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Dementias, Including Alzheimer's Disease

Dementias, Including Alzheimer's Disease

Goal

Reduce the morbidity and costs associated with, and maintain or enhance the quality of life for, persons with dementia, including Alzheimer’s disease.

Overview

Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—to such an extent that it interferes with a person’s daily life. Dementia is not a disease itself, but rather a set of symptoms. Memory loss is a common symptom of dementia, although memory loss by itself does not mean a person has dementia. Alzheimer’s disease is the most common form of dementia, accounting for the majority of all diagnosed cases.

Diagnosis of dementia is key to effective treatment and care. It is important to distinguish dementia from other conditionsa few temporary and/or treatablethat may cause loss of cognitive functioning. These conditions include:

  • Side effects from medication
  • Chronic alcoholism
  • Some tumors and infections in the brain
  • Vitamin B12 deficiency
  • Dehydration
  • Depression
  • Delirium

These conditions are not dementia, but they can be serious and should be treated by a doctor as soon as possible.

Why Are Dementias, Including Alzheimer’s Disease, Important?

In 2013, Alzheimer’s disease was the 6th leading cause of death, for all ages, based on death certificate data.1 Estimates vary, but analysis of data from the Health and Retirement Study estimated that the prevalence of dementia among people older than 70 years of age in the United States in 2010 was 14.7%.2 In 2010, the direct and indirect costs of dementia among those aged 70 years and older totaled an estimated $159 billion to $215 billion (depending upon the monetary value placed on informal care).2

Dementia affects an individual’s health, quality of life, and ability to live independently. It can diminish a person’s ability to effectively:

  • Manage medications and medical conditions
  • Make financial decisions
  • Drive a car or use appliances and tools safely
  • Avoid physical injury
  • Maintain social relationships
  • Carry out activities of daily living, such as bathing or dressing

People living with dementia are at greater risk for general disability and more frequent falls.3 Older adults with dementia are 3 times more likely to have preventable hospitalizations.4 As their dementia worsens, people need more medical and support services and, oftentimes, long-term care. These challenges can exact an emotional, physical, and financial toll on their families, caregivers, and society.5

There are important steps to take to improve the care and support for people with dementia and those who care for them. These include:

  • Increasing the availability of existing effective diagnostic tools
  • Decreasing the number of people with undiagnosed dementia
  • 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

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Understanding Dementias, Including Alzheimer’s Disease

Several factors determine the risk of developing dementia, including age and family history. Other factors affect the management of dementia by families, communities, and the health care system.

Age

Aging is a well-known risk factor for Alzheimer’s disease and other types of dementias. Among adults aged 65 years and older, the prevalence of Alzheimer’s disease doubles every 5 years.6

Gender

More women than men have Alzheimer’s disease and other dementias. Almost 2 in 3 Americans with Alzheimer’s disease are women. Of the 5.1 million people aged 65 years and older with Alzheimer’s disease in the United States, 3.2 million are women and 1.9 million are men.

Family History

People with a family history of Alzheimer’s disease are generally considered to be at greater risk of developing the disease. Researchers have identified 3 genes that are linked to early-onset Alzheimer’s disease. Until recently, only 1 gene had been identified that increases the risk of late-onset Alzheimer’s disease. However, by 2013, international teams studying the genetics of Alzheimer’s disease have identified and confirmed 19 new genes that are associated with increased risk of late-onset Alzheimer’s disease.7

Health Services

Primary care providers do not routinely test for Alzheimer’s disease or related dementias, so people with the disorder may be undiagnosed.4, 8 Alzheimer’s disease and other dementias are more often undiagnosed in rural and minority populations than in urban or white populations.

People with Alzheimer’s disease and other dementias frequently have other chronic medical conditions. Dementias can greatly complicate the medical management of these conditions, increasing the need for coordination of care among different specialists.9, 10

Lack of diagnosis of dementia can seriously reduce a person’s access to available treatments and valuable information. Active medical management, information and support, and coordination of medical and community services have been shown to improve quality and outcomes of care for people with dementia.11, 12

Emerging Issues in Dementias, Including Alzheimer’s Disease

Over the past decade, there has been significant scientific progress in understanding and managing dementia, with research focused on the most common form of the disorder, Alzheimer’s disease. During the next decade, it will be important that progress be made in:

  • Improving the early diagnosis of Alzheimer’s disease and other dementias
  • Developing interventions to delay or prevent Alzheimer’s disease and other dementias
  • Finding better ways to manage dementia when other chronic conditions are present
  • Understanding the influence of lifestyle factors on a person’s risk of cognitive decline and dementia
     

References

1Deaths: Final Data for 2013, table 9. Natl Vital Stat Rep. 2015;64(2). Hyattsville, MD: National Center for Health Statistics. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf.

2Hurd MD, Martorell P, Delavande A, Mullen KJ, Langa KM. Monetary costs of dementia in the United States. New England Journal of Medicine 2013;368:1326-34. DOI: 10.1056/NEJMsa1204629. 

3McGuire LC, Ford ES, Ajani UA. The impact of cognitive functioning on mortality and the development of functional disability in older adults with diabetes: The second Longitudinal Study on Aging. BMC Geriatr. 2006 May 1;6(8) [cited 2010 Mar 15]. Available from: http://www.biomedcentral.com/content/pdf/1471-2318-6-8.pdf [PDF - 291 KB]

4Bynum JP, Rabins PV, Weller W, et al. The relationship between a dementia diagnosis, chronic illness, Medicare expenditures, and hospital use. J Am Geriatr Soc. 2004 Feb;52(2):187-94.

5Elliott AF, Burgio LD, DeCoster J. Enhancing caregiver health: Findings from the resources for Enhancing Alzheimer’s Caregiver Health II Intervention. J Am Geriatr Soc. 2010 Jan;58(1):30-7.

6Jorm AF, Korten AE, Henderson AS. The prevalence of dementia: A quantitative integration of the literature. Acta Psychiatr Scand. 1987;76:465-79.

7Lambert JC, Ibrahim-Verbaas CA, Harold D, Naj AC, Sims R, Bellenguez C, et al. Meta-analysis of 74,046 individuals identifies 11 new susceptibility loci for Alzheimer’s disease. Nat Genet. 2013 Dec;45(12):1452-8. DOI: 10.1038/ng.2802. Epub 2013 Oct 27.

8Harris DP, Chodosh J, Vassar SD, et al. Primary care providers’ views of challenges and rewards of dementia care relative to other conditions. J Am Geriatr Soc. 2009 Dec;57(12):2209-16.

9Carpenter B, Dave J. Disclosing a dementia diagnosis: A review of opinion and practice, and a proposed research agenda. Geronotologist. 2004 Apr;44(2):149-58.

10Alzheimer’s Association, Bynum, J. Characteristics, costs, and health service use for Medicare beneficiaries with a dementia diagnosis—Report 1: Medicare current beneficiary survey. Lebanon, NH: Dartmouth Institute for Health Policy and Clinical Care, Center for Health Policy Research; 2009 Jan.

11Callahan DM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: A randomized controlled trial. JAMA. 2006 May 10;295(18):2148-57.

12Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care: A randomized, controlled trial. Ann Intern Med. 2006 Nov 21;145(10):713-26.

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