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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.

What kind of information should I bring to my first visit to the doctor? [ 08/30/13 ]

If you visit a new doctor, bring your medical records; for any doctor, bring a list of over the counter and prescription medicines you are currently taking. If you don't know the names of the drugs, bring the pill bottles with you. A medication or a combination of medications can sometimes cause symptoms that resemble Alzheimer's disease. Also make a list of current medical problems. It's a good idea to show the doctor a list of symptoms, behaviors and any problems carrying out routine activities (for example, paying bills) in yourself or your loved one that concern you.

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 there a connection between Alzheimer's disease and aluminum or other metals? [ 08/30/13 ]

Metals have been implicated in neurodegenerative diseases, although it is unlikely that any are the sole cause. For example, interest in a possible connection between aluminum and Alzheimer's disease arose over 40 years ago, and the toxicity of aluminum has been the subject of much controversy since that time. However, aluminum has never been proven to be a direct cause of Alzheimer's, and increasingly, evidence shows that Alzheimer's disease is likely caused not by one, but by a combination of factors.

Zinc, copper and iron have also been implicated in the formation of beta amyloid protein plaques that are part of Alzheimer's disease. Zinc and copper interact with amyloid beta precursor protein (APP) and beta amyloid itself, although their role is not clear. While copper promotes free radical formation, zinc is an antioxidant. However, high levels of zinc may contribute to the aggregation of beta amyloid. One particular way in which copper binds to beta amyloid appears to be toxic. Clearly, further research is necessary to determine the exact role of metals in Alzheimer's disease.

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.

Is there a test to detect a predisposition to Alzheimer's? [ 08/30/13 ]

There is a test currently available that can identify which forms of apolipoprotein (ApoE) are present in the blood. One form, ApoE4, is associated with an already well-studied condition, heart disease, and appears to increase the risk of developing Alzheimer's as well. However, this blood can only detect whether ApoE4 is present, not if and when the person will develop Alzheimer's.

In 2007, researchers at Stanford University published some promising study results in which 18 blood proteins (and resultant chemical signals) were tested to determine the risk of advancement from mild cognitive impairment (MCI) to Alzheimer's disease. In the study, the scientists were able to predict whether the subjects would progress to Alzheimer's with 90% accuracy. However, this study tested a relatively small number of people, and larger studies will need to be undertaken.

Are memory problems an indication of Alzheimer's disease? [ 08/30/13 ]

Mild forgetfulness and memory delays often occur as part of the normal aging process. Older individuals simply need more time to learn a new fact or to remember an old one. We all have occasional difficulty remembering a word or someone's name; however, those with Alzheimer's disease (AD) will find these symptoms progressing in frequency and severity. Everyone, from time to time will forget where they placed their car keys; an individual with Alzheimer's may not remember the purpose of the keys.

There has been recent interest in a condition called mild cognitive impairment (MCI). Individuals with MCI have memory impairment (pronounced forgetfulness), but are able to perform routine activities without assistance. However, MCI has been identified as a major risk factor for developing AD. While all patients who develop some form of dementia go through a period of MCI, not all patients exhibiting MCI will go on to develop AD.

Many conditions can contribute to the development of memory problems and dementia; AD is just one of them. A decline in intellectual functioning that significantly interferes with normal social relationships and daily activities is characteristic of dementia, of which AD is the most common form. AD and multi-infarct dementia (a series of small strokes in the brain) cause the vast majority of dementias in the elderly. Other possible causes of dementia-like symptoms include infections, drug interactions, a metabolic or nutritional disorder, brain tumors, depression or another progressive disease like Parkinson's disease.

If memory loss increases in frequency or severity, makes an impression on friends and family, begins to interfere with daily activities (employment tasks, social interactions, and family chores, for example), seek out qualified professional advice and evaluation by a physician with extensive knowledge, experience and interest in dementia and memory problems.

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

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.

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.

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Disclaimer: The information provided in this section is a public service of the BrightFocus Foundation, and should not in any way substitute for the advice of a qualified healthcare professional and is not intended to constitute medical advice. Although we take efforts to keep the medical information on our website updated, we cannot guarantee that the information on our website reflects the most up-to-date research. Please consult your physician for personalized medical advice; all medications and supplements should only be taken under medical supervision. The BrightFocus Foundation does not endorse any medical product or therapy.

Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.

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