Projected doubling of Americans living with dementia

Women are at much greater risk and shoulder the majority of costs

October 29, 2019

Science Daily/Milken Institute

The number of Americans living with Alzheimer's disease or other dementias will double to nearly 13 million over the next 20 years, according to the new Milken Institute report "Reducing the Cost and Risk of Dementia: Recommendations to Improve Brain Health and Decrease Disparities."

Milken Institute research estimates that by 2020, roughly 4.7 million women in the US will have dementia, accounting for nearly two-thirds of all people living with the condition.

The number of both women and men living with dementia is projected to nearly double by 2040, with the number of women projected to rise to 8.5 million, and the number of men expected to reach 4.5 million (up from 2.6 million in 2020), according to the report, which was released at the 2019 Milken Institute Future of Health Summit in Washington, D.C.

Over the next 20 years, the economic burden of dementia will exceed $2 trillion, with women shouldering more than 80 percent of the cumulative costs.

"Longer lifespans are perhaps one of the greatest success stories of our modern public health system," explains Nora Super, lead author of the report and senior director of the Milken Institute Center for the Future of Aging. "But along with this success comes one of our greatest challenges. Our risk of developing dementia doubles every five years after we turn 65; by age 85, nearly one in three of us will have the disease."

"With no cure in sight, we must double down on efforts to reduce the cost and risk of dementia," she added. "Emerging evidence shows that despite family history and personal genetics, lifestyle changes such as diet, exercise, and better sleep can improve health at all ages."

In collaboration with partners such as UsAgainstAlzheimer's, AARP and Bank of America, Super and her co-authors, Rajiv Ahuja and Kevin Proff, have developed detailed recommendations and goals for policymakers, businesses, and communities to improve brain health, reduce disparities, and ultimately change the trajectory of this devastating disease.

1) Promote strategies to maintain and improve brain health for all ages, genders, and across diverse populations

 2) Increase access to cognitive testing and early diagnosis

 3) Increase opportunities for diverse participation in research and prioritize funding to address health disparities

 4) Build a dementia-capable workforce across the care continuum

 5) Establish services and policies that promote supportive communities and workplaces for people with dementia and their caregivers

"As this important new report shows, dementia is one of the greatest public health challenges of our time," said Sarah Lenz Lock, SVP, Policy & Brain Health at AARP. "It also demonstrates that we have the power to create change, whether by helping consumers maintain and improve their brain health, advancing research on the causes and treatment of dementia, or supporting caregivers who bear so much of the burden of this disease. We at AARP look forward to working with the Milken Institute and other key partners to achieve these goals."

"Brain health broadens the fight against Alzheimer's to include everyone and is the key to defeating stigma, increasing early detection, speeding up research -- and ending this disease," said Jill Lesser, a founding board member of UsAgainstAlzheimer's. "This new look by the Milken Institute offers important recommendations and actions to help move us to an optimal system of brain health care in this country."

Among the breakthrough findings, new data have "unveiled key discoveries about the differences between men's and women's brains, and how they age. Moreover, women typically take on greater caregiver responsibilities than men. Women caregivers are more likely to be impacted financially and leave their jobs or miss work to care for a family member. And research demonstrates that spousal caregivers may be at a higher risk of cognitive impairment or dementia than non-caregivers."

"With this research, the Milken Institute has taken an important step to better understand the impacts of dementia on diverse populations," said Lorna Sabbia, Head of Retirement and Personal Wealth Solutions, Bank of America. "This study, together with our own research on life stages, women, health and wellness, plays a critically important role in our efforts to educate and provide guidance to individuals and families throughout their financial lives."

https://www.sciencedaily.com/releases/2019/10/191029084315.htm

Dementia patients' adult kids diagnosed earlier than their parents

Unknown genetic factors may affect when symptoms arise

October 22, 2019

Science Daily/Washington University School of Medicine

A new study indicates that people with dementia -- whose parents also had dementia -- develop symptoms an average of six years earlier than their parents.

A person's chance of developing dementia is influenced by family history, variations in certain genes, and medical conditions such as cardiovascular disease and diabetes. But less is known about the factors that affect when the first symptoms of forgetfulness and confusion will arise.

A new study from Washington University School of Medicine in St. Louis reveals that people with dementia -- whose parents also had dementia -- develop symptoms an average of six years earlier than their parents. Factors such as education, blood pressure and carrying the genetic variant APOE4, which increases the risk of dementia, accounted for less than a third of the variation in the age at onset - meaning that more than two-thirds remains to be explained.

"It's important to know who is going to get dementia, but it's also important to know when symptoms will develop," said first author Gregory Day, MD, an assistant professor of neurology and an investigator at the Charles F. and Joanne Knight Alzheimer's Disease Research Center (ADRC). "If we can better understand the factors that delay or accelerate the age at onset, we eventually could get to the point where we collect this information at a doctor's visit, put it through our calculator, and determine an expected age at onset for any adult child of a person with dementia."

The study is available online in JAMA Network Open.

Alzheimer's disease is the most common cause of dementia, affecting an estimated 5.8 million people in the United States. Between 10% and 15% of the children of Alzheimer's patients go on to develop symptoms of the disease themselves.

Day and colleagues, including senior author John C. Morris, MD, the Harvey A. and Dorismae Hacker Friedman Distinguished Professor of Neurology and head of the Knight ADRC, studied people with dementia who were participating in research studies at the Knight ADRC. They identified 164 people with dementia who had at least one parent who had been diagnosed with dementia.

Using medical records and interviews with participants and knowledgeable friends or family members, the researchers determined the age at onset of dementia for each participant and his or her parent or parents. People with one parent with dementia developed symptoms an average of 6.1 years earlier than the parent had. If both parents had dementia, the age at onset was 13 years earlier than the average of the parents' ages at diagnosis.

Changes over the past few decades in diagnostic criteria and social attitudes toward cognitive decline in later life partially explain why the study participants were diagnosed at younger ages than their parents, the researchers said. But other factors were likely at play as well.

"Nowadays there's less of a tendency to brush off confusion and forgetfulness as signs of getting older," Day said. "People who watched their parents decline with Alzheimer's disease are especially unlikely to dismiss such concerns. What's most interesting, I think, is that people with two parents with dementia developed the disease much younger than people with one parent. That suggests that it's more than just changes in diagnostic criteria or social attitudes. People with two parents with dementia may have a double dose of genetic or other risk factors that pushes them toward a younger age at onset."

As part of this study, the researchers analyzed a large set of known risk factors for Alzheimer's disease. They studied heritable factors such as ethnicity, race, genetic variants and which parent had the disease. They also looked at education, body mass index, diabetes, cardiovascular disease, blood pressure, blood cholesterol level, depression, tobacco use, excessive alcohol use, and histories of traumatic brain injury.

All of the factors together only accounted for 29% of the variability, meaning that most of what influences the age of dementia onset remains to be identified. Intriguingly, the researchers found that people who were diagnosed with Alzheimer's disease at unexpectedly younger or older ages than their parents were more likely than people diagnosed at the expected age to have certain mutations in Alzheimer's genes -- although it wasn't clear what effect these mutations have.

"These people are really interesting. We don't know why their symptoms began earlier or later than expected," Day said. "There were no other risk factors we could identify. We started this project looking for factors that we could target to give people more time before they start experiencing dementia. Although we're not yet at the point where we can modify people's genes, we can begin to explore how these genes may accelerate or slow down the onset of dementia in these individuals. By learning more about the effect of these genes on Alzheimer's disease, we may be able to develop novel treatments."

https://www.sciencedaily.com/releases/2019/10/191022174426.htm