April 28, 2017
Fighting Dementia: Yes We Can
Be Well

Fighting Dementia: Yes We Can

by John Swartzberg, M.D.  |  

I lost my favorite uncle to Alzheimer’s disease almost a decade ago. And a few years ago a good friend was diagnosed with vascular dementia from multiple small strokes (after Alzheimer’s disease, this is the most common cause of dementia). So I was happy to read about new research from the Framingham Heart Study, which found declining rates of vascular dementia. But as the editorial accompanying that study put it, “cautious optimism should not become complacency.”

Dementia affects at least 15 percent of people over age 70, with the risk increasing markedly with advancing years. It does have some biases, disproportionately afflicting women, Hispanics, and certain other minority groups, as well as unmarried people and those with less education.

Much has been written about the toll dementia takes on its suffer­ers and their loved ones. So many families have their personal stories. 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. Despite the apparent declines in rates of vascular dementia, a report by the Rand Corpora­tion predicted that the annual cost of caring for people with dementia could exceed half a trillion dollars by 2040—far outpacing that for cancer and heart disease.

Such estimates don’t even include the equally important “informal costs” of home care by family and friends. The Rand Corporation esti­mated that this additional cost can nearly double the total societal expense. Millions of Americans provide home care for family members with dementia, greatly reducing family finances and national productivity. With conditions such as Alzheimer’s, part of the problem is that care is generally needed for years. And demographic shifts mean that there will be far fewer caregivers in the future.

We urgently need to find better societal solutions while we await effective medical treatments and means of prevention. Some experts advocate insurance-style programs in which the costs of long-term care would be spread across the entire population. But as my colleague Teh-wei Hu, PhD, a health economist here at UC Berkeley and member of our Editorial Board, points out, the American public probably would be unwilling to pay the high price for such cost-sharing programs.

Where should we invest our money to tackle this problem? I’d invest in two areas. First, a Manhattan Project to investigate the underlying causes of—and treatments for—Alzheimer’s disease. Second, more aggressive public health campaigns to inform Americans about preventive measures against other types of dementia. Vascular dementia is largely preventable by the same steps that help protect the heart—notably exercise, a healthy diet, controlling blood cholesterol and blood pressure, and not smoking. Progress has been made in improving such cardiovascular risk factors, but because of disparities in health care as well as in education, large groups of Amer­icans have been left behind.

As for Alzheimer’s disease, I remain hopeful, based on our scientific achievements in medicine and public health over the past 150 years. Think of diphtheria, one of the most devastating diseases of the 19th and early 20th centuries. In 1920 alone, more than 200,000 Americans, many of them children, developed the disease and at least 15,000 died from it. Today it is prevented by a simple shot. Alzheimer’s disease is a tough nut to crack, but so was diphtheria before we understood its cause and how vaccines work. Perhaps we’ll discover a vaccine against Alzheimer’s as well—or at least effective drugs for it. I do believe this is a problem we can solve.