1. Alzheimer’s Disease: A Call for Risk Reduction and Early Acknowledgment
Kirstin Gramith, Pharm.D. Student Macy Royston, Pharm.D. Student
The Importance of Earlier
Acknowledgment
o The disclosure rate for Alzheimer’s disease diagnosis is
only 45%, even though 95% of Americans ages 60 and
over say they would want to know.2
o A major barrier to diagnosing dementia was the
attitude that diagnosis was more harmful than helpful.
This attitude was linked with the tendency to diagnose
dementia only when an unavoidable problem has
arisen.5
Benefits of early diagnosis2, 5
o Delay further cognitive, behavioral and functional
disability
o Decreased disease burden for patient and caregiver
o Improvement in quality adjusted life years
o Decrease in individual and societal healthcare costs
o Better access to treatments, care teams, support
services and enrollment in clinical trials
o Better medication management, more counseling,
ability to address driving and safety issues in advance
o Patients and families can better prepare for future
care
Sources
1. Alzheimer’s Association. What is dementia? [Internet]. 2015 [cited 2015 Nov 3]. Available from:
http://www.alz.org/what-is-dementia.asp
2. Alzheimer’s Association. 2015 Alzheimer’s disease facts and figures. Alzheimer’s Dement. 2015;11(3):332-84.
PubMed PMID: 25984581.
3. Norton S, Matthews F, Barnes D, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer’s disease:
an analysis of population-based data. Lancet Neurol. 2014;13(8):788-794. PubMed PMID: 25030513.
4. Rapp T, Andrieu S, Molinier L, Grand A, Cantet C, Mullins C, Vellas B. Exploring the relationship between
Alzheimer’s disease severity and longitudinal costs. Value Health. 2012;15(3):412-19. PubMed PMID:
22583450.
5. Bradford A, Kunik M, Schulz P, Williams S, Singh H. Missed and delayed diagnosis of dementia in primary
care. Alzheimer Dis Assoc Disord. 2009;23(4):306-314. PubMed PMID: 19568149.
6. Marasco R, Heely JA, Gardner M. The pharmacist’s role in managing patients with Alzheimer’s disease. J Am
Pharm Assoc. 2003;43(5 Suppl 1):S20-1. PubMed PMID: 14626518.
7. Skelton J. White paper on expanding the role of pharmacists in caring for individuals with Alzheimer’s
disease: APhA Foundation Coordinating Council to improve collaboration in supporting patients with
Alzheimer’s disease. J Am Pharm Assoc. 2008;48(6):715-721.
8. Alzheimer’s Association. 10 early signs and symptoms of Alzheimer’s [Internet]. 2015 [cited 2015 Dec 1].
Available from: http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp
Conclusions
o Alzheimer’s disease affects 5.3 million Americans
o There is no cure for Alzheimer’s disease and no
proven method of primary prevention of disease
pathology
o Risk reduction, timely diagnosis and early
intervention are the keys to delaying progression of
cognitive and behavioral symptoms and decreasing
costs to individuals and society
What Puts Us At Risk?
o While non-modifiable risk factors such as age and
genetics play a large role in developing Alzheimer’s
disease, recent literature suggests there is a relationship
between Alzheimer’s disease and modifiable risk factors
such as hypertension, diabetes mellitus, and obesity.
o Norton et al. analyzed seven modifiable risk factors in
order to estimate population attributable risk and
relative risk of Alzheimer’s disease, accounting for
shared variance between the risk factors.3
o Adjusting for non-independence, it is estimated that the
population attributable risk of these risk factors is 30.6%
in the United States and 28.2% worldwide.3
The Pharmacist’s Role6, 7
o Familiarize ourselves with the signs and symptoms
o Identify and inform patients at risk
o Encourage patients to manage modifiable risk factors
o Suggest techniques to aid in disease management
o Educate on the ten warning signs
o Evaluate and optimize the use of medications
Alzheimer’s disease is the 6th leading cause of
death in the United States
Ten Warning Signs8
Challenges in
planning or solving
problems
Memory loss
Difficulty completing
familiar tasks
Confusion
with time
or place
Trouble with visual
images and spatial
relationships
Decreased or poor
judgement
Problems
with words
in speaking
or writing
Changes in mood
or personality
Withdrawal from
work or social
activities
Misplacing
things or
inability to
retrace steps
Introduction
o Dementia is a general term describing the loss of
mental abilities and memory that interferes with daily
life.1
o Alzheimer’s disease is the most common form of
dementia, accounting for 60 to 80% of dementia cases.2
o In 2015, 5.3 million Americans are estimated to have
Alzheimer’s disease, 5.1 million being 65 years or older.2
o 1 in 6 women and 1 in 11 men have Alzheimer’s disease2
o Due to underdiagnosing, nearly half of Americans with
Alzheimer’s disease do not know they have it.2
o There is no cure for Alzheimer’s disease2
1.46 1.61 1.60 1.82 1.65 1.59 1.59
-
0.50
1.00
1.50
2.00
2.50
3.00
The Burden of Alzheimer’s Disease
o The estimated costs of health care, long-term care and
hospice for those suffering from Alzheimer’s disease
and other dementias is 226 billion dollars.2
o Rapp et al. found that worsening in severity of
cognitive, behavioral, and functional symptoms of
Alzheimer’s disease is associated with increased costs.4
o From 1990 to 2010, Alzheimer’s disease increased from
the 25th to the 12th most burdensome disease.
Alzheimer’s disease also increased from 32nd to 9th in
terms of years of life lost and from 17th to 12th in terms
of years lived with disability.2
Medicare
$113
Medicaid
$41
Out of
Pocket
$44
Other
$29
Cost of Care by Payment Type in 2015
In Billions of US Dollars
Relative Risk for Alzheimer’s
Disease