A new forecast model has revealed that an additional 9 million people will develop AD over the next 40 years.
Ron Brookmeyer, PhD, MS
The prevalence of Alzheimer disease (AD) in the United States is anticipated to increase by more than double its current rate, according to a new report published in Alzheimer’s & Dementia.1
A group of researchers from the University of California-Irvine utilized a forecast model to predict the prevalence of both clinically defined and preclinical AD, revealing an upward trend in mild cognitive impairment (MCI) caused by both conditions that will reach an estimated 15 million Americans by 2060.2 Currently, 6.08 million people in the United States have MCI, with neurodegeneration or amyloidosis—both signs of preclinical AD—affecting 46.7 million.
Led by Ron Brookmeyer, PhD, MS, professor of biostatistics, UCLA Fielding School of Public Health, the team’s analysis was the first of its kinds, as it included patients with biomarkers for preclinical AD but no impairment. This accounted for the differing data from previous forecasts. According to the authors, this was a notable difference, as those with preclinical AD are not destined to progress to dementia within their lifetimes, but the awareness of the prevalence of these patients could result in altered long-term treatment plans.
“An important point is that the resources needed to care for patients vary considerably over the course of the disease,” Brookmeyer told NeurologyLive’s sister publication, MD Mag. “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 MCI, 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.”
He added that this increase in AD prevalence creates a demand not just for physicians, but for their nurse and caregiver counterparts as well, which, according to Howard Fillit, MD, founding and executive director and chief scientific officer, Alzheimer’s Drug Discovery Foundation, must be taken into account when addressing AD. “There is no magic bullet,” Fillit told MD Mag.
“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 to see me in a month or 2, now it is 6.8 and everything is wonderful.’”
The challenge with AD—which will increase in parallel with its prevalence—is that there is no number to measure cognition, Fillit said. The lone measurement that’s made is taken through the interviews and exams with the physician, which require long periods of time and rarely account for the additional time that’s essential for educating patients and caregivers.
This burden of treatment may lay with the clinician, but Brookmeyer noted that the new projection of AD prevalence can aid caregivers and providers in the development of healthcare needs planning. “As the science of AD prevention advances, estimates of the numbers of persons who could potentially benefit from interventions that slow disease progression will be important in planning,” he explained.
With regard to planning for future spending, the timing of the forecast model was exceptional. In its Bypass Budget Proposal for Fiscal Year 2019, the National Institutes of Health (NIH) already estimated that in order to properly address the increasing number of patients with dementias and AD, the funding for research and development for the 2019 fiscal year alone should be $2 billion.3
“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.”
1. Brookmeyer R, Abdalla N, Kawas CH, Corrada MM. Forecasting the prevalence of preclinical and clinical Alzheimer’s disease in the United States. Alzheimers Dement. 2018;14(2):121-129.
forecast shows 6 million with Alzheimer’s disease, cognitive impairment [news release]. Bethesda, MD: National Institute on Aging Information Center. December 7, 2017. nih.gov/news-events/news-releases/new-forecast-shows-6-million-alzheimers-disease-cognitive-impairment. Accessed January 3, 2018.
3. Sustaining momentum: NIH takes aim at Alzheimer’s disease & related dementias. NIH Bypass Budget Proposal for Fiscal Year 2019. National Institutes of Health website. nia.nih.gov/sites/default/files/2017-07/FY19-bypass-budget-report-508_0.pdf. Published July 28, 2017. Accessed January 3, 2018.