Patient Identification and Initial Strategies Alzheimers Disease AD

Alzheimer’s Disease (AD): More Than Just Memory Loss ► AD is a progressive, degenerative

Alzheimer’s Disease Overview ► Progressive, degenerative brain disease characterized by an increasing loss of

Current Prevalence of AD ► AD is the fourth leading cause of death due

AD Is the Most Prevalent Type of Irreversible Dementia Va. D, vascular dementia; DLB,

Mortality Due to AD: Impact of Age Rate per 100, 000 population 1, 000

Cost of AD in the US ► Annual treatment costs ~ $100 billion $18,

Does Treatment Affect the Cost of AD? ► Savings are small for mild and

Who Are the Caregivers? ► The overwhelming majority of patients live at home and

Caregiver Burden ► Caregivers spend from 40– 100 hours per week with the patient

Factors That Create “Breaking Point”for Caregiver ► Amount of time spent caring for the

Neuropathological Changes Characteristic of AD Normal AP AP = amyloid plaques Courtesy of George

Key Risk Factors for AD ► Primary risk factors l l ► Age Family

AD Is Often Misdiagnosed Patient initially diagnosed with AD Patient’s first diagnosis other than

Treatment Alternatives ► Symptoms Non-pharmacological l Neuroleptics l Anti-depressants l Anti-convulsants l Ch. EIs

AD Treatment Algorithm Stage of AD Treatment Options Mild Ch. EI Moderate Ch. EI/

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Patient Identification and Initial Strategies

Alzheimer’s Disease (AD): More Than Just Memory Loss ► AD is a progressive, degenerative disease involving: l Loss of memory and other cognitive functions l Decline in ability to perform activities of daily living l Changes in personality and behavior l Increases in resource utilization l Eventual nursing home placement

Alzheimer’s Disease Overview ► Progressive, degenerative brain disease characterized by an increasing loss of memory & other cognitive functions ► Characterized by changes in activities of daily living (ADL), behavior & personality, cognition including judgment – ABCs ► Most common cause of dementia among people aged 65 or over

Current Prevalence of AD ► AD is the fourth leading cause of death due to disease for people > 65 years of age in the United States 1 ► Approximately 4 million people in the United States have AD 2 1. Murphy SL. Natl Vital Stat Rep. 2000; 48: 1 -106. 2. Evans DA et al. Milbank Quarterly. 1990; 68: 267 -289.

AD Is the Most Prevalent Type of Irreversible Dementia Va. D, vascular dementia; DLB, dementia with Lewy bodies; FTD, frontotemporal dementia. reflects difficulties diagnosing/reporting dementias; only estimations of prevalence can be made. Irreversible dementias (%) 100 80 60 40 20 0 AD Va. D DLB Guttman R et al. Arch Fam Med. 1999; 8: 347 -353. Mc. Keith IG et al. Neurology. 1996; 47: 1113 -1124. Cherrier MM et al. J Am Geriatr Soc. 1997; 45: 579 -583. FTD Other

Mortality Due to AD: Impact of Age Rate per 100, 000 population 1, 000 10 100 1 0. 01 Under 45 45– 54 55– 64 65– 74 75– 84 Age (years) Reprinted with permission from Hoyert DL et al. Natl Vital Stat Rep. 1999; 47: 1 -104. 85+

Cost of AD in the US ► Annual treatment costs ~ $100 billion $18, 408/patient per year for mild AD l $30, 096/patient per year for moderate AD l $36, 132/patient per year for severe AD l Leon J et al. Health Aff (Millwood). 1998; 17: 206 -216.

Does Treatment Affect the Cost of AD? ► Savings are small for mild and very severe AD ► Prevention of even a small decline in cognition for patients with moderate AD would save ~ $3, 700 per patient annually ► Relatively small improvements in patients with moderate AD would save ~ $7, 100 per patient annually Ernst RL et al. Arch Neurol. 1997; 54: 687 -693.

Who Are the Caregivers? ► The overwhelming majority of patients live at home and are cared for by family and friends l l l 77% are women 73% are over 50 years of age 33% are the sole providers 45% are children of the patient 49% are spouses Remainder are close family members or friends Consumer Health Sciences, LLC. Princeton, NJ; December 1999.

Caregiver Burden ► Caregivers spend from 40– 100 hours per week with the patient ► 90% are affected emotionally (frustrated, drained) ► 75% report feeling depressed; 66% have significant depression ► Half say they do not have time for themselves and that the stress affects family relations ► Many experience a significant loss of income Coping. Available at: http: //www. alzheimers. com. Accessed September 2000.

Factors That Create “Breaking Point”for Caregiver ► Amount of time spent caring for the patient ► Loss of identity ► Patient misidentifications and clinical fluctuations ► Nocturnal deterioration of patient Annerstedt L et al. Scand J Public Health. 2000; 28: 23 -31.

Neuropathological Changes Characteristic of AD Normal AP AP = amyloid plaques Courtesy of George Grossberg M. D. ; St. Louis University AD NFT = neurofibrillary tangles

Key Risk Factors for AD ► Primary risk factors l l ► Age Family history Genetic marker such as APOE-4, trisomy 21, mutations in presenilin 1, 2 Cardiovascular risk factors e. g. hyperlipidemia/ hypertension (the role of statins and omega 3 fatty acids) Possible risk factors l l l Head trauma Low level of education Depression Increased zinc? Increased homocysteine (the role of B-vitamins, e. g. Folic acid)

AD Is Often Misdiagnosed Patient initially diagnosed with AD Patient’s first diagnosis other than AD 35% 14% No 72% Yes 28% 14% 9% 7% 21% Dementia (not AD) Depression Stroke No diagnosis Normal aging Other Source: Consumer Health Sciences, LLC. Alzheimer’s Caregiver Project. 1999.

Treatment Alternatives ► Symptoms Non-pharmacological l Neuroleptics l Anti-depressants l Anti-convulsants l Ch. EIs l NMDA receptor antagonists l

AD Treatment Algorithm Stage of AD Treatment Options Mild Ch. EI Moderate Ch. EI/ Memantine (alone or in combination) Severe Memantine (alone or in combination)