New Alzheimer's Association Report Reveals Sharp Increases in Alzheimer's Prevalence, Deaths, and Cost of Care

For the second consecutive year, total payments to care for individuals living with Alzheimer's or other dementias are projected to surpass a quarter of a trillion dollars ($277 billion), which includes an increase of nearly $20 billion over last year, according to data reported in the Alzheimer's Association 2018 Alzheimer's Disease Facts and Figures report released recently.

An accompanying special report, "Alzheimer's Disease: Financial and Personal Benefits of Early Diagnosis," highlights new economic modeling data indicating early diagnosis of Alzheimer's during the mild cognitive impairment (MCI) stage of the disease could save the nation as much as $7.9 trillion in health and long term care expenditures. The report also highlights personal benefits of early diagnosis for individuals and families.

New findings from the report show the growing burden of Alzheimer's on people living with the disease, their families, and caregivers, as well as society at large. The number of older Americans is growing rapidly, so too is the number of people living with Alzheimer's and the subsequent impact to the nation's economy. By 2050, the total cost of care for Alzheimer's is projected to increase to more than $1.1 trillion.

"This year's report illuminates the growing cost and impact of Alzheimer's on the nation's health care system, and also points to the growing financial, physical, and emotional toll on families facing this disease," says Keith Fargo, PhD, director of scientific programs and outreach for the Alzheimer's Association. "Soaring prevalence, rising mortality rates, and lack of an effective treatment all lead to enormous costs to society, Alzheimer's is a burden that's only going to get worse. We must continue to attack Alzheimer's through a multidimensional approach that advances research while also improving support for people with the disease and their caregivers."

Given the long duration of this disease, the strain on Alzheimer's caregivers can last several years and produce serious declines in caregiver physical, emotional, and financial well-being. In 2017, 16 million Americans provided an estimated 18.4 billion hours of unpaid care in the form of physical, emotional, and financial support—a contribution to the nation valued at $232.1 billion. The difficulties associated with providing this level of care are estimated to have resulted in $11.4 billion in additional health care costs for Alzheimer's and other dementia caregivers in 2017.

Mortality from Alzheimer's disease continues to rise. While deaths from other major causes continue to decrease, new data from the report show that deaths from Alzheimer's disease have more than doubled, increasing 123% between 2000 and 2015. For context the number of deaths from heart disease—the number one killer in America—decreased 11%.

"Discoveries in science mean fewer people are dying at an early age from heart disease, cancer, and other diseases," Fargo says. "Similar scientific breakthroughs are needed for Alzheimer's disease, and will only be achieved by making it a national health care priority and increasing funding for research that can one day lead to early detection, better treatments and ultimately a cure."

The Impact of Alzheimer's Biomarkers and Earlier Diagnosis
The Facts and Figures special report explains how the identification of biological markers, or biomarkers, for Alzheimer's will be critical to improving disease diagnosis and researching treatments that may prevent or delay the onset of clinical symptoms, such as memory loss, confusion, and difficulties carrying out routine day-to-day tasks.

Alzheimer's biomarkers are transforming the way that researchers and physicians understand the disease, from one based on symptoms to one based on changes in the brain. Individuals no longer need to be diagnosed with Alzheimer's after significant damage is already done to the brain. Instead, due to awareness of Alzheimer's and recognition of early symptoms, as well as the development and approval of beta-amyloid imaging biomarkers, Alzheimer's diagnosis can occur earlier in the disease process than ever before, such as in the MCI due to Alzheimer's stage of the disease.

The report also highlights new economic modeling data showing early diagnosis during the MCI stage of the disease would result in cost savings as much as $7.9 trillion over the lifetime of all Americans living today. 

"Diagnosing Alzheimer's earlier has huge cost-savings implications," Fargo says. "Studies show the expenses associated with identification of people with mild cognitive impairment—the earliest stage at which clinical symptoms are present—are lower than those associated with people in the later stage of dementia. In addition, costs are lower once a person with Alzheimer's gets on the right care path. The disease is better managed, there are fewer complications from other chronic conditions, and unnecessary hospitalizations are avoided. The sooner the diagnosis occurs, the sooner these costs can be managed and savings can begin."

Earlier diagnosis was also associated with greater per-person savings. The new modeling data indicates that in today's environment—in which diagnosis usually occurs in the dementia stage if at all—the projected health and long term care costs of an individual with Alzheimer's is $424,000. Under an early diagnosis scenario in which an individual has a greater likelihood of being diagnosed during the MCI stage, the average per-person cost is projected to be $360,000—a savings of $64,000 per individual.

The special report also details personal benefits of early diagnosis, including the following:

• Accurate diagnosis: Early diagnosis can help determine if cognitive changes are truly due to Alzheimer's or some other—perhaps even treatable—condition.
• Medical benefits: Early diagnosis allows individuals to adopt lifestyle changes which may help preserve their existing cognitive function for as long as possible; interventions such as controlling blood pressure, smoking cessation, and exercise. 
• Participation in clinical trials: Early diagnosis allows individuals to enroll in clinical trials that advance research and may provide medical benefits.
• Planning for the future: Early diagnosis allows individuals more time to plan for the future while they are cognitively able to make legal, financial, and end-of-life decisions.
• Emotional and social benefits: Early diagnosis provides individuals with an opportunity to maximize time spent engaging in meaningful activities and interacting with the most important people in their lives. It can also open doors to many educational and support programs.

Updated Alzheimer's Statistics
The Facts and Figures report provides an in-depth look at the latest national statistics and information on Alzheimer's prevalence, incidence, mortality, costs of care, and caregiving.

Prevalence, Incidence, and Mortality

• An estimated 5.7 million Americans of all ages are living with Alzheimer's dementia in 2018.
• By 2025—just seven years from now—the number of people age 65 and older with Alzheimer's dementia is estimated to reach 7.1 million—an increase of almost 29% from the 5.5 million age 65 and older affected in 2018.
• Barring the development of medical breakthroughs, the number of people age 65 and older with Alzheimer's dementia may nearly triple from 5.5 million to 13.8 million by 2050.
• Two-thirds of Americans over age 65 with Alzheimer's dementia (3.4 million) are women.
• Every 65 seconds, someone in the United States develops Alzheimer's dementia. By mid-century, someone in the United States will develop the disease every 33 seconds.
• Alzheimer's is the sixth-leading cause of death in the United States, and it is the fifth-leading cause of death for those age 65 and older.
• As the population of the United States ages, Alzheimer's is becoming a more common cause of death, and it is the only top 10 cause of death that cannot be prevented, cured, or even slowed.

Cost of Care

• Total national cost of caring for those with Alzheimer's and other dementias is estimated at $277 billion (not including unpaid caregiving) in 2018, of which $186 billion is the cost to Medicare and Medicaid; out-of-pocket costs represent $60 billion of the total payments, while other costs total $30 billion.
• Total payments for health care, long term care, and hospice care for people with Alzheimer's and other dementias are projected to increase to more than $1.1 trillion in 2050 (in 2018 dollars).
• In 2017, the lifetime cost of care for a person living with dementia was $341,840—with 70% of this cost borne by families directly through out-of-pocket costs and the value of unpaid care.

Caregiving

• Nearly one-half of all caregivers (48%) who provide help to older adults do so for someone with Alzheimer's or another dementia.
• Approximately two-thirds of caregivers are women, and one-third of dementia caregivers are daughters.
• Forty-one percent of caregivers have a household income of $50,000 or less.
• It is estimated that the United States has approximately half the number of certified geriatricians that it currently needs, and only 9% of nurse practitioners report having special expertise in gerontological care.

Source: Alzheimer's Association