Changing the Trajectory of Alzheimer's Disease - News Release

ALZHEIMER’S DISEASE TO COST UNITED STATES

$20 TRILLION OVER NEXT 40 YEARS

Washington, D.C., May 19, 2010 – A new report from the Alzheimer’s Association, “Changing the Trajectory of Alzheimer’s Disease: A National Imperative” shows that in the absence of disease-modifying treatments, the cumulative costs of care for people with Alzheimer’s from 2010 to 2050 will exceed $20 trillion, in today’s dollars. The report, which examines the current trajectory of Alzheimer’s based on a model developed by the Lewin Group for the Alzheimer’s Association, also shows that the number of Americans age 65 and older who have this condition will increase from the 5.1 million today to 13.5 million by mid-century.

“We know that Alzheimer’s disease is not just ‘a little memory loss’- it is a national crisis that grows worse by the day,” said Harry Johns, President and CEO of the Alzheimer’s Association. “Alzheimer’s not only poses a significant threat to millions of families, but also drives tremendous costs for government programs like Medicare and Medicaid.”

Total costs of care for individuals with Alzheimer’s disease by all payers will soar from $172 billion in 2010 to more than $1 trillion in 2050, with Medicare costs increasing more than 600 percent, from $88 billion today to $627 billion in 2050. During the same time period, Medicaid costs will soar 400 percent, from $34 billion to $178 billion. One factor driving the exploding costs by 2050 is that nearly half (48 percent) of the projected 13.5 million people with Alzheimer’s will be in the severe stage of the disease – when more expensive, intensive around-the-clock care is often necessary.

Changing the Current Trajectory

The new report is not all bad news, however, as it shows that Medicare and Medicaid can achieve dramatic savings – and lives could be significantly improved – with even incremental treatment improvements. Based on the same Lewin Group model, the report explores two alternate scenarios: one in which a disease-modifying treatment could delay the onset of Alzheimer’s by five years, and another in which a hypothetical treatment could slow the progression of this condition.

“Today, there are no treatments that can prevent, delay, slow or stop the progression of Alzheimer’s disease,” said Johns. “While the ultimate goal is a treatment that can completely prevent or cure Alzheimer’s, we can now see that even modest improvements can have a huge impact.”

Impact of a Hypothetical Treatment Delaying Onset: A treatment breakthrough that delays the onset

of Alzheimer’s by five years – similar, perhaps, to the effect of anti-cholesterol drugs on preventing heart disease – would result in an immediate and long-lasting reduction in the number of Americans with this condition and the cost of their care. A breakthrough that delays onset by five years and begins to show its effect in 2015 would decrease the total number of Americans age 65 and older with Alzheimer’s from 5.6 million to 4 million in 2020.

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Assuming the breakthrough occurred in 2015:

• The number of people age 65 and older with Alzheimer’s would be reduced by 5.8 million in 2050 – 43% of the 13.5 million Americans who would have been expected to have the condition in that year would be free of the conditions.

• In 2050, the number of people in the severe stage would also be much smaller with the treatment breakthrough – 3.5 million instead of the expected 6.5 million.

• Annual Medicare savings compared to current trends would be $33 billion in 2020 and climb to $283 billion by mid-century, while annual Medicaid savings would increase from $9 billion in 2020 to $79 billion in 2050.

Impact of Hypothetical Treatment Slowing Progression: A treatment breakthrough that slowed disease progression – much as we have managed to do with HIV/AIDS and several cancers – would result in far fewer people with Alzheimer’s disease in 2050 in the severe stage when care demands and costs are greatest. Assuming the breakthrough occurred in 2015:

• In 2020, the number of people age 65 and older with Alzheimer’s disease in the severe stage would drop from 2.4 million to 1.1 million. In 2050, the number of people in the severe stage would decline from an expected 6.5 million to 1.2 million.

• Annual Medicare savings compared to current trends would be $20 billion in 2020 and jump to $118 billion in 2050, while Medicaid savings would be $14 billion in 2020 and $62 billion in 2050.

Addressing the Chronic Underinvestment in Research

Ultimately solving the Alzheimer crisis will mean addressing the chronic underinvestment in research. This forecast of a rapidly aging population and dramatic rise in the number of Alzheimer cases in the coming years should catapult the government into action.

“Given the magnitude and the impact of this disease, the government’s response to this burgeoning crisis has been stunningly neglectful,” said Johns. “Alzheimer’s is an unfolding natural disaster. The federal government has sent a token response and has no plan. Immediate and substantial research investments are required to avoid an even more disastrous future for American families and already overwhelmed state and federal budgets,” continued Johns. “For the human effects and the country’s fiscal future, we must change the trajectory of the Alzheimer crisis.”

“The impact of Alzheimer’s disease - both in terms of lives affected and costs of care – is staggering. As government leaders contend with the best approaches to rein in Medicare and Medicaid costs, we know Alzheimer’s will place a massive strain on an already overburdened health care system,” said Robert J. Egge, Vice President of Public Policy for the Alzheimer’s Association. “This report highlights that while we strive for the ideal – a treatment that completely prevents or cures Alzheimer’s disease – even more modest, disease-modifying treatments would provide substantial benefits to families and contribute to the solvency of Medicare and Medicaid.”

The Association is working to enact critical legislation to address these issues. The National Alzheimer’s Project Act creates a National Alzheimer’s Project Office and an inter-agency Advisory Council responsible for developing a national plan to overcome the Alzheimer crisis. Drawing on the expertise residing in various government agencies as well as individuals living with the disease, caregivers, providers and other stakeholders, this office would provide strategic planning and coordination for the fight against Alzheimer’s across the federal government as a whole, touching on a broad array of issues from research to care to support.

After the embargo lifts, the full text of the Alzheimer’s Association’s “Changing the Trajectory of Alzheimer’s Disease: A National Imperative” can be viewed at www.alz.org/trajectory.

By Alzheimer’s Association

The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer’s.

RELEASED MAY 19 AT 10AM ET.

CONTACT: Toni Williams, 202.638.8666; toni.williams@alz.org

Research Explores the Connection between Normal Pressure Hydrocephalus and Alzheimer's Disease

It is estimated that as many as 250,000 people in the U.S. who are experiencing symptoms of Alzheimer's disease and, may actually have related conditions such as NPH ....

Normal Pressure Hydrocephalus (NPH) is a neurological condition which typically affects adults ages 55 and older. This condition was first described in the 1960s as a triad of gait disturbance, dementia, and bladder incontinence.

The ventricles of the brain appear enlarged although the cerebrospinal fluid (CSF) pressure remains normal. Once properly diagnosed, the progression of NPH can be delayed through the surgical implantation of a shunt, a device that channels CSF away from the brain to another part of the body where it can be absorbed.
An estimated 5.3 million Americans have Alzheimer's disease (AD), 5.1 million of which are 65 and older, and 200,000 of which are under 65 with early-onset AD. About 60 to 80 percent of all cases of dementia are attributed to AD.

The proliferation of beta-amyloid plaque is considered a key factor in the development of AD. Beta-amyloid protein accumulates in the brains of patients with AD, activating immune cells that try unsuccessfully to remove it. That triggers the release of poisons that eventually kill nerve cells, leaving behind a trail of plaques and tangles - the remains of nerve cells and fibers, clogged up with beta-amyloid.

Research done at the University of Virginia Health Science Center in Charlottesville, Va., analyzed the clinical connection of NPH to AD. The results of this study, Elucidating the Etiology of Normal Pressure Hydrocephalus (NPH) and the Spectrum of Surgically Treatable Dementias, will be presented by Sebastian F. Koga, MD, 11:20-11:34 am, Tuesday, May 4, 2010, during the 78th Annual Meeting of the American Association of Neurological Surgeons in Philadelphia. Co-authors are David T. Bourne, MD, David E. Bruns, MD, and John A. Jane Sr., MD, PhD.

It is estimated that as many as 250,000 people in the U.S. who are experiencing symptoms of AD and dementia, may actually have related conditions such as NPH, and could benefit from CSF diversion surgery. "Because the symptoms are similar to AD, some patients with NPH are never properly diagnosed or treated, while others who are treated for NPH may suffer concomitantly from AD," stated Dr. Koga. New advances in neurodegenerative proteomics have led to the discovery of biomarkers in CSF which can be used to diagnose various forms of early dementia and perhaps to predict which patients will benefit from shunt implantation.

"Although there are certain differences in the clinical presentation of NPH and AD, our research suggests that these two forms of dementia are part of a wider spectrum of tau-protein abnormalities in the brain. This new perspective could change diagnostic criteria and redefine the surgical treatment options available to patients suffering from dementia," remarked Dr. Koga.

In an effort to mirror recent research advances in AD, this study evaluated CSF biomarkers and correlated these to cortical histopathology samples and neuropsychological outcomes. An ongoing prospective longitudinal study is being conducted at the University of Virginia to include NPH patients treated at this institution, with comprehensive testing performed before and after shunting.

In the first 50 consecutive patients, CSF profiling was performed for biomarkers beta-amyloid, T-tau, P-tau, APOε4 genotyping, and cortical biopsy evaluations for neuritic plaques and tau tangles. These results were analyzed in relationship to clinical progress and neuropsychological testing. The following results were noted:
•Failure to improve after shunting was closely correlated to large numbers of neuritic plaques on biopsy and increased beta-amyloid in CSF.

•The high number of plaques and tangles in frontal lobe biopsies would indicate an advanced form of AD in a significant number of patients.

•Analysis of T-tau, P-tau and beta-amyloid shows that NPH progression mirrors the changes seen in patients with AD.

"Up to 35 percent of NPH patients suffer clinical declines similar to AD patients. The likelihood and pace of this decline can be predicted using currently available CSF biomarkers, which should help reduce the number of shunt re-operations in the future. Improved screening methods are required to refine diagnosis and predict the benefits of CSF diversion. This study further elucidated that NPH is a surgically treatable form of dementia in many cases, and must be considered in the spectrum of tau-proteinopathies. Further in-depth studies are indicated," concluded Dr. Koga.

Dr. Koga and his senior colleagues at the University of Virginia are working to establish a Neurodegenerative Proteomics Laboratory and a specialized NHP Clinic to optimize and expand the treatment options for patients suffering from tau-protein dementias.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 7,600 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.

Disclosure: the author reports no conflicts of interest.

http://www.aans.org/Library/Article.aspx?ArticleId=66409

Contact: Betsy van Die
Media Representatives: If you would like to cover the meeting or interview a neurosurgeon — either on-site or via telephone — please contact the AANS Communications Department at (847) 378-0517 or call the Annual Meeting Press Room beginning Monday, May 3 at (215) 418-2409.

By Bob DeMarco


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