Alzheimer’s crisis coming to America
Current quibbling over what Jeb Bush meant when he said it’s time to phase out and replace Medicare – as opposed to “attacking the seniors,” as one woman at a recent event bellowed out – will soon seem quaint against the realities of our future.
Never mind projections that the program will be able to finance only 86 percent of its obligations by 2030. Or that by 2050, the number declines to 80 percent, according to a recently released Social Security and Medicare Boards of Trustees report.
These are relatively comforting numbers compared with new projections from the Alzheimer’s Association. By 2050, the group says, 13.8 million Americans may have Alzheimer’s disease, at a cost of $1.1 trillion per year, mostly to Medicare and Medicaid.
Today, by comparison, 5.3 million have the disease.
“Basically, it will bankrupt Medicare,” said Robert Egge, the Alzheimer’s Association’s chief public policy officer. I met with Egge and chief science officer Maria Carrillo during the association’s recent international conference in Washington.
The 2015 cost of care for Alzheimer’s and all other dementias is estimated at $226 billion, with 68 percent being paid by Medicare and Medicaid, Egge said.
This total includes only direct costs for the care of Alzheimer’s sufferers – there currently is no treatment – and doesn’t take into consideration unpaid care by families. Within the next 10 years, 19 states will see at least a 40 percent increase in the number of people affected.
Lest you feel overwhelmed by numbers – and demoralized by the reduction of human suffering to numerical values – suffice it to say that we are in a state of emergency.
Yet, even with this obvious urgency, relatively few resources have been dedicated to research for prevention and treatment compared with other chronic diseases. This, despite the fact that Alzheimer’s is the sixth leading cause of death in the United States, according to the Centers for Disease Control and Prevention.
Current federal research funding is less than $600 million annually, while top scientists say they’ll need $2 billion a year to meet the association’s 2025 goal of prevention and effective treatment. There’s cause for some hope. Last month, bipartisan House and Senate subcommittees approved increasing funding to the National Institutes of Health for Alzheimer’s research by 50 percent and 60 percent, respectively.
If this funding becomes law – and the association’s goals are met – costs could be reduced by $220 billion over the first five years and $367 billion in 2050 alone, according to an association report. Sixty percent of those savings would accrue to Medicare and Medicaid.
Among other scientific developments reported this week, researchers have isolated a “common ancestor” among all forms of dementia, including Alzheimer’s, Parkinson’s and Lewy body.
“All are caused by misfolding proteins,” Carrillo explained to me. Two different “misfolded” proteins – amyloid beta and tau – are toxic to brain cells.
I am sad to report these proteins cannot be corrected with daily doses of a sturdy zinfandel. There is, however, a new drug that delivers a molecule scientists have created to “chaperone” these proteins so that they fold correctly.
Carrillo doesn’t want to overstate the value of this one-target-one-molecule approach, though it is promising. She suggests that eventually we’ll treat Alzheimer’s with a “cocktail” that will be created based on an individual’s genetic makeup and other factors.
Other hope-inspiring developments include six diagnostic tools that, in combination, can be useful in predicting Alzheimer’s. They include memory and thinking tests, as well as MRI scans that can measure the thickness of the brain’s right entorhinal cortex and the volume of the hippocampus, both of which are important to memory.
It is reassuring that both policymakers and scientists are committed to tackling these diseases. But women especially should be interested in the progress of dementia research. For reasons unknown, women suffer Alzheimer’s at a higher rate – two-thirds of today’s sufferers are women. And women’s function declines twice as fast as men’s. This fall, the association will issue an international call for research on why this is so.
In the meantime, Congress should waste no time in correcting the travesty of too-little funding for a devastating disease that demands our urgent attention. Otherwise, what to do about Medicare will be rendered irrelevant.