis may well be true but more study is required to prove or disprove it.

And so it may be with brain games.

I know that many game manufacturers have cast outlandish claims into the commercial marketplace in an effort to sell "health" to the worried well. As such, I think that the scientists involved in the BBC study have correctly suggested some claims have probably been too aggressive given the current level of evidence of a benefit from brain exercises.

However, please note that their study was not particularly well designed as they were looking for an improvement in cognition based on very little brain exercise, over a short period of time, compared to a group of control subjects who also used their brains in similar exercises. These limitations are described here by Berard Croisile of HAPPYneuron and here by Alvaro Fernandez of SharpBrains, both affiliated with the brain exercise industry and both well versed in the state of the science in this field.

Keep in mind that the scientific process encompasses more than a single study, even when the study is well-designed. The full process involves hypothesis generation, iterative testing of hypotheses, and reproduced results through various study designs. Scientific facts are rarely plucked from a single study but rather shaped and codified through a series of controlled experiments and analysis. In terms of understanding the health benefits of playing brain games, the scientific process is still in its infancy.

On the whole, the hypothesis that using your brain in challenging ways will exercise neural circuits and keep them healthy is both plausible and supported by a growing body of scientific evidence. We all agree that questions about how much exercise, which types of exercises, and how much benefit one can accrue are topics requiring more study.

However, we must not generalize the conclusions from the BBC study into the false belief that the scientific jury has reached a verdict on this matter. The preponderance of evidence suggests that exercising your brain is most likely good for your cognitive health.

NIH Says "Alzheimer's not Preventable"

Contributed by: Dennis Fortier, President, Medical Care Corporation

Based on current evidence, the recent conclusion reached by a National Institute of Health panel of experts, is pretty sound. They concluded that we do not yet have proof that the progression of Alzheimer's disease pathology can be slowed by actively reducing known risk factors and by adopting certain lifestyle changes such as smoking cessation, intellectual stimulation, and physical exercise.

Careful Interpretation Required
As we often write in this blog, scientists speak in a language of precision that serves them well amongst themselves but often leads to unintended conclusions in the public realm. This is a case where I think it is worthwhile to translate the panel's conclusion for public consumption.

Here is a quote from one of the panel experts; this was one of the direct comments that generated the hopeless headlines in countless news outlets over the past week:
"There is not a high level of evidence that any of these factors (supplements, mental exercise, medications) can prevent Alzheimer's or age-related cognitive decline."
Now let me state it in another way that would be equally acceptable to the independent and precision minded scientists on the panel:
"There is not a high level of evidence that any of these factors (supplements, mental exercise, medications) do not prevent Alzheimer's or age-related cognitive decline."
It is a simple switch in perspective but might have dramatically changed the message that most lay-readers take away.

I understand that many commercially driven entities are selling solutions with exaggerated claims about efficacy. We all appreciate the consumer advocacy the expert panel has provided in helping us understand how well certain supplements or brain games have been (or have not been) validated with solid science. However, it is important to stay balanced and to understand that certain approaches, although not proven, have growing evidence of benefits. When those approaches have no harmful side-effects and are supported by rock-solid common sense, it might be best to present them with some degree of optimism.