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.
Use And Costs Of Long
An estimated 70% of older adults with Alzheimer’s or other dementias live in the community, compared with 98% of older adults without Alzheimer’s or other dementias. Of those with dementia who live in the community, 74% live with someone and the remaining 26% live alone. As their disease progresses, people with Alzheimer’s or other dementias generally receive more care from family members and other unpaid caregivers. Many people with dementia also receive paid services at home in adult day centers, assisted living facilities or nursing homes or in more than one of these settings at different times during the often long course of the disease. Medicaid is the only public program that covers the long nursing home stays that most people with dementia require in the late stages of their illnesses.
6.3.1 Use of long-term care services by setting
Long-term care services provided at home and in the community
Transitions between care settings
6.3.2 Costs of long-term care services
Affordability of long-term care services
Long-term care insurance
Medicaid costs
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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 biological 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 cognitive decline and dementia by being physically active, 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, social isolation, low educational attainment, cognitive inactivity and air pollution.
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What Are The Most Common Types Of Dementia
- Alzheimers disease. This is the most common cause of dementia, accounting for 60 to 80 percent of cases. It is caused by specific changes in the brain. The trademark symptom is trouble remembering recent events, such as a conversation that occurred minutes or hours ago, while difficulty remembering more distant memories occurs later in the disease. Other concerns like difficulty with walking or talking or personality changes also come later. Family history is the most important risk factor. Having a first-degree relative with Alzheimers disease increases the risk of developing it by 10 to 30 percent.
- Vascular dementia. About 10 percent of dementia cases are linked to strokes or other issues with blood flow to the brain. Diabetes, high blood pressure and high cholesterol are also risk factors. Symptoms vary depending on the area and size of the brain impacted. The disease progresses in a step-wise fashion, meaning symptoms will suddenly get worse as the individual gets more strokes or mini-strokes.
- Lewy body dementia. In addition to more typical symptoms like memory loss, people with this form of dementia may have movement or balance problems like stiffness or trembling. Many people also experience changes in alertness including daytime sleepiness, confusion or staring spells. They may also have trouble sleeping at night or may experience visual hallucinations .
Can Alzheimer’s Disease Be Prevented
As the exact cause of Alzheimer’s disease is not clear, there’s no known way to prevent the condition.
But there are things you can do that may reduce your risk or delay the onset of dementia, such as:
- staying physically fit and mentally active
These measures have other health benefits, such as lowering your risk of cardiovascular disease and improving your overall mental health.
Read more about preventing Alzheimer’s disease.
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Why Is It So Difficult To Diagnose
Even when patients bring up their memory loss or cognitive problems during their routine check-ups, their primary doctors might not always be able to detect it. According to USA Today, 72 percent of doctors had trouble distinguishing between normal aging of the brain and cognitive decline. Another 60 percent of them werent versed in using tests like spinal tests and brain scans to look out for key markers of Alzheimers in the body.
At the same time, theres some questions about how useful these screenings are when it comes to everyday life, because not all health care professionals are ready or able to advise a patient about how the condition will impact decisions such as whether they should continue to drive.
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.
Source: Alzheimers Associations 2021 Facts & Figures Report
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What Are Risk Factors
- Risk factors are aspects of your lifestyle, environment and genetic background that increase the likelihood of getting a disease.
- Risk factors on their own are not causes of a disease. Rather, risk factors represent an increased chance, but not a certainty, that dementia will develop.
- Similarly, having little or no exposure to risk factors does not necessarily protect a person from developing dementia.
There are some risk factors that can be changed, and some that cannot â read on to know which are which!
Read about risk factors for dementia in our downloadable, print-friendly infosheet.
This sheet also contains strategies and lifestyle changes that can help you reduce your risk of developing dementia.
Projections For The Future
Total annual payments for health care, long-term care and hospice care for people with Alzheimer’s or other dementias are projected to increase from $355 billion in 2021 to more than $1.1 trillion in 2050 . This dramatic rise includes more than three-fold increases both in government spending under Medicare and Medicaid and in out-of-pocket spending.
6.6.1 Potential impact of changing the trajectory of Alzheimer’s disease
The Alzheimer’s Association commissioned a study of the potential cost savings of early diagnosis, assuming that 88% of individuals who will develop Alzheimer’s disease would be diagnosed in the MCI phase rather than the dementia phase or not at all. Approximately $7 trillion could be saved in medical and long-term care costs for individuals who were alive in 2018 and will develop Alzheimer’s disease. Cost savings were due to a smaller spike in costs immediately before and after diagnosis due to the diagnosis being made during the MCI phase rather than the dementia phase, which has higher costs, and lower medical and long-term care costs for individuals who have diagnosed and managed MCI and dementia compared with individuals with unmanaged MCI and dementia.
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What Causes Alzheimers Disease
In recent years, scientists have made tremendous progress in better understanding Alzheimers and the momentum continues to grow. Still, scientists dont yet fully understand what causes Alzheimers disease in most people. In people with early-onset Alzheimers, a genetic mutation may be the cause. Late-onset Alzheimers arises from a complex series of brain changes that may occur over decades. The causes probably include a combination of genetic, environmental, and lifestyle factors. The importance of any one of these factors in increasing or decreasing the risk of developing Alzheimers may differ from person to person.
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
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Dementia With Young Onset
Most studies on prevalence of dementia focus on subjects aged over 65 years. Although age is well established as its most important risk factor, dementia may also affect people under the age of 65. Few data exist on the prevalence of dementia in younger people. A recent study in the UK was designed to determine the prevalence of dementia in people under the age of 65 in a large catchment area and use these figures to estimate the number of younger people affected by dementia in the UK. The prevalence of dementia in those aged 3064 was 54 per 100 000. For those aged 4564, the prevalence was 98 per 100 000. Like the studies mentioned above describing prevalence over the age of 65, there was a strong age dependency: from the age of 35 years onwards, the prevalence of dementia approximately doubled with every five year increase in age. In contrast with studies describing populations over 65, males seem at a higher risk to become demented before they reach the age of 65 than females.
Causes of dementia with young onset . Based on Harvey et al.
Risk Factors For Alzheimer’s Dementia
The vast majority of people who develop Alzheimer’s dementia are age 65 or older. This is called late-onset Alzheimer’s. Experts believe that Alzheimer’s, like other common chronic diseases, develops as a result of multiple factors rather than a single cause. Exceptions are cases of Alzheimer’s related to uncommon genetic changes that increase risk.
2.7.1 Age, genetics and family history
The greatest risk factors for late-onset Alzheimer’s are older age,, genetics, and having a family history of Alzheimer’s.-
Age
Age is the greatest of these three risk factors. As noted in the Prevalence section, the percentage of people with Alzheimer’s dementia increases dramatically with age: 3% of people age 65-74, 17% of people age 75-84 and 32% of people age 85 or older have Alzheimer’s dementia. It is important to note that Alzheimer’s dementia is not a normal part of aging, and older age alone is not sufficient to cause Alzheimer’s dementia.
Genetics
| APOE Pair |
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- One in 10 people age 65 and older has Alzheimer’s dementia.,,
- The percentage of people with Alzheimer’s dementia increases with age: 3% of people age 65-74, 17% of people age 75-84, and 32% 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.
3.1.1 Underdiagnosis of Alzheimer’s and other dementias in the primary care setting
3.1.2 Prevalence of subjective cognitive decline
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The 10 Warning Signs Of Alzheimers
Memory loss that disrupts everyday life is not a normal part of aging. It may be a sign of Alzheimers disease, a fatal degenerative brain disorder that worsens over time and causes changes in thinking, reasoning, and behavior. It occurs due to complex brain changes and leads to dementia.
Alzheimers disease generally affects the parts of the brain associated with learning first. Therefore, trouble remembering recently learned information is the most common early symptom of the disease. The symptoms worsen with its progression and include confusion, disorientation, and behavioral changes. At the late stage, the individual gradually loses the ability to speak, swallow, and walk.
Although the disease is more common in people 65 and older , it can also affect those in their 30s, 40s, and 50s .
The following 10 warning signs are common changes that might point to Alzheimers or another dementia. Early detection and early diagnosis are necessary because they provide the best opportunities for treatment, support, and planning for the future.
- Memory changes that disrupt daily life
- Challenges in planning or solving problems
- Difficulty completing familiar tasks
- Withdrawal from work or social activities
- Changes in mood and personality
Not all of these signs mean that a person has Alzheimers, but they do indicate the need to seek medical help.
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Different Types Of Dementia
Dementia is a word used to describe a group of symptoms that occur when brain cells stop working properly. There are a number of diseases that cause dementia.
Alzheimers disease is the most common cause of dementia, but there are other types of dementia too. It is possible to have more than one type of dementia at the same time. Alzheimers is sometimes seen with vascular dementia or dementia with Lewy bodies. You might hear this called mixed dementia.
Page last reviewed: 05/07/2018
Although often thought of as a disease of older people, around 4% of people with Alzheimers are under 65. This is called early-onset or young-onset Alzheimers. It usually affects people in their 40s, 50s and early 60s.
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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.
Managing Alzheimer’s Disease Behavior
Common behavioral symptoms of Alzheimers include sleeplessness, wandering, agitation, anxiety, and aggression. Scientists are learning why these symptoms occur and are studying new treatments drug and nondrug to manage them. Research has shown that treating behavioral symptoms can make people with Alzheimers more comfortable and makes things easier for caregivers.
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Brain Changes Of Alzheimer’s Disease
A healthy adult brain has about 100 billion neurons, each with long, branching extensions. These extensions enable individual neurons to form connections with other neurons. At such connections, called synapses, information flows in tiny bursts of chemicals that are released by one neuron and detected by another neuron. The brain contains about 100 trillion synapses. They allow signals to travel rapidly through the brain, and the information they carry creates the cellular basis of memories, thoughts, sensations, emotions, movements and skills.
The accumulation of the protein fragment beta-amyloid into clumps outside neurons and the accumulation of an abnormal form of the protein tau inside neurons are two of several brain changes associated with Alzheimer’s.
Plaques and smaller accumulations of beta-amyloid called oligomers may contribute to the damage and death of neurons by interfering with neuron-to-neuron communication at synapses. Inside neurons, tau tangles block the transport of nutrients and other molecules essential for normal function and neuron survival. Although the complete sequence of events is unclear, beta-amyloid may begin accumulating before abnormal tau, and increasing beta-amyloid accumulation is associated with subsequent increases in tau.,
Diagnosis Of Dementia Due To Alzheimer’s Disease
- Obtaining a medical and family history from the individual, including psychiatric history and history of cognitive and behavioral changes.
- Asking a family member to provide input about changes in thinking skills and behavior.
- Conducting problem-solving, memory and other cognitive tests, as well as physical and neurologic examinations.
- Having the individual undergo blood tests and brain imaging to rule out other potential causes of dementia symptoms, such as a tumor or certain vitamin deficiencies.
- In some circumstances, using PET imaging of the brain to find out if the individual has high levels of beta-amyloid, a hallmark of Alzheimer’s normal levels would suggest Alzheimer’s is not the cause of dementia.
- In some circumstances, using lumbar puncture to determine the levels of beta-amyloid and certain types of tau in CSF normal levels would suggest Alzheimer’s is not the cause of dementia.
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Who Does Dementia Affect
More than 920,000 people in the UK are living with dementia a number expected to rise to over a million by 2024 .
The vast majority of people with dementia are aged 65 and over, accounting for over 880,000 people. However, an estimated 40,000 people under 65 are living with dementia in the UK .
- there are over 25,000 people with dementia from black and minority ethnic groups in England and Wales, and this is estimated to rise to nearly 50,000 by 2026
- there are 209,600 new cases of dementia in the UK each year
- worldwide, around 50 million people are currently estimated to have dementia and there are 10 million new cases each year
- two thirds of people with dementia are women and over 600,000 women in the UK are now living with dementia. The condition is the leading cause of death in women in the UK.
According to Alzheimers Disease International, the total estimated worldwide cost of dementia was US $1 trillion in 2018. If dementia care were a country, it would be the worlds 18th largest economy . If dementia care were a company, it would be the worlds largest by annual revenue exceeding Apple, Google and Exxon.