A report today in the New England Journal of Medicine attempts to quantify the costs associated with the growing incidence of dementia/Alzheimer’s disease (AD). I should mention here that there are two main types of AD. The first type is called ”familial” or early-onset AD, and is dominantly inherited in a classic Mendelian manner. The second type is called sporadic or late-onset AD, which is thought to be caused by a complex constellation of genetic and environmental factors. Late-onset AD is by far the most prevalent form of the disease and the one we usually associate with the aging population. I would first like to highlight some interesting statistics in the NEJM article regarding the demographics of the study group. Of note:
- Of course, age was a significant risk factor. Prevalence in the US of AD in persons over the age of 70 is estimated to be ~15%. Once you reach 85, the incidence is ~20% of the population.
- White males were at the lowest risk of developing AD.
- Being single increased risk.
- There was a negative correlation with education level/household income and developing AD.
Thus, if you are a poor minority woman, you are at the highest risk of developing AD in this study cohort. Now for the real meat of the study: costs. They estimated that the cost per person per year to be ~$50,000, with out of pocket costs ~$7,000/yr. The total cost in the US was estimated in 2010 to be between $157 billion and $215 billion, with Medicare paying ~11 billion of these costs (1).
Some of you may know that my lab has worked on AD, and we still have a passing interest in neurodegeneration. We have written a critical review of the AD field (2) highlighting the lack of progress in developing new therapeutics. I have to say, I have been somewhat skeptical that this disease can even be targeted by a drug (or drugs). For the most part, in the past year or two I have lost the passion for studying this disease. This all changed for me on Easter Sunday. I am by no means a religious person, but I bring my daughters to mass and Sunday school on a regular basis. On Easter, a woman and her father sat in the pew in front of us. She asked us for a hymn book and said she only needed one because her dad had AD. I sat there listening to her explain to her father where they were and why they were there. At one point during the service, the congregation sang the hymn “We Remember” composed by Marty Haugen. The first verse of the song starts with:
We remember how you loved us
The daughter of this man suffering from this terrible disease starting crying. The dad noticed, and just looked at her confused. It was all I could do to keep from breaking down as well, and I realized that the true cost of AD is not monetary, but emotional. I think I may have gotten my passion back for studying this disease.
(1) Note: all of these statistics directly from this article: Hurd et. al., Monetary Costs of Dementia in the United States, N. Engl. J. Med., 368;14, April 4, 2013.
(2) D. Boehning, J.M. Barral, Protein quality control in Alzheimer’s disease: the contentious role of ubiquilin-1. Future Neurology, 7(1): 5-8 (2012).