Ask an Expert about Alzheimer's Disease
Everyone’s talking about a new study that says Alzheimer’s disease might be responsible for 500,000 deaths each year—as opposed to 84,000 yearly deaths as reported by CDC. Why are these two numbers so far apart? [ 03/19/14 ]
The new study by Bryan D. James, PhD, et al (including BrightFocus-funded Kristine Yaffe, MD), was published online in Neurology on March 5, 2014. There are a couple of explanations for why their estimates of deaths differ from the official figures reported by CDC.
The researchers performed a statistical analysis, then applied their results to similar age groups in the U.S. population. Their findings have to be interpreted with caution because:
- The study results are an estimate of deaths from AD—and not an actual count.
- The study population may not accurately depict the U.S. population.
For example, the analysis was based on data from 2,566 people enrolled in two previous clinical trials. Each participant received regular medical care and was diagnosed with AD in timely fashion. In contrast, many elderly people in the U.S. don’t receive regular medical care and often their AD symptoms go undiagnosed.
In addition, these researchers derived their estimate from people aged 75 years and older. This group had already survived the most common “killers” in old age—heart attack, stroke, and cancer and thus might have been more likely to die from Alzheimer’s than other diseases. The researchers themselves recognize these possible biases in their study and call their estimate “crude.” They suggest the truth may lie somewhere between their estimate and CDC’s data.
Mortality Reporting—An Imperfect Science
It is widely acknowledged that deaths from Alzheimer’s disease tend to be undercounted due to standard reporting mechanisms. CDC mortality figures are drawn from information on death certificates, where one cause of death is listed. Right now, this is the best way to count the actual numbers of death in the U.S., which is different from using statistical predictions based on the general population. Unfortunately, however, listing one cause on the death certificate doesn’t capture the reality of dying for many elderly people, when there may be multiple factors at play.
Alzheimer’s disease, in particular, contributes to death over a period of years. People with AD have difficulty shopping for food, planning meals, and caring for themselves in the most basic ways, including sleeping, eating, and protecting themselves from accidents and falls. Eventually they have difficulty managing their own health problems and their general health may decline because they are too disoriented to seek care from a doctor or take medications they need for a chronic condition.
The list of problems grow deadlier: in advanced stages, Alzheimer’s disease is linked to difficulties with swallowing and severe malnutrition. That, in turn, can lead to life-threatening illnesses, such as pneumonia. If one illness or infection proves fatal, the immediate cause of death (for example, “pneumonia” or “sepsis”) is written on the death certificate. Alzheimer’s disease is then omitted as an underlying cause. Many groups, including BrightFocus Foundation, think it’s time for comorbidities or more than one cause of death to be listed on the death certificate. Until that happens, Alzheimer’s disease and its impact on the very end of life may be drastically underrepresented.
I read that a neurologist has special tests that can determine if uncharacteristic behavior is due to dementia or some other condition. My husband's neurologist diagnosed my husband with Alzheimer’s disease; however, he did not give him any tests. Are there tests that are routinely given as part of an Alzheimer’s disease evaluation? [ 08/30/13 ]
Physicians can correctly diagnose Alzheimer's disease (AD) about 90 percent of the time based on mental and behavioral symptoms, a physical examination, neuropsychological tests, and laboratory tests. It is possible that your husband's symptoms were so pronounced (to the trained eye) that the neurologist felt confident in declaring an AD diagnosis without further testing. To learn more about the tests that are routinely performed as part of an Alzheimer's disease evaluation, please read the section titled “What are the diagnostic tests used in Alzheimer's disease?” under Frequently Asked Questions (FAQ).
How long does Alzheimer's disease last on average? [ 08/30/13 ]
On average, patients with Alzheimer's disease live for 8 to 10 years after diagnosis. However, this terminal disease can last for as long as 20 years.
Is Alzheimer's covered by Medicare/Medicaid? [ 08/30/13 ]
Medicare is a federal health insurance program for people age 65 or older who receive Social Security retirement benefits. To receive assistance from Medicare, a person must meet specific eligibility requirements. Medicare covers some, but not all, of the services a person with Alzheimer's disease may require. For example, the program does not cover long term healthcare. Medicaid is a federal program for certain individuals and families with low incomes and resources, typically administered by state agencies; eligibility and benefits vary from state to state. Medicaid can cover all or a portion of nursing home costs. A person with Alzheimer's can qualify for long term care only if there are minimal income and cash assets. Medicaid may be applied for by calling each state's Department of Human Services or Medicaid Assistance Program.
Who should I go to if I suspect I may have Alzheimer's disease? [ 08/30/13 ]
First, visit your regular family physician. The physician will probably do a variety of tests to determine the probability of Alzheimer's. Specialists such as neurologists, gerontologists and geriatric psychiatrists may also be involved in the evaluation process.
How is Alzheimer’s disease diagnosed? [ 08/30/13 ]
While an autopsy can confirm the presence of the disease, skilled physicians can correctly diagnose Alzheimer's disease about 90 percent of the time based on mental and behavioral symptoms, a physical examination, and neuropsychological and laboratory tests. Scientists have recently developed a number of new biomarker and brain scanning techniques that may help to improve diagnosis.
Mentally, having trouble following instructions, losing one's orientation, displaying poor judgment, and having difficulty managing money, shopping, or driving are all possible symptoms of Alzheimer's disease.
The physical exam will usually include a general physical, blood tests, and urinalysis. The doctor can use such test results to eliminate other forms of dementia—for instance, certain vitamins and hormones can provoke symptoms of dementia if they are present in too little a quantity. Brain scans can rule out non-Alzheimer's disease dementia and can reveal structural changes present in Alzheimer's disease.
The physician will determine whether neuropsychological testing is called for to examine memory, attention, math calculations, language and other intellectual functions.
The place to start is with one's own physician, who may then suggest specialists to do further testing.
Are there treatments available for Alzheimer’s disease? [ 08/30/13 ]
Yes, while there is no cure for Alzheimer's disease as yet, there are medications that can help control its symptoms and to help manage conditions such as agitation, depression, or psychosis (hallucinations or delusions), which may occur as the disease progresses:
Cholinesterase inhibitors: People with Alzheimer's disease have low levels of a key nerve messenger, called acetylcholine, believed to be important for memory and thinking. Four drugs called cholinesterase inhibitors make more of that messenger available by slowing its breakdown, enabling greater cell-to-cell communication and slowing the progress of cognitive impairment in some patients with early- to middle-stage Alzheimer's disease. The four cholinesterase inhibitors are:
- Razadyne® (galantamine)
- Exelon® (rivastigmine)
- Aricept® (donepezil)
- Cognex® (tacrine)
All four have been approved by the Food and Drug Administration (FDA) for early- to middle-state Alzheimer's disease; Aricept® is also approved for severe-stage symptoms. Cognex® was the first approved cholinesterase inhibitor but is rarely prescribed today due to safety concerns.
Namenda® (memantine) The first FDA-approved drug for moderate to severe Alzheimer's disease, Namenda is thought to protect brain cells by regulating a nerve communication chemical, called glutamate, that is released in great quantities by Alzheimer's-damaged cells. Glutamate is normally involved with learning and memory, but when released in excess by damaged cells, it attaches to “docking sites” called NMDA receptors that in turn accelerate cell damage.
Treatment for mental illnesses People with the later stages of Alzheimer's disease often experience depression, agitation, paranoia, delusions, and/or hallucinations, which can in turn cause screaming, repetitive questions, hoarding, pacing, hyperactivity, and aggressive behavior.
These symptoms can arise from non-medical triggers as well as medical causes. The former could take the form of a change in the person's environment (a new place to live, a new caretaker, a change in routine) or from frustration at the inability to communicate. If the trigger can be identified, the environment can be modified to change the behavior.
If non-medical intervention doesn't work, or the patient becomes a danger to himself or others, a physician should be asked to evaluate the need for medical treatment.
Sources for financial assistance for Alzheimer's disease prescription drugs can be found at www.brightfocus.org/alzheimers/resources/alzheimers-disease.html. Always consult a physician before taking any medications.
Are there drugs that can delay the onset of Alzheimer's disease? [ 08/30/13 ]
Aricept (donepezil), an Alzheimer's disease treatment appears to have a slowing effect—though limited—on the progression from mild cognitive impairment (MCI) to Alzheimer's disease, according to a study published in April 2005 by the New England Journal of Medicine. Those with MCI, such as the study participants, experience memory problems, but are able to function independently; however, MCI is often a transitional stage that leads to the serious cognitive decline of Alzheimer's disease. Over the first year of the three-year trial, MCI patients treated with Aricept had a reduced risk of progressing to Alzheimer's disease compared to patients who took a placebo, an inactive pill. The study found the effect of the Aricept treatment lasted longer (up to two to three years) in those patients carrying the ApoE4 gene. Previous studies have shown that those with the ApoE4 gene have a higher risk of developing Alzheimer's than the general population. Source: Mayo Clinic, Rochester and the National Institute on Aging
Disclaimer: The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for the advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice. BrightFocus Foundation does not endorse any medical product or therapy. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.
Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.
Last Review: 04/29/13