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The Current State of Alzheimer’s Disease

Beth Kallmyer, M.S.W.

Vice President, Constituent Services Governor’s Conference, 2012

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Outline • Brief overview of Alzheimer’s disease • Impact of Alzheimer’s disease • National Alzheimer’s Plan • Pharmacological interventions • Non-pharmacological interventions • Alzheimer’s Association programs &

services

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What is Alzheimer’s Disease? • Alzheimer's is a type of dementia that

causes problems with memory, thinking and behavior. – Alzheimer's is the most common form of

dementia – Alzheimer’s is not a normal part of aging. – Alzheimer's worsens over time. – Alzheimer's has no current cure, but treatments

for symptoms are available and research continues.

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The challenge began 100 years ago… • November 1906: Alois Alzheimer

presented first case in Germany • 51-year-old Auguste D. had

profound memory loss, confusion, language difficulty, unfounded suspicions about husband and hospital staff

• Her young age made Alzheimer think Auguste had a rare disease associated with middle age

tangles

plaques

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What is happening in the brain?

cortex shrivels, especially near hippocampus

ventricles enlarge

AD brain = smaller overall

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Causes of Alzheimer’s • Age: The greatest known risk factor

• Likelihood doubles about every five years after age 65, after age 85 the risk reaches nearly 50 percent

• Family History • A parent, brother or sister or child with

Alzheimer’s = you are more likely to develop Alzheimer’s disease

• Risk and deterministic genes

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Causes of Alzheimer’s • Heart-head connection:

• Each heartbeat pumps about 20-25 percent of blood to head

• Brain cells use at least 20 percent of the food and oxygen your blood carries

• Increased risk suspected if high blood pressure, heart disease, stroke, diabetes and high cholesterol

• Head injury: • Strong link between serious head injury and future

risk of Alzheimer’s disease

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Our Challenge

is Urgent

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Alzheimer’s Disease is the 21st Century Healthcare Epidemic

2050

1 in 8 age 65+ 1 in 2 age 85+

16 AS MANY AS

5 MORE THAN

2012

million million

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Alzheimer’s is no longer an emerging crisis – it is here. • An estimated 5.4 million people are living with Alzheimer’s disease today – 5.2 million people age 65 and older and 200,000 under the age of 65 with younger-onset. • Among those 65 and older, 1 in 8 has Alzheimer’s and nearly half of individuals age 85 and older have the disease. • Every 68 seconds, someone develops Alzheimer’s and by 2050 someone will develop the disease every 33 seconds.

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Alzheimer’s and Mortality

• 6th leading cause of death across all ages

• 5th leading cause of death for those aged 65 and older

• Only cause of death among the top 10 in America without a way to prevent, cure or even slow its progression.

• Change in the Number of Deaths: 66%

• Between 2000 and 2008

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Caring for people with Alzheimer’s or other dementias will cost the United States $200 billion in 2012, including $140 billion paid by Medicare and Medicaid.

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Why is Alzheimer’s such a cost driver?

Most people with Alzheimer’s have 1 or more spends o other serious chronic conditions, and dementia complicates the management of other conditions.

A senior with diabetes and Alzheimer’s costs Medica Medicare 81% more than one with diabetes and no Alzh Alzheimer’s and an older person with Alzheimer’s and c cancer costs Medicare 53% more than one with cancer but no Alzheimer’s.

Nearly 30% of people with Alzheimer’s or B another dementia are on both Medicare and Medicaid.

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The costs for caring for people with Alzheimer’s and other dementias will soar from $200 billion this year to a projected $1.1 trillion per year by 2050.

This dramatic rise includes a 500% increase in combined Medicare and Medicaid spending and a 400% increase in out-of-pocket spending for families.

Costs are growing because the number of people with the disease is growing – and fast

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Alzheimer’s doesn’t just happen to individuals – it happens to families.

The economic value of the unpaid care provided to serious those with Alzheimer’s and other dementias totaled $210 billion.

Caregivers take on a tremendous physical and emotion emotional burden to care for a loved one with Alzheim Alzheimer’s. As a result, Alzheimer’s and dementia Alz car caregivers had nearly $9 billion in health care costs of their own.

In 2011, 15.2 million family members and friends provided 17.4 billon hours of unpaid care to those with Alzheimer’s and other dementias.

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The National Alzheimer’s Project Act (NAPA) Public Law 111-375

• Passed unanimously by both houses of Congress on a bipartisan basis requires:

– The creation of an Alzheimer’s Advisory Council.

– National Plan with annual updates.

– Annual recommendations for priority actions.

– Evaluation of all federally funded efforts in Alzheimer’s research, care and services – along with their outcomes.

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What is available to treat Alzheimer’s disease?

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Pharmacological Non-Pharmacological

Two Types of Interventions

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Pharmacological Interventions

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Pharmacological • Rigorous Phase I – IV

clinical trials process • Effective for subset of

individuals • Costly

Non-Pharmacological

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Normal Alzheimer’s disease

Continuum of Alzheimer’s Disease

Adapted from Sperling et al. 2011

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Current Alzheimer drugs boost signaling among dwindling neurons

Cholinesterase Inhibitors tacrine (Cognex) donepezil (Aricept) rivastigmine (Exelon) galantamine (Razadyne)

Glutamate Moderators Memantine (Namenda)

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• A broad range of drugs are in clinical trials • These drugs impact biological processes

associated with AD • More than 100 clinical trials on-going

across the US today

Therapeutic Pipeline for Alzheimer’s

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Pathway to Your Medicine Cabinet

PhRMA 2012 Annual Report

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A first-of-its-kind, free, confidential, online and phone-based tool that provides comprehensive clinical trial information and an individualized

trial matching service for people with Alzheimer’s and related dementias.

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Advances in Early Detection of Alzheimer’s

Functional and Molecular Imaging

Structural Neuroimaging

Genetics

Proteomics

Protein production & clearance rates

Targeted biochemical

Neuropsychometric tests

Epidemiology

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Non-Pharmacological Interventions

-Interventions for individuals with Alzheimer’s disease

-Interventions for care-partners of a person with Alzheimer’s disease

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Pharmacological • Rigorous Phase I – IV

clinical trials process • Effective for subset of

individuals • Costly

Non-Pharmacological • Moving towards more

rigorous testing model (like pharmaceuticals)

• Effective for subset of individuals

• Relatively low cost

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• Improved quality of life for individual with Alzheimer’s and their caregiver

• Potential improved cognition, mood, behavior, etc. for individual with Alzheimer’s

• Potential improved quality of life, psychological well-being and mood for care-provider

• Low cost and relatively easy to implement

Benefits of Non-Pharmacological Interventions

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• Target outcomes for interventions: – Improve cognition – Improve Activities of Daily Living (ADL) – Improve Behavior – Improve Mood – Improve Quality of Life – Delay institutionalization

Interventions for Individuals with Alzheimer’s disease

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• Interventions tested to help with cognition: – Cognitive training – group sessions or individual

sessions; teaching of strategies to improve verbal learning; timing varies

– Cognitive stimulation – group sessions; themed activities to orientate and stimulate cognition through association and categorization, etc; 30-60 min, 2-5/week, 4-20 weeks

– Multi-component intervention – enriched group cognitive stimulation and the following: reminiscence, physical exercise, ADL training, support, etc.

Examples of Interventions for Individuals with Alzheimer’s

Olazaran et al. Dementia & Geriatric Cognition Disorders. 2010;30(2):161-78.

** Multi-component intervention found most beneficial

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• Target outcomes for interventions for caregiver: – Improve Psychological Well Being – Improve Mood – Improve Quality of Life

Interventions for Individuals Caring for Someone with Alzheimer’s

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• Interventions tested to help with care provider’s psychological well being: – Cognitive stimulation – group sessions; themed

activities to orientate and stimulate cognition through association and categorization, etc; 30-45 min, 2-3/week, 8-10 weeks

– Multi-component interventions – long-term programs based on caregiver education and support; other components uses depending on individual needs; individual sessions with family caregiver and other family members; 90 min, 1/1-3 weeks, 6-8 mos.

Examples of Interventions for Individuals caring for person with Alzheimer’s

Olazaran et al. Dementia & Geriatric Cognition Disorders. 2010;30(2):161-78.

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• Combination interventions – for individual with Alzheimer’s and their caregiver

• Lifestyle intervention – Diet – Exercise – Diet & exercise – Increasing social engagement – Controlling vascular risk factors (high blood pressure, smoking, etc)

Other Avenues Being Explored…

Olazaran et al. Dementia & Geriatric Cognition Disorders. 2010;30(2):161-78.

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Our vision is a world without Alzheimer’s disease

Our mission: • Advance research • Provide care

and support • Increase Concern &

Awareness • Public Policy &

Advocacy Efforts

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Largest Private Funder of Alzheimer's Research in the World

• Over $300 million to more than 2,100 scientific investigations since 1982

• Fund scientists at all stages of their career; open calls and targeted research funding (RFAs)

• Fund all types of research • 2012: 922 applications; over 70 research awards to

12 countries, ~$12.2M

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Nationwide chapter network • Information and referral • Care consultation • Support groups • Education • Safety services

24/7 Nationwide Helpline

• Information and referral in 140 languages

Alzheimer’s Association

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Alzheimer’s Association International Conference

• July 13-18, 2013 in Boston • Nearly 5000 attendees • All types of research highlighted • Social, Behavioral & Care Research Track

• Dementia Care @ AAIC

– Wednesday, July 17 – Submission now open for oral & poster sessions – www.alz.org/aaic

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Get day-to-day help

Get support

Plan for the future

• Daily care • Stages & behaviors • Support • Safety • Care Options • Legal & financial planning

www.alz.org/care

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Online Tools

• Alzheimer's Navigator • ALZConnected • Care Team Calendar • Comfort Zone® • Community Resource Finder

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Alzheimer’s Navigator • Map out a plan to approach Alzheimer's

– Step-by-step guidance-short surveys – Tips and tools – Local programs and services

• Move at your own pace – Review at your convenience – Prioritize an action plan – Invite others

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ALZConnected

• Connect with others – Message boards – Community solutions – Create and join private groups – Inbox

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Care Team Calendar

A free, personalized online tool to organize family and friends who want to help.

• Powered by Lotsa Helping Hands • Post items for which assistance is needed. • Helpers can sign up for specific tasks. • Friends and family can access AlzConnected message

boards, post announcements and photos, and share information.

• Add new helpers when ask to help.

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Comfort Zone®

• A comprehensive web-based location management service.

• Families can remotely monitor a person with Alzheimer’s by receiving automated alerts when a person has travelled beyond a preset zone.

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Community Resource Finder

• A comprehensive database of resources • All in one location, easy to search

– Medical care – Residential care – Community services – Alzheimer’s Association

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Thank you for your time

Questions?

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