Monthly Archives: February 2011

The Costs of Alzheimer’s Disease

Alzheimer’s disease affects 5.3 million people in the United States, and it is the 7th leading cause of death.  In Wisconsin alone, 110,000 people currently live with Alzheimer’s.  Despite its prevalence, effective treatments and cures have yet to be found.  Due to the lack of therapies, those diagnosed with the disease often require long-term care, and Alzheimer’s care is a significant cost for patients, the state, and the country.

While older Americans make up about 12 percent of the population, they account for 90 percent of nursing home residents.  In 2010, Alzheimer’s costs reached $172 billion dollars.  Additionally, there are an estimated 10.9 million unpaid caregivers in the US providing around 12.5 billion hours of care.  This contribution was valued at almost $144 billion, $2.6 billion in Wisconsin alone.

Long-term care and other Alzheimer’s costs are paid by a variety of sources including Medicare and Medicaid.  In 2004, Medicare costs per Alzheimer’s patient ($15,145) were almost three times higher than costs for other Medicare recipients of the same age ($5,272).  That same year, 28 percent of Medicare recipients aged 65 or older also received Medicaid benefits.  Medicaid payments per Alzheimer’s patient ($6,605) were more than nine times higher than payments for other elderly people of the same age ($718).

Although Medicare, Medicaid, and other funding sources provide support for much of Alzheimer’s care, patients and families still must pay high out-of-pocket costs.  These costs include premiums, co-payments, and services that are not covered by other sources.  In 2004, out-of-pockets costs for Medicare recipients with Alzheimer’s averaged $2,464.  Average out-of-pocket costs for patients living in nursing homes or assisted living facilities were significantly higher at $16,689.

Another cost accrued by Alzheimer’s patients is hospice care.  The average length of stay for hospice patients with a diagnosis of Alzheimer’s was 105 days in 2008.  Total payments for hospice care from all sources totaled $2.8 billion in 2004 with per person payments averaging $976 (compared to $120 per person for patients without Alzheimer’s).

Because the costs of Alzheimer’s care is so high, and because the aging of the baby boomer generation is expected to greatly increase the number of Alzheimer’s patients, strategies for decreasing Alzheimer’s care costs is necessary.  This decrease could be achieved by shortening the disease course through earlier detection of the disease and more effective treatments.  With these improvements, treatments would slow cognitive decline, delay the age at which the disease appears, and increase the years that Alzheimer’s patients can remain at home.

In a 2009 paper, two Wisconsin researchers addressed this issue and calculated the potential cost savings if early detection and treatment of Alzheimer’s were possible.  Using a statistical analysis, the authors found that early detection and effective treatment of a 70-year-old woman with mild cognitive impairment would lead to $5,000 in state savings and  $10,000 in federal savings.  When a program of caregiver support was added to early detection and treatment, the analysis yielded even higher savings.  The authors stated that, by their calculations, the state savings were higher than the cost of implementing an early diagnosis program.  Therefore, if the state paid all costs of implementing an early detection and caregiver intervention program not covered by federal funds, the state would still save approximately $10,000 per diagnosed patient.

Currently, there is little incentive for caregiver support.  This paper concludes that the lack of support for family and friends is fiscally irresponsible.  With the development of caregiver support programs, patients could remain out of nursing home care for a longer period of time, thus significantly decreasing long-term care costs.

The high costs of Alzheimer’s care will continue to rise as people live longer and baby boomers approach the age at which Alzheimer’s is diagnosed.  In addition to the impact on Medicare and Medicaid spending, out-of-pocket costs put another stress on patients and caregivers.  With the current economic climate across the country, cuts in support for Alzheimer’s care may become necessary.

However, many studies are now focusing on the ability to detect and treat Alzheimer’s early, before cognitive decline can be measured.  Through earlier detection, more effective treatment, and additional support for caregivers, the costs of Alzheimer’s care for the state, the country, and families would decline.  Such a program would also provide hope and reassurance to those affected by a disease currently surrounded by uncertainty.

Data for this post provided by the Alzheimer’s Association.

Imaging Brain Changes in Alzheimer’s Disease

Alzheimer’s research aims to decrease some of the uncertainty surrounding causes, diagnosis, and treatment of the disease.  Many researchers believe that an important aspect of treatment will involve identifying the disease early and treating those early changes in the brain.

Beta-amyloid plaques are aggregates found in the brain of Alzheimer’s patients. Historically, these plaques were only identifiable upon autopsy.

A beta-amyloid plaque

Recently, better techniques for imaging these plaques have been developed.  As techniques improve, more information about the effects of the development of the disease on the brain can be gathered.

In a recent paper in Brain: A Journal of Neurology (published online February 9th), Gael Chetelat and colleagues use imaging techniques to more fully recognize early brain changes in Alzheimer’s progression and how those changes relate to memory decline.  Using magnetic resonance imaging (MRI), the researchers image and recognize a portion of the brain called grey matter.  They also use positron emission tomography (PET) to visualize a tracer that marks beta-amyloid deposits.  They aim to relate the breakdown of brain matter and the location of beta-amyloid plaques to the degree of memory loss in patients in the pre-dementia stage of Alzheimer’s disease.

The researchers find that memory performance of patients in the pre-dementia stage relates to two changes in the brain.  The first change is increased beta-amyloid deposition, specifically in the temporal neocortex.  The temporal neocortex is part of the outer layer of the brain located on either side, and it plays a critical role in visual processing, storage of language, and memory.

Labeling of temporal beta-amyloid deposition (left) and location of reduced grey matter in the hippocampus (right)

The second change in the brain is a decrease in grey matter in the hippocampus.  The hippocampus is located inside the brain structure with mirror-image halves in the right and left sides of the brain, and it is important in navigation and long-term memory.  The authors suggest that these insults to the brain structure should be considered separately as researchers look for possible targets of therapies.

The prospect of imaging specific changes in brain structure is exciting.  If these changes can be related to future Alzheimer’s progression or other forms of memory loss (which the authors caution cannot be done from their study), early identification of these insults may allow time for intervention and treatment that can slow or stop memory loss.  Knowledge of the specific locations of the insults as well as improvements in the techniques available to image the brain will be invaluable advances in the fight against dementia and Alzheimer’s.

Beta-amyloid photo here.  MRI photos from Chetelat study here.

A Personally Tested 30-Step Program to Become a Science Writer

1. Attend college intending to study science, but take a variety of interesting writing classes as well.

2. When it comes time to declare a major, decide that biology has more “promise” than writing or literature (because this is what your advisor tells you).

3. Take an expensive MCAT preparation class as you plan to enroll in an MD/PhD program.

4. After months of preparation, decide the MCAT and medical school are definitely not for you and take the GRE instead.

5. Apply to several graduate schools including Stanford.

6. Get a rejection letter from Stanford.

7. Get a second rejection letter from Stanford one week later.

8. Interview at University of Wisconsin – Madison.

9. Wonder if the fact that a large portion of your extended family lives within 20 miles of Madison is a deterrent to choosing that school.

10. Decide that the fact that a large portion of your extended family lives      within 20 miles of Madison is actually a draw to that school.

11. Attend the University of Wisconsin – Madison.

12. Enjoy your graduate classes during the first two years of your program as you realize you really like reading and learning about science.

13. Find a lab in which to do your research and begin a research project.

14. Outline several hypotheses about your project explaining why you may see the results that you see.

15. Perform experiments over the next several years that disprove each one of those hypotheses, one by one.

16. Realize at this point that the research you did as an undergraduate did not adequately prepare you for graduate work and that you may not be cut out for research after all.

17. After a series of experiments that are essentially fishing expeditions, fall upon an interesting result.

18. Recreate your project based on that interesting result.

19. Realize that even after getting an interesting result you still don’t feel cut out for research.

20. Begin to look into alternative career options you may have after completing your PhD program.

21. Continue working on your project that has now become centered on metabolism.

22. Find your college biochemistry book so that you can remember something about metabolism.

23. Attend career fairs and panels and strike gold as you listen to a science writer talk about her career.

24. Realize that you can read about, talk about and think about science without actually having to do the research yourself.

25. Do a happy dance.

26. Begin to apply to science writing programs as you continue experiments and begin to write your thesis.

27. Get accepted into science writing programs and decide to stay at Madison.  (Get no rejection letter from Stanford – but only because you didn’t apply there).

28. Finish and successfully defend your thesis.

29. Begin the science writing program and rediscover the fun of writing and reading about science when it doesn’t have to apply to your PhD project.

30. Start a blog on which you get to write the story of how you became a science writer.