The com­ing Alzheimer’s emer­gency

The Washington Post Sunday - - SUNDAY OPINION - KATH­LEEN­PARKER kath­leen­parker@wash­post.com

Cur­rent quib­bling over what Jeb Bush meant when he said it’s time to phase out and re­place Medi­care — as op­posed to “at­tack­ing the se­niors,” as one woman at a re­cent event bel­lowed out — will soon seem quaint against the re­al­i­ties of our fu­ture.

Never mind pro­jec­tions that the pro­gram will be able to fi­nance only 86 per­cent of its obli­ga­tions by 2030. Or that by 2050, the num­ber declines to 80 per­cent, ac­cord­ing to a re­cently re­leased So­cial Se­cu­rity and Medi­care Boards of Trustees re­port.

These are rel­a­tively com­fort­ing num­bers com­pared with new pro­jec­tions from the Alzheimer’s As­so­ci­a­tion. By 2050, the group says, 13.8 mil­lion Amer­i­cans may have Alzheimer’s dis­ease, at a cost of $1.1 tril­lion per year, mostly to Medi­care and Med­i­caid.

To­day, by com­par­i­son, 5.3 mil­lion have the dis­ease.

“Ba­si­cally, it will bank­rupt Medi­care,” said Robert Egge, the Alzheimer’s As­so­ci­a­tion’s chief public pol­icy of­fi­cer. I met with Egge and chief science of­fi­cer Maria Car­rillo dur­ing the as­so­ci­a­tion’s re­cent in­ter­na­tional con­fer­ence in Washington.

The 2015 cost of care for Alzheimer’s and all other de­men­tias is es­ti­mated at $226 bil­lion, with 68 per­cent be­ing paid by Medi­care and Med­i­caid, Egge said.

This to­tal in­cludes only di­rect costs for the care of Alzheimer’s suf­fer­ers — there cur­rently is no treat­ment — and doesn’t take into con­sid­er­a­tion un­paid care by fam­i­lies. Within the next 10 years, 19 states will see at least a 40 per­cent in­crease in the num­ber of peo­ple af­fected.

Lest you feel over­whelmed by num­bers— and de­mor­al­ized by the re­duc­tion of hu­man suf­fer­ing to nu­mer­i­cal val­ues — suf­fice it to say that we are in a state of emer­gency. Yet, even with this ob­vi­ous ur­gency, rel­a­tively few re­sources have been ded­i­cated to re­search for preven­tion and treat­ment com­pared with other chronic dis­eases. This, de­spite the fact that Alzheimer’s is the sixth lead­ing cause of death in the United States, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Preven­tion.

Even with this ob­vi­ous ur­gency, rel­a­tively few re­sources have been ded­i­cated to re­search for preven­tion and treat­ment com­pared with other chronic dis­eases.

Cur­rent fed­eral re­search fund­ing is less than $600 mil­lion an­nu­ally, while top sci­en­tists say they’ll need $2 bil­lion a year to meet the as­so­ci­a­tion’s 2025 goal of preven­tion and ef­fec­tive treat­ment. There’s cause for some hope. Last month, bi­par­ti­san House and Se­nate sub­com­mit­tees ap­proved in­creas­ing fund­ing to the Na­tional In­sti­tutes of Health for Alzheimer’s re­search by 50 per­cent and 60 per­cent, re­spec­tively.

If this fund­ing be­comes law — and the as­so­ci­a­tion’s goals are met — costs could be re­duced by $220 bil­lion over the first five years and $367 bil­lion in 2050 alone, ac­cord­ing to an as­so­ci­a­tion re­port. Sixty per­cent of those sav­ings would ac­crue to Medi­care and Med­i­caid.

Among other sci­en­tific de­vel­op­ments re­ported this week, re­searchers have iso­lated a “com­mon an­ces­tor” among all forms of de­men­tia, in­clud­ing Alzheimer’s, Parkin­son’s and Lewy body.

“All are caused by mis­fold­ing pro­teins,” Car­rillo ex­plained to me. Two dif­fer­ent “mis­folded” pro­teins — amy­loid beta and tau — are toxic to brain cells.

I am sad to re­port these pro­teins can­not be cor­rected with daily doses of a sturdy zin­fan­del. There is, how­ever, a new drug that de­liv­ers a mol­e­cule sci­en­tists have cre­ated to “chap­er­one” these pro­teins so that they fold cor­rectly.

Car­rillo doesn’t want to over­state the value of this one-tar­get-one-mol­e­cule ap­proach, though it is promis­ing. She sug­gests that even­tu­ally we’ll treat Alzheimer’s with a “cock­tail” that will be cre­ated based on an in­di­vid­ual’s ge­netic makeup and other fac­tors.

Other hope-in­spir­ing de­vel­op­ments in­clude six di­ag­nos­tic tools that, in com­bi­na­tion, can be use­ful in pre­dict­ing Alzheimer’s. They in­clude mem­ory and think­ing tests, as well as MRI scans that can mea­sure the thick­ness of the brain’s right en­torhi­nal cor­tex and the vol­ume of the hip­pocam­pus, both of which are im­por­tant to mem­ory.

It is re­as­sur­ing that both pol­i­cy­mak­ers and sci­en­tists are com­mit­ted to tack­ling these dis­eases. But women es­pe­cially should be in­ter­ested in the progress of de­men­tia re­search. For rea­sons un­known, women suf­fer Alzheimer’s at a higher rate — two-thirds of to­day’s suf­fer­ers are women. And women’s func­tion declines twice as fast as men’s. This fall, the as­so­ci­a­tion will is­sue an in­ter­na­tional call for re­search on why this is so.

In the mean­time, Congress should waste no time in cor­rect­ing the trav­esty of too-lit­tle fund­ing for a dev­as­tat­ing dis­ease that de­mands our ur­gent at­ten­tion. Oth­er­wise, what to do about Medi­care will be ren­dered ir­rel­e­vant.

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