A UC-Irvine developed model predicts that by 2060, more than 15 million Americans will be living with cognitive impairment due to AD.
Ron Brookmeyer, PhD, MS
Using a forecast model to predict clinical and preclinical AD, the investigators found that by 2060, 15 million people in the United States will be living with mild cognitive impairment due to AD or clinical AD. Currently, there are an estimated 6.08 million Americans with the condition, while 46.7 million have either amyloidosis or neurodegeneration, or both - signs of preclinical AD.
Led by Ron Brookmeyer, PhD, MS, a professor of biostatistics at the UCLA Fielding School of Public Health, the group attempted to account for patients with biomarkers for preclinical AD, but who do not have impairment, for the first time, resulting in different data than previous forecasts.
This is important, as not all of those with preclinical AD will progress to dementia within their lifetime. However, the knowledge that these patients will increase in number does call for adjustments in the current plans for treatment long-term.
“An important point is that the resources needed to care for patients vary considerably over the course of the disease,” Brookmeyer told MD Magazine. “Persons with mild cognitive impairment require fewer resources and caregiving needs than persons with Alzheimer’s disease dementia. Of the 15 million by 2060, we estimate that about 5.7 million will have mild cognitive impairment, and another 9.3 million will have AD dementia. Of the 9.3 million, about 4 million will need an intensive level of care equivalent to that of nursing homes.”
“The increasing Alzheimer’s prevalence affects not only demands on physicians but demands for nursing and caregiving for patients as well,” he added. Howard Fillit, MD, the founding executive director and chief scientific officer at the Alzheimer’s Drug Discovery Foundation, told MD Magazine that when a physician treats a patient with AD, they are also treating the caregiver, and in this instance “there is no magic bullet.”
“We can write prescriptions like we can for hypertension, but we don’t have an easy biomarker like cholesterol or hemoglobin A1C (HbA1c),” Fillit, who has worked with patients with AD for almost 40 years, said. “[We can’t say,] ‘your HbA1c is 7.2, I’m going to give you this drug, come see me in a month or 2, now it is 6.8 and everything is wonderful.’”
One of the biggest burdens for physicians is the measurement of AD is based on cognition, for which “there’s no number,” Fillit said. It often requires an interview or an exam of sorts, and that does not include the time it takes to then educate the patient and their caregiver about the condition.
Although the burden will be on the physicians, nurses, and caregivers to bear, this new understanding of AD’s projected prevalence increase will provide those caregivers with assistance in the planning of health care needs, Brookmeyer said.
“As the science of Alzheimer’s prevention advances, estimates of the numbers of persons who could potentially benefit from interventions that slow disease progression will be important in planning,” he added.
And that planning has already begun. In July 2017, the National Institutes of Health (NIH), in its Bypass Budget Proposal for Fiscal Year 2019, estimated that in order to combat the increasing number of people with AD and related dementias, funding for research and development for the 2019 fiscal year would require about $2 billion—an increase of $1.1 billion from the previous budget proposal.
“This is a critical time in Alzheimer’s research. The path toward a cure remains very difficult, even with everything we have learned,” Francis S. Collins, MD, PhD, the director the NIH, wrote in the proposal. “But we are beginning to see a way forward, where we can now dare to think in terms of true precision medicine in the realm of Alzheimer’s disease— the possibility of treating the right person with the right intervention at the right time. With sustained momentum, we have the best hope of realizing that vision.”