The Global Cost of Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation
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With each new study, the numbers get bigger and scarier. The latest report, The Global Economic Impact of Dementia, released by the non-profit group Alzheimer's Disease International, is no exception. The full report can be downloaded here.

At a top line level, the report estimated the annual cost of care for demented patients at over $600B or about 1% of the world's gross domestic product. Astoundingly, that figure is dwarfed by the projected rise in costs over the next decades. In fact, the report estimates that costs could reach nearly $2 trillion by the year 2050. A good summary of these findings are published online by Time.

While a cure is the goal that everyone seeks, a cold economic look at the disease makes it clear that the crippling expense of care comes primarily from patients in the moderate to severely demented stages of illness, when they cannot administer their own lives. While delaying progression to those stages might seem to be an uninspiring health care goal, it is a very attractive economic goal.

To that end, earlier intervention and robust treatment, including a balanced diet, physical exercise, pharmaceutical therapy, and tight control of diabetes and any present cardiovascular risks, should be a high priority in the primary care setting.

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Confusion about Alzheimer's Diagnostic Guidelines and Clinical Care

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The press is currently overflowing with coverage of the proposed changes to the outdated guidelines for diagnosing Alzheimer's disease. Most of the articles I have read have taken a sensationalistic and misleading slant. It may be superficially interesting to emphasize that early identification of AD will benefit drug makers, but that should not overshadow the real clinical benefit of earlier intervention.

Facts in a Nutshell
Current guidelines dictate that a person who consults a physician and complains of memory loss does not have AD until they become demented. Physicians can look for other causes of memory loss, such as depression, stroke, or thyroid disorder, and treat any problems they find. However, if nothing is found, and AD is strongly suspected, the guidelines prevent an actual diagnosis and treatment until the patient's symptoms progress to the dementia stage. The new guidelines would allow physicians to identify the disease at an earlier, and perhaps more treatable, stage of progression.

This point, that our current practice of late diagnosis is partially driven by outdated diagnostic standards, is highlighted in a report today from the Medical Research Council in the UK. This report clearly shows that primary care physicians are waiting too long to diagnose dementing illnesses and therefore, not treating them optimally.

I understand the mistrust of big pharma; they've earned their reputation. But I also understand that the effort to contain the growing Alzheimer's problem will absolutely enrich those with a piece of the solution. Don't forget that it will also diminish returns for those who currently profit from caring for demented patients.

Alzheimer's disease starts with a long slow period of accumulating pathology that is still not well understood. The current practice of waiting for clear symptoms before diagnosing and treating the disease has proven disastrous because too much brain damage occurs prior to the emergence of definitive clinical signs.

Merely recognizing that the disease is underway prior to full-blown dementia is not a greedy plot underwritten by the pharmaceutical and imaging industries; it is a scientifically sound approach to improving care in this field. It will enable more timely intervention and a clearer understanding of treatment efficacy with currently approved approaches.

Yes, we need to understand the pathology better and yes, we need new treatments that stop or slow disease progression; but we will never get those if we don't look at the disease clearly. Adhering to the current guidelines that deny the presence of AD prior to the patient becoming demented is a barrier to progress.