Alzheimer's Patients in the U.S. to More than Double by 2060!

Original: Dec. 11, 2017; Updated: Nov. 12, 2019.

Did you know? As individuals live longer, their risk of "developing dementia" will continue to grow - exponentially though. Their risk of developing dementia will increase by one-third after turning 85. For Alzheimer's (a subset of dementia), the UCLA Fielding School of Public Health study shows that the number of Americans with Alzheimer’s dementia or mild cognitive impairment will increase to 15 million by 2060 - a two-fold increase over today's total (Reddy, 2019). Other studies report that nearly 82 million individuals are expected to be living with dementia (Hull, 2019).

Nature of the Illness? Alzheimer's is a chronic neurodegenerative disease, with no available cure at present. It starts slowly but progressively increases over time. Considered one of the most feared medical conditions, it strips its victims of their memories and disables them from self-care and other essentials daily living functions. Mild cognitive dementia refers to an intermediate clinical state - not yet fully-fledged dementia.

In the U.S., there are about 47 million people today who have some evidence of preclinical Alzheimer's - either a build-up of protein fragments called beta-amyloid or neuro-degeneration of the brain but don't yet have symptoms. According to the Alzheimer’s Association estimates, the number of Americans with Alzheimer’s dementia now is about 5.5 million. There is also about 2.4 million U.S. citizens with mild cognitive impairment due to Alzheimer’s disease (Reddy, 2019). The total annual cost to treat their mental disorders (dementia and Alzheimer's diseases) is now about $243 billion annually (Helmer, 2019).

Alzheimer's Dementia Prevalence Simulation: The Journal of the Alzheimer's Association research objective is to stimulate the prevalence of those U.S. citizens with mild cognitive impairment or preclinical Alzheimer’s diseases. For their methodology, researchers closely analyzed findings from many of the largest studies conducted about the rates of progression of Alzheimer’s disease. Then, they created computer modeling from information of these studies. One of the underlying parameters of the computer model was the aging of the American population.

Using the computer model, the researchers found that by the year 2060, 9.3 million Americans will have dementia due to Alzheimer’s, while about 5.7 million will be suffering from mild cognitive impairment. Among the ones who will have dementia, 4 million will be in need of intensive care akin to what’s provided in nursing homes. According to Ron Brookmeyer, the findings illustrate the need to create methods to slow the progression of the disease in individuals with early indications of neuro-pathological changes. Such indications could result in more widespread of Alzheimer’s dementia, if kept unchecked.

The findings highlight the need to develop measures that could slow the progression of the disease in people who have said Ron Brookmeyer, professor of bio-statistics at the UCLA Fielding School of Public Health and the study’s lead author. The country’s population is aging and with it comes a growing number of people with Alzheimer’s disease.

Considering how the U.S. population is aging, there will be more individuals with added risk of Alzheimer’s disease. "Estimates by disease state and severity are important because the resources needed to care for patients vary so much over the course of the illness," noted Brookmeyer. In response, there is an urge to develop new ways to identify progressive symptoms in individuals with indications of neuro-pathological changes.

As advances in the pharmacological "treatment or cure for dementia" regress or disappoint, researchers focus has shifted to prevention measures (Reddy, 2019). New interventions could be developed to slow the progression of the disease. "Many of them will not progress to Alzheimer's dementia in their lifetimes. We need to have improved methods to identify which persons will progress to clinical symptoms, and develop interventions for them that could slow the progression of the disease, if not stop it all together."

Certain issues limit its broader perspective to the population. One issue is the participants of the study don’t fully represent all the demographics in America. Another one is other forms of dementia — like vascular dementia — weren’t examined. There are many other dementia types, to be identified by an ageing population.

Partial Reason for Dementia: "A March 2015 retrospective study on 3,434 participants with history of OTC and prescription drug use showed 797 or 23% of the participants had developed Dementia over the 7-year period. The collaboration between the University of Washington and Seattle healthcare system showed the anticholinergics as the main culprit. These are types of drugs used for treatment of urinary incontinence, Parkinson's disease, and COPD (Chronic Obstructive Pulmonary disease), as well. In blocking the actions and effects of acetylcholine - a chemical which causes muscles to contract, to activate pain responses, and to regulate endocrine and REM sleep functions. The findings show that refraining from such medicines may help with increased brain function (Hull, 2019)."

Dancing to Fight Dementia: A study at the Albert Einstein College of Medicine is evaluating whether "group dancing" could help in preventing dementia. Though there is not enough research yet to conclusively determine the utility of dancing, there has been a number of studies showing the benefits of exercise in general to improving cognitive skills. Therefore, with aerobic exercise resulting into positive structural changes in the brain, would "group dance" improve cognitive health, also?

Previous studies have shown "different forms of exercise had different but sometimes overlapping benefits to brain and cognitive health," noted Art Kramer of the Center for Cognitive and Brain Health at Northeastern University in Boston. Other researchers were able to show that dance may provide special benefits (being more focused) over exercise in general.

The Einstein study will shed more light on the issue by comparing the cognitive effects of "group dance" classes with treadmill walking. Here, the hypothesis is that "group dancing" in general and "social ballroom dancing" in particular will be "more efficient" than treadmill exercise in improving cognitive skills. Arguably, such form of dancing might be beneficial, as it's "involves not only physical exercise but also social and cognitive activity." For the study, 32 participants age 65 and older were defined as "at risk of developing dementia" based on memory test, own accounts of remembering and recalling, as well as performing certain tasks.

Then, they were divided up into two groups - one group twice a week for the "group dancing" to the "hustle & salsa to tango and fox trot, and another twice a week for the "treadmill walking." After measuring their "executive function," both group of participants had testing done before, during, and after of their cognitive processes for coordinating complex behaviors such as planning and reasoning. They also receive MRI brain scans to explore any changes in the functional and structural connectivity in the brain. After tabulating the data, the findings might show that "group dancing" contribute to "reducing the risk of developing dementia - mainly given its combination benefits of social engagement, cognitive engagement and physical activity (Reddy, 2019).

Hospices' Role: With the increase in their numbers coinciding with the complexity of their care, Alzheimer's patients might require more services along their continuum of care. More important than ever are the invaluable services for end of life hospice's care, like "symptom control, pain management, and bereavement care." Such hospice care can be afforded via "domiciliary or inpatient care, nursing homes, or home care." Though hospice care is expanding in the US, hospices across the UK are facing budgetary shortages, leading to cut, delay, or cancel of services. The 30% of government funding for adult hospice care has not kept up with increases in either need and costs (Small, 2019).

Provider Profile: Neurological disorders affect more than 100 million Americans every year - patients of all ages. Neurologists are their main medical providers whose foci are the diagnosis and treatment of conditions that affect their brain, spinal cords, and nerves. With deep understanding of the nervous system functionalities, those providers might diagnose spina bifida in utero or treat elderly suffering with Alzheimer's or Parkinson's disease.

With over 600 neurological diseases, it is almost impossible for neurologists to be well-versed in the latest research and treatments. They often specialize on specific areas of the nervous system, like the movement, seizure, headache, and memory disorders, with additional focus on the treatment of specific conditions. They work at hospitals, medical clinics, as well as private medical offices. Some might also be engaged in applying research for treatments or cures for diseases that affect the nervous system.

Their treatment plans span both acute and chronic conditions. This might be a "consult after suffering a concussion" or a key provider "if you are living with a disease such as epilepsy or muscular dystrophy." Typically, the first step is to diagnose for neurological disorders using tests ranging from CT scans and magnetic resonance imaging (MRI) to biopsies. Once the diagnosis is confirmed, an array of treatments such as medication, supplements, biofeedback, and relaxation training are deployed. For surgery, the neurologist refer patients to a neurosurgeon (Helmer, 2019).

Side Note: It is important to keep Alzheimer's patients mentally engaged. As they get older, time seems to just roll over with every year seems shorter. Our brain marks time through novel/recurring experiences. As we grow up from toddlers, adolescents, to adults, we continue to create and reinforce memories. Then, we settle down into a routine as adults, turning our days, weeks, months, and even years into one long time zone. To keep time from flying by, we need to deliberately create new memories, the British psychologist Claudia Hammond explains (Yeager, 2019).

Side Note: According to a John Hopkins study of participants' brain scans, hearing loss could contribute to brain atrophy. Dr. Frank Lin study postulates the effect of hearing impairment on individuals. He asserts those individuals are more likely to engage less in conversation, much less being around others. The findings revealed that mild hearing loss doubled the risk of dementia, while moderate loss tripled the risk. Individuals with severe loss were five-times more likely to develop dementia (John Hopkins Medicine, 2019).

Note: Holiday Tips for Dementia Caregivers & Dementia Patients (Alzheimers.net, 2019). The following content is unedited ... 

"1. Avoid crowded and noisy places. Loud or startling noises can further confuse or frustrate someone living with dementia. Instead, prioritize smaller and more low-key events that won't add to confusion or stress.

 2. Give yourself permission to say "no." You are not obligated to attend every social gathering of the season, and you are not obligated to host parties in your home. Remember that each commitment you agree to means you are saying no to something else, like relaxing with family.

3. Involve your loved one in holiday preparations. The holidays are fun and having loved ones participate in the fun can create special memories for you. Decorating cookies, hanging decorations, setting the table, and even wrapping gifts are some examples of things people with dementia can do.

5. Maintain routines. This can be challenging when gatherings go late, but try to keep your loved one on a similar routine so holiday preparations do not become disruptive.

6. More meaning, less stuff. If your to-do list is pages long and you aren't enjoying the season, take a step back and see what you can cut to enjoy the holidays with your family. It's a time for giving, a time for family, a time for friends and togetherness. Be kind to yourself, remove some items on your list, and enjoy the presence of loved ones.

7. Prepare out-of-town-guests. Holiday visits can be challenging for caregivers and guests alike. Let visiting family and guests know that their loved one may not remember them and explain any known behavioral issues to make yourself and guests feel more comfortable should something arise.

Note: Neil Small is a professor of Health Research, Faculty of Health Studies, University of Bradford, UK

References:

Alzheimers.net. (November, 2019). Tis the Season: Holiday Tips for Dementia Caregivers. Breath, Believe, Recover. Leeza's Care Connection, https://campaign.r20.constantcontact.com/render?m=1101954620289&ca=777e1b3e-1b11-40e3-a386-d4a3896bb709

John Hopkins Medicine. (2019, November). Breath, Believe, Recover. Leeza's Care Connection, https://campaign.r20.constantcontact.com/render?m=1101954620289&ca=777e1b3e-1b11-40e3-a386-d4a3896bb709

Dings, Dhinoj. (2017, Dec. 7). The Number Of American Alzheimer’s Patients Will More Than Double By 2060. International Business Times. https://www.msn.com/en-us/health/medical/the-number-of-american-alzheimer’s-patients-will-more-than-double-by-2060/ar-BBGl2vU?li=AA5LBhu&ocid=spartanntp

Helmer, Jodi. (2019, September). Who's Who: Neurologist. Ai's Impact on Medicine. WebMD, p. 75

Hull, Jewel. (2019, Nov. 7). The Lake Murray Fish Wrapper - www.lexingtonchronicle.com, p. 10

Reddy, Sumathi. (2019, August 20). Your Health: Dancing to Fight Dementia. WSJ, p. A10

Small, Neil (2019, Sept. 23). Hospices have a role to play in dementia care. [Letters]. Financial Times, p. 18

Yeager, Selene. (2019, Aug/Sept). As I get older, time seems to just fly by. Every year seems shorter. AARP / Real Possibilities, Vol. 61, No. 5A, p. 15

Supplement Readings:

2017 Alzheimer's Disease Facts and Figures. Alzheimer Association. https://www.alz.org/facts/

Mather, Mark. (2016, January). Fact Sheet: Aging in the United States. Population Reference Bureau. https://www.prb.org/Publications/Media-Guides/2016/aging-unitedstates-fact-sheet.aspx

Rivero, Enrique. (2017, Dec. 8). About US: Population of Americans with Alzheimer’s will more than double by 2060, UCLA study shows. UCLA Health. https://www.uclahealth.org/population-of-americans-with-alzheimers-will-more-than-double-by-2060-ucla-study-shows

Well-More Assisted Living/Memory Care/Skilled Nursing/Rehab - www.Well-More.com