Costs for care of Alzheimer’s patients estimated at $200 billion annually

The lack of progress in treatment for Alzheimer’s disease has been very disappointing, especially since one in eight older Americans has Alzheimer’s and payments for care are estimated at $200 billion per year.

“A lot of the clinical trials have failed, unfortunately,” said Denise Compton, PhD, a neuropsychologist\clinical psychologist and assistant professor at the UAMS Reynolds Institute on Aging Walker Memory Center. “The research community is shifting their emphasis slightly. The hope of the research community would be to detect the disease in the brain prior to detection of clinical symptoms that are severe enough to cause dementia, and then develop effective treatments at that very early stage. They are making progress at early diagnosis. Neuro-imaging has advanced, but not to the point of using it for a conclusive diagnosis.”

Compton said finding effective treatments has been so difficult because of the lack of understanding the true causes of the disease. It is not known if the amyloid protein plaques found in the brain are causing the symptoms or if they are a result of other causative factors.

Despite the staggering cost of Alzheimer’s, advocacy groups such as the Alzheimer’s Association are concerned at the paucity of money available for research.

“But the political climate has trended toward a decrease in funding for things like research, rather than an increase,” Compton said. “From the public health policy perspective, the cost of taking care of these increasing numbers of patients is going to be tremendous.”

Screening for Alzheimer’s can be difficult. Often primary care providers are consulted when family members have difficulty coping.

“I don’t know that primary care providers have time to do a thorough evaluation,” Compton said. “What we know for sure is that Alzheimer’s is the most common cause of dementia in older adults, but there are many other diseases and disorders that can cause someone to have a change in their mental status. It takes a fairly thorough evaluation to make sure you are treating the right conditions. In our memory center here, we see a lot of people experiencing cognitive problems due to medication side effects or general medical conditions. Those things have to be ruled out or addressed first before we diagnose mild cognitive impairment or dementia.”

Compton recommends physicians consider referrals to the Walker Memory Center at the UAMS Reynolds Institute of Aging.

“Consultation service is available,” Compton said. “There are lots of causes for dementia. We assist community providers with a comprehensive diagnostic evaluation and provide advice on both medical treatments and caregiver interventions. We have social workers, neuropsychologists, a behavioral neurologist and a geriatric psychiatrist as part of our multi-disciplinary team. So we can be helpful.”

Currently, because of the lack of safe and effective medications for behavioral problems associated with moderate to severe Alzheimer’s, Compton said they focus heavily on caregiver education and intervention. The goal is to manage behavior with caregiver education rather than medicine that often has adverse side effects.

Compton highly recommends Alzheimer’s prevention through regular exercise, a healthy diet, maintaining a good body weight, controlling blood pressure and avoiding diabetes. Diabetics have higher rates of Alzheimer’s, which has been described by some as Type 3 diabetes.

In addition to those preventive measures, also recommended are intellectually challenging and intellect preserving activities like higher education, leisurely activities, socialization, exercise, statins, a cholesterol lowering diet, and protection from head trauma. Music and puzzles aimed at optimizing the emotional and cognitive reserve of aging persons are recommended by Sara Battar, MD, associate chief of staff for geriatrics and extended care service, Central Arkansas Veterans Healthcare System (CAVHS).

For patients who are showing early symptoms, Battar said three types of drugs have been proven to statistically impact cognition: Donepezil, Rivastigmine, and Galantamine can provide a five- to ten-month delay in progression to full-blown Alzheimer’s.

“That is a lot,” she said. “That is six more months someone doesn’t have to be institutionalized.”

Early diagnosis and appropriate management of dementias can improve quality of life for both the patients and caregivers. Effective management would most likely stabilize or slow the cognitive decline, help reduce the decline of independence, and help better prepare for and manage behavioral and psychological symptoms of dementia.

CAVHS has a memory clinic geared to early diagnosis and management of dementia and memory related disorders.

“We do neuropsychological testing, and one of the areas we are concentrating on is early diagnosis of impaired driving that is a threat to patients and those on the road,” Battar said. “We are working hard on making the program more popular and visible. If they are only mildly impaired drivers, our specially trained staff can assist them with tolls for safe driving and warnings about when to stop driving.”

One unique facet of the VA program is contrary to the physicians unilaterally deciding a treatment for patients, they enter into a partnership with the veterans served.

“Instead of traditional treatment, we ask patients to tell us what is important to them, and we will figure out a way to meet those needs,” Battar said. “It is coming away from just medicine and pills to what is personally, emotionally, spiritually and socially important to this person. We ask, ‘What is it that you would like to do, but cannot do now because of your illness?’ The patient’s priority will become our priority.”

An example is a 101-year-old inpatient who is a good guitar player and singer.

“If he doesn’t look too happy, hand him a guitar or ask him to sing a song for you, and he goes into a different world,” she said. “He isn’t agitated or upset. His memory is compromised, but he starts calming down, reminisces about his youthful days, remembers the words to some old songs, and is a joy to be with.”

The VA is investing a lot in training future generations of health professionals to care for dementia patients. It also has services like adult day healthcare from 8 a.m. to 4 p.m. While in attendance, patients play games, and interact with other veterans. The family knows their loved one is safe, and will get his or her medications, medical appointments, food and caring company.

“That allows the family to be able to work, and attend to their own needs” Battar said. “And when it is time and now this person needs another level of care such as hospice care, we help families shift gears and work with them to facilitate a closure. Staff from various disciplines work with compassion and competence to take care of patients with dementia and their families across various stages from mild memory loss to advanced and terminal stages of the illness. It is indeed a very rewarding and privileged opportunity to serve those who already served.”

For more information visit:

www.alz.org or

www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet