October 23, 2016
Derailing Dementia
Be Well

Derailing Dementia

by John Swartzberg, M.D.  |  

I lost my favorite uncle a few years ago to Alzheimer’s disease. Last month, a good friend was diagnosed with vascular dementia from multiple small strokes (vascular dementia, also called multi-infarct dementia, is the second most common cause of dementia in the U.S. next to Alzheimer’s disease).

Dementia is an equal opportunity disease, affecting three out of 20 people over 70 years old. It does have some interesting biases: women more than men; Hispanics and other non-white ethnicities greater than whites; unmarried more than married; less educated more than educated.

There has been much written about the toll this problem takes on the individual and his or her loved ones. So many families have their personal story. I remember my aunt saying she would never put my uncle into “one of those homes.” But, in spite of her heroic efforts, she, like most, relented; she really had no choice.

There’s also an enormous toll on society. A recent report by the Rand Corporation predicts that the annual cost caring for people with dementia could exceed half a trillion dollars by 2040. It points out that already the “market costs” (Medicare, out of pocket, formal home care, nursing home care) of dementia outstrip cancer and heart disease.

But, market costs do not include the equally important “informal costs” of home care. The Rand Corporation estimates that this additional cost can raise the total societal expense nearly 50 to 100 percent. Millions of Americans provide care in the home for a family member. This is productivity time lost to society and loss of income for the family. With conditions such as Alzheimer’s disease, part of the issue is the length of time in which care is needed; this can exhaust both finances and the caregivers. And, demographic shifts suggest that there will be far fewer caregivers in the future.

Finding a better solution is urgent. Some have suggested an insurance-style solution where the costs of long-term care could be spread across the entire population rather than focused on individuals and families struggling with the disease. Teh Wei Hu, my good friend and a professor in the School of Public Health at UC Berkeley, is a health economist. He points out that the costs of this type of insurance may be beyond what society would be willing to pay.

Where should we invest our money to tackle this problem? While insurance on a societal level sounds attractive (if affordable), it manages the problem but doesn’t solve it.

I’d rather invest in two other areas: One, a Manhattan Project-like assault into understanding the underlying causes of—and treatments for—Alzheimer’s disease. Two, I'd like to see a more aggressive public health approach to inform and educate Americans as to effective preventive measures for most types of dementia.

The research argument reminds me of the discussions several generations ago about what to do with the scourge of polio. In the 1950’s, nearly 50,000 people a year, mostly children, were paralyzed by the polio virus. Iron lungs could take the place of respiratory muscles and many advocated for increased investment in producing these.

Fortunately, the bulk of society’s money went to discovering vaccines. Thanks to vaccination, we'll see the complete eradication of polio in the near future; it was eradicated in the U.S. in 1979.

Perhaps we’ll discover a vaccine that will prevent Alzheimer’s disease; perhaps there will be a drug; perhaps both. Certainly, we could pour more and more money into research and not come up with a solution. But, given the scientific achievements in medicine and public health over the past 150 years, there’s every reason to think this is a problem we can solve.

It’s also important to recognize that much more can be done right now. Multi-infarct dementia is preventable for the most part by taking care of your cardiovascular system: exercise, a healthy diet, controlling your cholesterol and blood pressure.

Dementia rates have dropped by more than 20 percent during the past two decades, according to a large study of people ages 65 and older in England and Wales, published in The Lancet in July 2013. The authors attributed this improvement to better control of blood pressure and cholesterol. Better education, also linked to lower risk, may be another factor. U.S. experts expect the same trend is occurring here.

As for Alzheimer’s disease, I think there’s something tucked into the statistics I mentioned above. They all are a reflection of the health of a society: less socioeconomic disparity, better access and opportunity for education, a more stable family life. We can do much better in all of these areas.