By: Ada Seldin
An impending storm is threatening to stagger the health care system and the nation at large. Alzheimer’s disease, which now affects as many as 5.1 million Americans, is projected to triple its toll by 2050, to 13.8 million Americans.1 These sky-rocketing rates can be attributed to aging of the ‘baby boomers.’2 The prevalence of Alzheimer’s disease doubles for every five years after age of 65.3 ‘Baby boomers’ refers to the 76.4 million people born in the United States between 1946 and 1964.4 People at the lower end of this group have recently turned 65, and thus their chances of developing Alzheimer’s disease will exponentially increase in the coming years. Those at the upper end of the baby boomer range will turn 65 in about 15 years, and their prevalence of Alzheimer’s will increase thereafter. These projections are significant, as a rise of this magnitude in the Alzheimer’s disease population has the potential to drain healthcare resources and devastate both the victims of the disease and their caregivers.
Alzheimer’s disease is a progressive neurodegenerative disorder involving neurons in the nucleus basalis that project throughout the cerebral cortex to the areas of the brain responsible for memory and cognition. The death of these neurons leads to memory loss, cognitive decline, behavioral and psychiatric disorders, and an increasing inability to perform daily activities. Alzheimer’s patients often suffer from language disturbances such as anomic aphasia, a severe difficulty in recalling words or names. They also exhibit apraxia, the inability to perform a learned movement in response to a command, even though the command is understood, the patient is willing to obey, and the muscles needed for the movement are intact.
Perhaps most disturbing to caregivers and family members is the appearance of delusions, paranoia, and loss of social control. Deteriorating memory may present itself as the patient getting lost coming home from a place he or she frequents, such as the grocery store. The onset of the disease is insidious, and caregivers often cannot pinpoint when symptoms began to surface. In the late stages, Alzheimer’s patients fail to recognize even their immediate family members. Unfortunately, we have yet to develop a cure or treatment for this awful disease.
Current first line medications, the acetylcholinesterase inhibitors—donepezil, rivastigmine, and galantamine, temporarily slow the progression of the disease, but the patient ultimately continues to decline in mental, functional, and psychiatric status. Acetylcholinesterase inhibitors are most effective in the early stages of the disease. Later on, another drug called memantine could be added on to the existing therapy. However, memantine, too, shows marginal benefit.5 Thus, without truly effective medications, families are left to watch their loved ones wither away into a semblance of who they once were.
Alzheimer’s has a tremendous impact on family members who act as informal caregivers. One can imagine how physically draining it is to care for a person who is disoriented and incapable of performing basic tasks, such as bathing and dressing. In addition, there is a significant emotional aspect to this disease as the caregiver observes his or her spouse, parent, grandparent, or sibling become helpless and sometimes psychiatrically unstable. As a result, caregivers have poorer overall health outcomes than their counterparts who do not provide such care. They often develop depression and anxiety, due to prolonged stress. Alzheimer’s also inflicts a financial burden to both families and society. The yearly cost for a patient under 24-hour care at a nursing home is estimated at $78,000.3 Nearly half of the nursing home population consists of residents with Alzheimer’s disease. Moreover, people with Alzheimer’s are hospitalized 2 to 3 times as often those without. The government absorbs a substantial amount of this financial burden through Medicare and Medicaid.3 Thus, it is in the financial and humanitarian interest of the government to find an effective means of preventing or curing Alzheimer’s before it ravages the baby boomer population.
Recognizing the importance of finding a solution to the Alzheimer’s crisis, the Obama Administration, on January 4, 2011, signed into law the National Alzheimer’s Project Act (NAPA), which stipulates the formation of the Advisory Council on Alzheimer’s Research, Care, and Services. It also requires the Secretary of the U.S Department of Health and Human Services to establish the National Alzheimer’s Project in collaboration with this council. The purpose of the National Alzheimer’s project is “to create and maintain a national plan to overcome Alzheimer’s disease.” In February 2012, the Obama Administration took another leap in the fight against Alzheimer’s when it announced a $156-million investment to help meet the goals of the National Alzheimer’s Project.3
The National Alzheimer’s Project has set, as its foundation, five primary goals: to prevent and effectively treat Alzheimer’s disease by 2025, to enhance care quality and efficiency, to expand support for people with Alzheimer’s disease and their families, to enhance public awareness and engagement, and to improve data to track progress. Preventing Alzheimer’s disease will require a better understanding of its underlying factors, in order to modify risk factors and promote protective factors.3 Although we have a vague understanding of the pathophysiology of the disease, the precise cause continues to elude us.
Early-onset Alzheimer’s disease, which occurs in people ages 30 to 60 and comprises less than 5% of the total Alzheimer’s population, has been linked to single gene mutations on chromosomes 21, 14, and 1. In each of these mutations, the abnormal breakdown of amyloid precursor protein is a primary cause of neuronal damage. This protein normally undergoes specific cleavage by the enzyme secretase before being broken down by the cell’s proteasome. When the amyloid precursor protein is not properly cleaved, it cannot be broken down by the proteasome. Thus, it accumulates in the cell, leading to neuronal destruction and amyloid plaque formation. As more neurons die, the brain slowly atrophies, the characteristic signs and symptoms of Alzheimer’s disease become apparent. On the other hand, a direct genetic association has not yet been found with late-onset Alzheimer’s disease, which occurs in people over 60 and comprises the vast majority of cases.
Having a specific allele of apolipoprotein E predisposes one to developing Alzheimer’s. 6 The NIH is conducting whole genome sequencing to identify areas of genetic variation that correspond to increased or decreased risk of developing the disease. This research is expected to yield new targets for drug development, to improve diagnostic screening and disease monitoring procedures, and, hopefully, to discover ways to prevent disease onset. The search for effective drug therapies will also involve bridging the gaps in our comprehension of the molecular and cellular mechanisms of Alzheimer’s disease progression and conducting clinical trials on the most promising agents. HHS and the Department of Veterans Affairs continue to conduct clinical trials on both pharmaceuticals and lifestyle interventions. Because insufficient enrollment in such trials is a major barrier, HHS is also responsible for coordinating community-, national-, and international outreach programs to increase enrollment. The National Alzheimer’s Project also seeks to coordinate federal government research with that of the private sector, as well as ongoing research abroad.3
The time frame set by the National Alzheimer’s Project is consistent with the need to halt this disease in its tracks before the elderly population increases exponentially. As recognized and addressed in the NAPA, it is vital to promote Alzheimer’s awareness and to educate the public about the disease. Although over 85% of Americans are aware of Alzheimer’s disease, misconceptions about diagnosis and clinical management abound. These misconceptions can cause delays in diagnosis, which, in turn, reduce the effectiveness of treatment. Furthermore, widespread education can help Alzheimer’s patients and their families feel less isolated and stigmatized.3 Perhaps most important, as Alzheimer’s receives greater attention, the resulting increase in research initiatives and funding could bring us closer to a cure.
- “Alzheimer’s Patient Population Projected to Triple by 2050.” Alzheimer’s Patient Population Projected to Triple by 2050. N.p., n.d. Web. 25 Mar. 2013.
- “Alzheimer Disease in the United States (2010–2050) Estimated Using the 2010 Census.” Alzheimer Disease in the United States (2010–2050) Estimated Using the 2010 Census. N.p., n.d. Web. 25 Mar. 2013.
- “National Plan to Address Alzheimer’s Disease.” National Plan to Address Alzheimer’s Disease. N.p., n.d. Web. 25 Mar. 2013.
- “Baby Boomers.” History.com. A&E Television Networks, n.d. Web. 25 Mar. 2013.
- Beizer, Judith. “Alzheimer’s Disease and Related Dementias,” PowerPoint presentation. St John’s University, D’Angelo Center Room 206, 3/12/13
- “Alzheimer’s Disease Genetics Fact Sheet.” National Institute on Aging. N.p., n.d. Web. 25 Mar. 2013.