Dementia Incidence and Cost

Any of us who are aging certainly feel fear, even dread, around the prospect of developing Alzheimer’s or any other serious dementia.  And for the health system, these diseases are already the number one spending category with little ability to effectively manage the costs.  Alzheimer’s is currently the fifth leading cause of death in the Medicare population.  Since people often need to be institutionalized, usually in specialized care facilities, a heavy burden falls on Medicaid programs as well.  And the costs, financial and psychological, to family and other informal caregivers is also immense.  A study in the journal Alzheimer’s & Dementia portrays a grim picture of rising incidence.   (A & D Article)   About 6.1 million people are estimated to have been diagnosed with Alzheimer’s or mild cognitive impairment in 2017, with the total number projected to rise to 15 million by 2060.  Alzheimer’s currently has significantly higher prevalence rates among African-American and hispanic populations, and these groups are expect to disproportionately contribute to rising incidence rates.  The authors sought to use Medicare FFS data to give some precision to estimates of future disease prevalence.

There were 3.2 million Medicare FFS beneficiaries with an Alzheimer’s or related dementia in 2014.  Women had a greater prevalence than men, at 13.35 versus 9.2%, but this may have an interaction with age, where the prevalence was 3.6% among those aged 65 to 74, versus 34.6% for the cohort over age 84.  African-American prevalence was 14.7%, while hispanic was 12.9% and caucasian 11.3%.  A number of strategies have been identified around “brain health”, including a variety of activities that may stave off development of a dementia, such as music, learning a language, crosswords and physical exercise.  But the real effect of these is not clear and once people have Alzheimer’s or another dementia there is no truly effective treatment.  Drug companies have drilled a series of dry holes trying to find a drug that works.  All that currently exists has minimal efficacy and often serious side effects.  In the absence of a preventative medication or one that would reverse the disease’s course, institutionalization is almost inevitable.  We desperately need to find some treatments soon, or the costs of this disease will be a terrible burden on the health system, but more importantly on individuals and their families.