April 2018

Early Diagnosis of Dementia Essential to Health Care Savings

The nation could save as much as $7.9 trillion in health and long-term care expenditures with earlier diagnosis of Alzheimer’s, according to the special report in the Alzheimer’s Association 2018 Alzheimer’s Disease Facts and Figures report. The special report — Alzheimer’s Disease: Financial and Personal Benefits of Early Diagnosis — features new economic modeling data indicating that early diagnosis of Alzheimer’s during the mild cognitive impairment (MCI) stage of the disease could yield significant cost savings through reduced unnecessary hospitalizations and fewer complications from other chronic conditions.

In today’s environment — in which diagnosis too often occurs in the dementia stage or not at all — the projected health and long-term care costs of an individual with Alzheimer’s is $424,000. The special report explores an early diagnosis scenario in which an individual has a greater likelihood of being diagnosed during the MCI stage; if so, the average per-person cost is projected to be $360,000 — a savings of $64,000 per individual.

In addition to health care savings, early diagnosis also has numerous personal benefits for individuals and families.  People living with Alzheimer’s, for example, can adopt lifestyle changes that may help preserve existing cognitive function for as long as possible and participate in clinical trials that may provide medical benefits. Further, it allows for more time to develop a care plan and perform other future planning regarding legal, financial, and end-of-life decisions.

Learn more about a public health approach to increasing early detection and diagnosis of Alzheimer’s at alz.org/publichealth. 

2018 Report: Growing Impact of Alzheimer’s

The Alzheimer’s Association 2018 Alzheimer’s Disease Facts and Figures report shows that the impact of Alzheimer’s — both human and financial — is growing rapidly.  An estimated 5.7 million Americans are currently living with Alzheimer’s, and the total national cost of caring for people with Alzheimer’s and other dementias is expected to exceed a quarter of a trillion dollars this year.  And, deaths from Alzheimer’s disease increased 123 percent between 2000 and 2015 while deaths from other major causes decreased.

“Discoveries in science mean fewer people are dying at an early age from heart disease, cancer and other diseases,” said Keith Fargo, Scientific Programs & Outreach Director for the Alzheimer’s Association. “Similar scientific breakthroughs are needed for Alzheimer’s disease and will only be achieved by making it a national health priority.”

Other findings from this year’s Facts and Figures report include:

• Total national cost of caring for those with Alzheimer’s and other dementias is estimated to be $277 billion in 2018.
• More than 16 million Americans provide provided 18.4 billion hours of unpaid care for people with Alzheimer’s or other dementias in 2017, a contribution to the nation valued at $232.1 billion.
• It is estimated that the United States has approximately half the number of certified geriatricians that it currently needs, and only nine percent of nurse practitioners report having special expertise in gerontological care.

The full text of the Facts and Figures report—including state-specific data on prevalence, costs, and caregiving—can be viewed online.

Cognitive Impairment Increases Co-Morbid Complications

A literature review found that moderate to severe cognitive impairment — including diagnosed and undiagnosed dementia — increased the risk of mortality, prolonged institutional stays, and decreased function in persons with multiple chronic conditions. Across the 147 articles included for review, the authors also found that significant cognitive impairment may have an impact on the subsequent development of other chronic conditions.

Dementia complicates the management of chronic conditions, including cardiovascular disease, diabetes, and stroke, which may lead to unnecessary hospitalization, poor treatment adherence, or difficulty attending appointments. The authors note that significant cognitive impairment may hinder an individual’s ability to recognize or respond appropriately to early symptoms of chronic conditions.

The Healthy Brain Initiative Road Map—a public health guidebook to address cognitive impairment jointly developed by the Alzheimer’s Association and the Centers for Disease Control and Prevention—recommends better understanding of the effect of dementia on various outcomes including disease management, morbidity, and mortality. 

First Annual Evaluation of New York State Alzheimer’s Caregiver Support Program

The Alzheimer’s Disease Caregiver Support Initiative is a 5-year, multi-component initiative by the New York State Department of Health with annual funding of $25 million. Designed to support caregivers and people with dementia living in the community, the first year’s evaluation report details significant progress to build organizational capacity and develop a cohesive infrastructure throughout the state.

The Caregiver Support Initiative focuses on expanding community supports while also equipping the medical system to provide early diagnoses, quality care management, and linkages to community supports. As service availability expanded during the first year, utilization increased. Core community support service providers documented assisting nearly 12,600 individuals in 23,500 helpline calls, 13,000 New Yorkers in educational sessions, and 5,200 individuals in support groups. Caregivers who received support were found to have been providing care for longer and at a greater intensity than the national average. The clinical Centers of Excellence for Alzheimer’s Disease (CEAD) conducted nearly 5,100 diagnostic assessments, developed 5,900 care plans, and made 18,400 referrals to community services. Almost 12,200 physicians, health care professionals, and students participated in CEAD training. (All data rounded to nearest 100.)

Future evaluations of the initiative will include analyses of health care utilization and costs as well as the impact on caregiver burden. Read the first year’s evaluation online.

Public Health Needs Assessment: South Dakota

In South Dakota, a needs assessment is helping inform the development of a plan to address Alzheimer’s within the state. Commissioned by the South Dakota Alzheimer’s Disease and Related Dementias State Plan Work Group, the needs assessment revealed two major takeaways: services and resources for those living with dementia and their caregivers are inadequate or missing throughout the state; and where services and resources exist, they are constrained by high costs, insufficient workforce numbers, a lack of know-how, and debilitating stigma.

The needs assessment made the following recommendations to improve care in South Dakota:

1. Ensure quality services and resources are available to people with dementia and their caregivers in both rural and urban settings.
2. Develop funding priorities and strategies to ensure Alzheimer’s and dementia services and resources are more affordable for facilities to provide and for families to access.
3. Execute the necessary steps on state and local levels to develop an adequately sized and skilled dementia workforce throughout South Dakota.
4. Prioritize the education and training of professional care providers to improve care quality and efficiencies and provide training opportunities to family caregivers.
5. Reframe how Alzheimer’s and other dementias are understood, seen and cared for throughout South Dakota to reduce stigma and improve the quality of life for people with dementia.

Needs assessments like South Dakota’s can help communities develop, implement, and maintain a public health response to Alzheimer’s and other dementias. Consider conducting a needs assessment in your own state by using the Needs Assessment Toolkit from the Alzheimer’s Association.

Reminder: Risk Reduction Webinar

Remember to join the Alzheimer's Association this Thursday, April 5 from 2:00 to 3:00 pm ET for an interactive webinar to learn what works to reduce risk for dementia and how state and local public health agencies can educate the public. Please register in advance.

Controlling hypertension and cutting smoking are among the interventions recommended by The Lancet International Commission on Dementia Prevention, Intervention and Care based on its evidence review and meta-analysis. Lon Schneider, MD, MS, Keck School of Medicine of the University of Southern California, will discuss the Commission’s lifespan-based model of dementia risk and interventions that may maximize cognition. Molly French, Alzheimer's Association, will highlight the Association's 2015 evidence review of modifiable risk factors and a new study of lifestyle interventions.

The webinar will also feature two health departments that have provided important leadership on moving the science of risk reduction into campaigns to educate the public. Speakers will include Beth Sulkowski, Alzheimer's Association South Carolina Chapter; Rachel Wexler, New Mexico Department of Health; and Gary Giron, Alzheimer's Association New Mexico Chapter. Finally, webinar participants will learn about free communications resources that are available to help public health professionals integrate brain health messaging in health education campaigns. Be sure to register online, mark your calendars for this National Public Health Week event, and forward this message to any interested colleagues.

Researcher Spotlight: Alzheimer’s Disease Registry

This edition of Alzheimer’s Public Health News features insightful work coming from the Healthy Brain Research Network (HBRN). Created by the Centers for Disease Control and Prevention (CDC) to further advance the Healthy Brain Initiative, the HBRN is a thematic public health research network that comprises the collaborative strengths, expertise and diversity of its core academic institutions and community and public health partnerships. Learn more about the HBRN.

The South Carolina Healthy Brain Research Network (SC-HBRN), a network of researchers and community and state partners, provides Alzheimer’s and other dementias education, and conducts research aimed to improve awareness and communication about cognitive health. SC-HBRN also engages with the Arnold School of Public Health’s Office for the Study of Aging (OSA) at the University of South Carolina. OSA is also home to the South Carolina Alzheimer’s Disease Registry, the nation’s oldest and most comprehensive statewide registry of residents diagnosed with Alzheimer’s and other dementias. The Registry has maintained a record of diagnosed cases of dementia in the state since 1988. Data from the Registry indicate that the prevalence of dementia has increased over time and 93,310 residents are living with Alzheimer’s or another dementia. Through the use of the Registry, OSA promotes collaborative research to advance understanding of dementia, supports social and medical services planning, and identifies solutions to the challenges faced by those affected. OSA is also dedicated to providing high-quality education to caregivers of individuals with Alzheimer’s and community members through the Dementia Dialogues® program, which has been utilized by the Utah Department of Health. The SC-HBRN, in partnership with OSA, continues to advance research and education on cognitive health and dementia through research and stakeholder engagement.

The Alzheimer’s Public Health E-News is supported (in part) by Cooperative Agreement #5 NU58DP006115-03, funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
For subscription services or to view previous issues of Alzheimer’s Public Health News, please visit http://alz.org/publichealth/public-health-news.asp or contact John Shean (jshean@alz.org).