Alzheimer’s Disease and Dementia

by Asia Sikora, PhD, Assistant Professor, Department of Health Promotion, Social and Behavioral Health

Alzheimer’s disease (AD) is now the fifth leading cause of death for those 65 years of age and older in the United States. An estimated 5.4 million people are currently affected by some form of dementia, the most common of which is AD. While the cause of AD is yet unknown, it is believed that the accumulations of proteins inside and outside of nerve cells in the brain contribute to its development. Other major risk factors include advanced age, family history, diabetes, smoking, depression, and the presence of the epsilon 4 allele of the gene Apolipoprotein E (APOE- ε4).

The costs associated with this disease are significant and will continue to rise with a rapidly aging population. In 2010, an estimated 15 million people provided 17 billion hours of unpaid care, a value of $202 billion in foregone labor market productivity. In addition, the cost of health care, long-term care, and hospice for those with dementia is projected to be $183 billion in 2011, with Medicare and Medicaid shouldering 70% of the burden.

Researchers around the country and at the University of Nebraska Medical Center are engaging in a wide spectrum of projects related to this disease—determining risk factors, finding medical and nonmedical interventions, and providing effective care for those afflicted with the debilitating condition. Only cognitive engagement and physical activities show a fairly consistent association with decreased risk of AD and cognitive decline, according to a 2010 report released by the Agency for Healthcare Research and Quality. The report concluded that more evidence is needed to understand whether other factors have a consistent association with AD or cognitive decline. Currently, five drugs have been approved by the US Food and Drug Administration for the management of AD symptoms; however, these therapies only slow the progression of the disease in early to moderate stages for six to twelve months and are effective for only half of the individuals who take them.

In addition to the absence of effective pharmaceutical therapy and conclusive evidence of preventive factors, several major challenges continue to face the medical community. The first is a looming shortage of geriatric physicians and specialists, such as social workers, registered nurses, and pharmacists, to help provide paid caregiver services. Second, proper guidelines incorporating new, simple, and cost-effective tests for dementia need to be developed and adopted by the medical community to identify patients who require further screening and to promote earlier detection. Finally, family members and caregivers need to be better informed about the disease, its symptoms, and the support available to them and for those afflicted. Knowing the difference between memory loss as a sign of the aging process rather than part of a disease process will help maintain a higher quality of life for those afflicted through proper diagnosis and care.