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Goal
Reduce the morbidity and costs associated with, and maintain or enhance the quality of life for, persons with dementia, including Alzheimer’s disease.
Overview
Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—to such an extent that it interferes with a person’s daily life. Dementia is not a disease itself, but rather a set of symptoms. Memory loss is a common symptom of dementia, although memory loss by itself does not mean a person has dementia. Alzheimer’s disease is the most common cause of dementia, accounting for the majority of all diagnosed cases.
Diagnosis of dementia is key to effective treatment and care. It is important to distinguish dementia from temporary, reversible conditions that may cause loss of cognitive functioning. Temporary, reversible conditions include:
Series of strokes
Side effects from medication
Chronic alcoholism
Some tumors and infections in the brain
Vitamin B12 deficiency
Dehydration
These conditions are not dementia, but they can be serious and should be treated by a doctor as soon as possible.
Why Are Dementias, Including Alzheimer’s Disease, Important?
Alzheimer’s disease is the 6th leading cause of death among adults aged 18 years and older.1 Estimates vary, but experts suggest that up to 5.1 million Americans aged 65 years and older have Alzheimer’s disease. These numbers are predicted to more than double by 20502 unless more effective ways to treat and prevent Alzheimer’s disease are found.
Dementia affects an individual’s health, quality of life, and ability to live independently. It can diminish a person’s ability to effectively:
Manage medications and medical conditions.
Maintain a bank account.
Drive a car or use appliances safely.
Avoid physical injury.
Maintain social relationships.
Carry out activities of daily living, such as bathing or dressing.
People living with dementia are at greater risk for general disability and experience frequent injury from falls.3 Older adults with dementia are 3 times more likely to have preventable hospitalizations.4 As their dementia worsens, people need more health services and, oftentimes, long-term care. Many individuals requiring long-term care experience major personal and financial challenges that affect their families, their caregivers, and society.5
There are important steps to take to improve the identification of and care for people with dementia. These include:
Increasing the availability of existing effective diagnostic tools.
Decreasing the number of people with undiagnosed dementia.
Reducing the severity of symptoms through better medical management.
Supporting family caregivers with social, behavioral, and legal resources.
Encouraging healthy behaviors to reduce the risk of co-occurring conditions.
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Understanding Dementias, Including Alzheimer’s Disease
Several factors determine the risk of developing dementia, including age and family history. Other factors affect the management of dementia by families, communities, and the health care system.
Age
Aging is a well-known risk factor for Alzheimer’s disease and other types of dementias. Among adults aged 65 years and older, the prevalence of Alzheimer’s disease doubles every 5 years.6
Family History
People with a family history of Alzheimer’s disease are generally considered to be at greater risk of developing the disease. Researchers have identified 3 genes that are linked to early-onset Alzheimer’s disease. Until recently, only 1 gene had been identified that increases the risk of late-onset Alzheimer’s disease. However, during 2009 and 2010, international teams studying the genetics of Alzheimer’s disease have identified and confirmed 3 new genes that are associated with increased risk of late-onset Alzheimer’s disease.7
Health Services
Many individuals with Alzheimer’s disease or other dementias are undiagnosed. Primary care providers do not routinely test for Alzheimer’s disease.4, 8 Alzheimer’s disease and other dementias are more often undiagnosed in rural and minority populations than in urban or white populations.
Some chronic conditions are common in people with Alzheimer’s disease and other dementias. Dementias can greatly complicate the medical management of these conditions; this increases the need for coordination of care among different specialists.9, 10
Lack of diagnosis seriously reduces a person’s access to available treatments and valuable information. Active medical management, information and support, and coordination of medical and community services have been shown to improve quality and outcomes of care for people with dementia.11, 12
Emerging Issues in Dementias, Including Alzheimer’s Disease
Over the past decade, there has been significant scientific progress in understanding and managing dementia, with most of the research focused on Alzheimer’s disease. During the next decade, it will be important that progress be made in:
Improving the early diagnosis of Alzheimer’s disease and other dementias.
Developing interventions to delay or prevent Alzheimer’s disease and other dementias.
Finding better ways to manage dementia when other chronic conditions are present.
Understanding the influence of lifestyle factors on a person’s risk of cognitive decline and dementia.
References
1 Xu JQ, Kochanek KD, Murphy SL, et al. Deaths: Preliminary data for 2007. Natl Vital Stat Rep. 2009;58(1). Hyattsville, MD: National Center for Health Statistics.
2 Herbert LE, Scherr PA, Bienias JL, et al. Alzheimer’s disease in the US populations: Prevalence estimates using the 2000 census. Arch Neurol. 2003;60:1119-22.
3 McGuire LC, Ford ES, Ajani UA. The impact of cognitive functioning on mortality and the development of functional disability in older adults with diabetes: The second Longitudinal Study on Aging. BMC Geriatr. 2006 May 1;6(8) [cited 2010 Mar 15]. Available from: http://www.biomedcentral.com/content/pdf/1471-2318-6-8.pdf .
4 Bynum JP, Rabins PV, Weller W, et al. The relationship between a dementia diagnosis, chronic illness, Medicare expenditures, and hospital use. J Am Geriatr Soc. 2004 Feb;52(2):187-94.
5 Elliott AF, Burgio LD, DeCoster J. Enhancing caregiver health: Findings from the resources for Enhancing Alzheimer’s Caregiver Health II Intervention. J Am Geriatr Soc. 2010 Jan;58(1):30-7.
6 Jorm AF, Korten AE, Henderson AS. The prevalence of dementia: A quantitative integration of the literature. Acta Psychiatr Scand. 1987;76:465-79.
7 Jun G, Naj AC, Beecham GW, et al. Meta-analysis confirms CR1, CLU, and PICALM as Alzheimer disease risk loci and reveals interactions with APOE genotypes. Arch Neurol. Published online August 9, 2010. doi:10.1001/archneurol.2010.201.
8 Harris DP, Chodosh J, Vassar SD, et al. Primary care providers’ views of challenges and rewards of dementia care relative to other conditions. J Am Geriatr Soc. 2009 Dec;57(12):2209-16.
9 Carpenter B, Dave J. Disclosing a dementia diagnosis: A review of opinion and practice, and a proposed research agenda. Geronotologist. 2004 Apr;44(2):149-58.
10 Alzheimer’s Association, Bynum, J. Characteristics, costs, and health service use for Medicare beneficiaries with a dementia diagnosis—Report 1: Medicare current beneficiary survey. Lebanon, NH: Dartmouth Institute for Health Policy and Clinical Care, Center for Health Policy Research; 2009 Jan.
11 Callahan DM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: A randomized controlled trial. JAMA. 2006 May 10;295(18):2148-57.
12 Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care: A randomized, controlled trial. Ann Intern Med. 2006 Nov 21;145(10):713-26.
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