Treatment Of Alzheimer’s Dementia
2.5.1 Pharmacologic treatment
None of the pharmacologic treatments available today for Alzheimer’s dementia slow or stop the damage and destruction of neurons that cause Alzheimer’s symptoms and make the disease fatal. The U.S. Food and Drug Administration has approved five drugs for the treatment of Alzheimer’s â rivastigmine, galantamine, donepezil, memantine, and memantine combined with donepezil. With the exception of memantine, these drugs temporarily improve cognitive symptoms by increasing the amount of chemicals called neurotransmitters in the brain. Memantine blocks certain receptors in the brain from excess stimulation that can damage nerve cells. The effectiveness of these drugs varies from person to person and is limited in duration.
Many factors contribute to the difficulty of developing effective treatments for Alzheimer’s. These factors include the slow pace of recruiting sufficient numbers of participants and sufficiently diverse participants to clinical studies, gaps in knowledge about the precise molecular changes and biological processes in the brain that cause Alzheimer’s disease, and the relatively long time needed to observe whether an investigational treatment affects disease progression.
2.5.2 Non-pharmacologic therapy
How Is Alzheimers Disease Treated
Medical management can improve quality of life for individuals living with Alzheimers disease and for their caregivers. There is currently no known cure for Alzheimers disease. Treatment addresses several areas:
- Helping people maintain brain health.
- Managing behavioral symptoms.
- Slowing or delaying symptoms of the disease.
The Basics Of Alzheimers Disease
Scientists are conducting studies to learn more about plaques, tangles, and other biological features of Alzheimers disease. Advances in brain imaging techniques allow researchers to see the development and spread of abnormal amyloid and tau proteins in the living brain, as well as changes in brain structure and function. Scientists are also exploring the very earliest steps in the disease process by studying changes in the brain and body fluids that can be detected years before Alzheimers symptoms appear. Findings from these studies will help in understanding the causes of Alzheimers and make diagnosis easier.
One of the great mysteries of Alzheimers disease is why it largely affects older adults. Research on normal brain aging is exploring this question. For example, scientists are learning how age-related changes in the brain may harm neurons and affect other types of brain cells to contribute to Alzheimers damage. These age-related changes include atrophy of certain parts of the brain, inflammation, blood vessel damage, production of unstable molecules called free radicals, and mitochondrial dysfunction .
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Risk Factors And Prevention
Although age is the strongest known risk factor for dementia, it is not an inevitable consequence of ageing. Further, dementia does not exclusively affect older people young onset dementia accounts for up to 9% of cases. Studies show that people can reduce their risk of dementia by getting regular exercise, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol and blood sugar levels. Additional risk factors include depression, low educational attainment, social isolation, and cognitive inactivity.
What Are The Warning Signs Of Alzheimers Disease
Watch this video;play circle solid iconMemory Loss is Not a Normal Part of Aging
Alzheimers disease is not a normal part of aging. Memory problems are typically one of the first warning signs of Alzheimers disease and related dementias.
In addition to memory problems, someone with symptoms of Alzheimers disease may experience one or more of the following:
- Memory loss that disrupts daily life, such as getting lost in a familiar place or repeating questions.
- Trouble handling money and paying bills.
- Difficulty completing familiar tasks at home, at work or at leisure.
- Misplacing things and being unable to retrace steps to find them.
- Changes in mood, personality, or behavior.
Even if you or someone you know has several or even most of these signs, it doesnt mean its Alzheimers disease. Know the 10 warning signs .
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Numbers Of People With Dementia
Someone in the world develops dementia every 3 seconds. There are over 50 million people worldwide living with dementia in 2020. This number will almost double every 20 years, reaching 82 million in 2030 and 152 million in 2050. Much of the increase will be in developing countries. Already 60% of people with dementia live in low and middle income countries, but by 2050 this will rise to 71%. The fastest growth in the elderly population is taking place in China, India, and their south Asian and western Pacific neighbours.
Demographic ageing is a worldwide process that shows the successes of improved health care over the last century. Many are now living longer and healthier lives and so the world population has a greater proportion of older people. Dementia mainly affects older people, although there is a growing awareness of cases that start before the age of 65.
There are over 10 million new cases of dementia each year worldwide, implying one new case every 3.2 seconds.
Active Management Of Alzheimer’s Dementia
- Appropriate use of available treatment options.
- Effective management of coexisting conditions.
- Providing family caregivers with effective training in managing the day-to-day life of the care recipient.
- Coordination of care among physicians, other health care professionals and lay caregivers.
- Participation in activities that are meaningful to the individual with dementia and bring purpose to his or her life.
- Having opportunities to connect with others living with dementia; support groups and supportive services are examples of such opportunities.
- Becoming educated about the disease.
- Planning for the future.
To learn more about Alzheimer’s disease, as well as practical information for living with Alzheimer’s and being a caregiver, visit alz.org.
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Dementia Statistics Us & Worldwide Stats
You may personally know someone thats affected by dementia, perhaps you have been diagnosed and are currently living with a related condition. Although this diagnosis can be frightening, its important to understand that youre not alone. Across America alone, millions of individuals and their family members suffer from varying conditions which yield symptoms of dementia.
In fact, 7.7 million new cases are diagnosed every year, with 47.5 million people living with dementia worldwide. Based on the high number of individuals affected, dementia is one of the leading cause of dependency and mental impairment among the elderly population.
Alzheimers Is The Most
- Retirees are more fearful of Alzheimers than infectious diseases such as COVID-19, as well as cancer, strokes or heart attacks.
- Findings showed one-in-three of retirees listed Alzheimers as the chronic disease they feared most, 11 points higher than cancer and 13 points more than contagious diseases such as COVID-19.
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Support For Families And Alzheimer’s Disease Caregivers
Caring for a person with Alzheimers can have significant physical, emotional, and financial costs. The demands of day-to-day care, changes in family roles, and decisions about placement in a care facility can be difficult. NIA supports efforts to evaluate programs, strategies, approaches, and other research to improve the quality of care and life for those living with dementia and their caregivers.
Becoming well-informed about the disease is one important long-term strategy. Programs that teach families about the various stages of Alzheimers and about ways to deal with difficult behaviors and other caregiving challenges can help.
Good coping skills, a strong support network, and respite care are other things that may help caregivers handle the stress of caring for a loved one with Alzheimers. For example, staying physically active provides physical and emotional benefits.
Some caregivers have found that joining a support group is a critical lifeline. These support groups enable caregivers to find respite, express concerns, share experiences, get tips, and receive emotional comfort. Many organizations sponsor in-person and online support groups, including groups for people with early-stage Alzheimers and their families.
What To Do If You Suspect Alzheimers Disease
Getting checked by your healthcare provider can help determine if the symptoms you are experiencing are related to Alzheimers disease, or a more treatable conditions such as a vitamin deficiency or a side effect from medication. Early and accurate diagnosis also provides opportunities for you and your family to consider financial planning, develop advance directives, enroll in clinical trials, and anticipate care needs.
Medications To Treat The Underlying Alzheimer’s Disease Process
Aducanumab is the first disease-modifying therapy approved by the FDA to treat Alzheimers disease. The medication helps to reduce amyloid deposits in the brain and may help slow the progression of Alzheimers, although it has not yet been shown to affect clinical outcomes such as progression of cognitive decline or dementia. A doctor or specialist will likely perform tests, such as a PET scan or analysis of cerebrospinal fluid, to look for evidence of amyloid plaques and help decide if the treatment is right for the patient.
Aducanumab was approved through the FDAs Accelerated Approval Program. This process requires an additional study after approval to confirm the anticipated clinical benefit. If the follow-up trial fails to verify clinical benefit, the FDA may withdraw approval of the drug. Results of the phase 4 clinical trial for aducanumab are expected to be available by early 2030.
Several other disease-modifying medications are being tested in people with mild cognitive impairment or early Alzheimers as potential treatments.
Prevalence Of Alzheimer’s And Other Dementias In The United States
Based on updated calculations, an estimated 6.2 million Americans age 65 and older are living with Alzheimer’s dementia in 2021. Seventy-two percent are age 75 or older .
- More than 1 in 9 people age 65 and older has Alzheimer’s dementia.
- The percentage of people with Alzheimer’s dementia increases with age: 5.3% of people age 65 to 74, 13.8% of people age 75 to 84, and 34.6% of people age 85 and older have Alzheimer’s dementia. People younger than 65 can also develop Alzheimer’s dementia, but it is much less common and prevalence is uncertain.
The estimated number of people age 65 and older with Alzheimer’s dementia comes from an updated study using the latest data from the 2020 projections from the U.S. Census Bureau and the Chicago Health and Aging Project , a population-based study of chronic health conditions of older people.
National estimates of the prevalence of all dementias are not available from CHAP, but they are available from other population-based studies including the Aging, Demographics, and Memory Study , a nationally representative sample of older adults., Based on estimates from ADAMS, 11% of people age 65 and older in the United States have dementia.
3.1.1 Prevalence estimates
3.1.2 Mild cognitive impairment due to Alzheimer’s disease
3.1.3 Underdiagnosis of Alzheimer’s and other dementias in the primary care setting
3.1.4 Prevalence of subjective cognitive decline
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Total Cost Of Health Care And Long
Table reports the average annual per-person payments for health care and long-term care services for Medicare beneficiaries age 65 and older with and without Alzheimer’s or other dementias. Total per-person health care and long-term care payments in 2019 from all sources for Medicare beneficiaries with Alzheimer’s or other dementias were over three times as great as payments for other Medicare beneficiaries in the same age group .,
|TOTAL* Payments from sources do not equal total payments exactly due to the effects of population weighting. Payments for all beneficiaries with Alzheimer’s or other dementias include payments for community-dwelling and facility-dwelling beneficiaries.||50,201||14,326|
- * Payments from sources do not equal total payments exactly due to the effects of population weighting. Payments for all beneficiaries with Alzheimer’s or other dementias include payments for community-dwelling and facility-dwelling beneficiaries.
- Created from unpublished data from the Medicare Current Beneficiary Survey for 2011.
Estimates Of The Number Of People With Alzheimer’s Dementia By State
Table lists the estimated number of people age 65 and older with Alzheimer’s dementia by state for 2020, the projected number for 2025, and the projected percentage change in the number of people with Alzheimer’s between 2020 and 2025.,
|Projected Number with Alzheimer’s||Percentage Increase|
- Created from data provided to the Alzheimer’s Association by Weuve et al.,
As shown in Figure , between 2020 and 2025 every state across the country is expected to experience an increase of at least 6.7% in the number of people with Alzheimer’s. These projected increases in the number of people with Alzheimer’s are due solely to projected increases in the population age 65 and older in these states. Because risk factors for dementia such as midlife obesity and diabetes can vary dramatically by region and state, the regional patterns of future burden may be different than reported here. Based on these projections, the West and Southeast are expected to experience the largest percentage increases in people with Alzheimer’s dementia between 2020 and 2025. These increases will have a marked impact on statesâ health care systems, as well as the Medicaid program, which covers the costs of long-term care and support for many older residents with dementia, including more than a quarter of Medicare beneficiaries with Alzheimer’s or other dementias.
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What Is Alzheimers Disease
- Alzheimers disease is the most common type of dementia.
- It is a progressive disease beginning with mild memory loss and;possibly leading to loss of the ability to carry on a conversation and respond to the environment.
- Alzheimers disease involves parts of the brain that control thought, memory, and language.
- It can seriously affect a persons ability to carry out daily activities.
Projected Growth Of Dementia
If current trends continue and no action is taken, the number of people with dementia in the UK is forecast to increase to 1,000,000 by 2025 and 1,590,000 by 2040.
Many people talk about a ‘dementia time bomb’ that the state cannot cope with. This is misleading. A steady, rather than dramatic, growth is expected over the next 25 years.
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Use And Costs Of Health Care And Long
Among Medicare beneficiaries with Alzheimer’s or other dementias, black/African Americans had the highest Medicare payments per person per year, while whites had the lowest payments . The largest difference in payments was for hospital care, with black/African Americans incurring 1.7 times as much in hospital care costs as whites .
- Created from unpublished data from the National 5% Sample Medicare Fee-for-Service Beneficiaries for 2014.
In a study of Medicaid beneficiaries with a diagnosis of Alzheimer’s dementia that included both Medicaid and Medicare claims data, researchers found significant differences in the costs of care by race/ethnicity. These results demonstrated that black/African Americans had significantly higher costs of care than whites or Hispanics/Latinos, primarily due to more inpatient care and more comorbidities. These differences may be attributable to later-stage diagnosis, which may lead to higher levels of disability while receiving care; delays in accessing timely primary care; lack of care coordination; duplication of services across providers; or inequities in access to care. However, more research is needed to understand the reasons for this health care disparity.
A Costly And Growing National Crisis
- In 2021, the total national cost of caring for people living with Alzheimers and other dementias is projected to reach $355 billion. This number does not include the estimated $257 billion price of unpaid caregiving.
- Medicare and Medicaid are expected to cover $239 billion, or 67%, of the total health care and long-term care payments for people with Alzheimers or other dementias. Out-of-pocket spending is expected to be $76 billion, or 22% of total payments.
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Causes Of Alzheimer’s Disease And Related Dementias
The causes of Alzheimers disease are not currently known, but research suggests a combination of genetic, environmental and lifestyle factors may contribute and affect each individual differently. The most recognized risk factor for developing cognitive decline and dementia is advancing age. According to the National Institute on Aging, the likelihood of developing Alzheimers disease doubles every 5 years after age 65. The number of people with Alzheimers disease and related dementia increases dramatically after age eighty.
How Does Alzheimer’s Disease Affect The Brain
Scientists continue to unravel the complex brain changes involved in Alzheimers disease. Changes in the brain may begin a decade or more before symptoms appear. During this very early stage of Alzheimers, toxic changes are taking place in the brain, including abnormal buildups of proteins that form amyloid plaques and tau tangles. Previously healthy neurons stop functioning, lose connections with other neurons, and die. Many other complex brain changes are thought to play a role in Alzheimers as well.
The damage initially appears to take place in the hippocampus and the entorhinal cortex, which are parts of the brain that are essential in forming memories. As more neurons die, additional parts of the brain are affected and begin to shrink. By the final stage of Alzheimers, damage is widespread and brain tissue has shrunk significantly.
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Why Are Dementias Including Alzheimers Disease Important
In 2014, Alzheimers disease was the 6th leading cause of death among adults aged 18 years and older based on death certificate data.1 Estimates vary, but analysis of data from the Chicago Health and Aging Project and 2010 U.S. Census data suggests that the prevalence of dementia among adults aged 65 years and older in the U.S. in 2016 is 11%, or 5.2 million people.2,3 The estimated total cost for health care, long-term care, and hospice for persons with Alzheimer’s disease and other dementias is estimated to be $236 billion for 2016.2
Dementia affects an individuals health, quality of life, and ability to live independently. It can also diminish a persons ability to effectively:
- Manage medications and medical conditions
- Make financial decisions
There are important steps to take to improve the care and support for people with dementia and their caregivers. These include:
- Increasing the availability of existing effective diagnostic tools
- Reducing the severity of cognitive and behavioral symptoms through medical management
- Supporting family caregivers with social, behavioral, and legal resources
- Encouraging healthy behaviors to reduce the risk of co-occurring conditions