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Is Alzheimer’s even more deadly than we thought?

March 6, 2014 at 6:47 PM EDT
A new study in the journal Neurology finds Alzheimer’s may account for many more deaths than we previously realized. While the CDC ranks the disease as the sixth-leading killer in the U.S., the new study puts the annual death toll at around half-a-million, pushing it up to the third leading cause of death. Hari Sreenivasan learns more from Dr. Bryan James of Rush University Medical Center.
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GWEN IFILL: We have reported often on how the number of Americans coping with Alzheimer’s disease will grow in coming years. Now a new study finds Alzheimer’s may already account for many more deaths than realized.

Hari Sreenivasan, reporting from our New York studio, gets the details.

HARI SREENIVASAN: The CDC ranks Alzheimer’s as the sixth-leading killer in the U.S., accounting for nearly 85,000 deaths a year. But the study in the journal “Neurology” puts the annual death toll around half-a-million, making it the third-leading cause of death, just behind heart disease and cancer, and ahead of chronic lung disease and strokes.

Dr. Bryan James, an epidemiologist with Rush University Medical Center in Chicago, led the research. He joins us now.

So, what’s responsible for this discrepancy? They say 85,000. You say half-a-million. That’s a big gap.

DR. BRYAN JAMES, Rush University Medical Center: It is a big gap.

It’s about six times the numbers. And the reason for this, it’s — it’s very well documented that Alzheimer’s disease is underreported on death certificates. When people are filling out death certificates, they usually focus on the more immediate causes of death. And they have the opportunity to write the underlying causes, but Alzheimer’s disease is usually left off.

HARI SREENIVASAN: So, when we look at the research here, how did you find this discrepancy?

DR. BRYAN JAMES: Right.

So, rather than look at what’s written on people’s death certificates, knowing that it’s left off so often, we actually followed, you know, 2,500 older adults over time, and we saw who developed Alzheimer’s disease, and we saw the risk of death in the people who developed Alzheimer’s compared to those who didn’t.

And that’s how we developed an estimate of the excess deaths that we can attribute to Alzheimer’s. And then we extrapolated it to all deaths in the United States, and we came up with this number of half-a-million deaths due to Alzheimer’s disease.

HARI SREENIVASAN: So, give me an example of how Alzheimer’s is the underlying cause of death, if a heart attack is what’s listed on the death certificate.

DR. BRYAN JAMES: Right.

Yes, I think many people don’t realize that Alzheimer’s disease is a fatal disease. It leads to death very slowly over many years. It starts in the part of your brain that controls your memory and your thinking, and we’re all pretty much aware of that. But what people don’t know is that, over time, it slowly spreads to the parts of your brain that control your more basic functions, like swallowing and breathing and your heart rate.

And this can lead to fatal conditions such as pneumonia and heart failure.

HARI SREENIVASAN: So, how significant is this finding? Is this changing the way we’re thinking about the burden of the disease?

DR. BRYAN JAMES: I think that’s exactly right.

I mean, we already know that five million people are living with this disease in the country and that this number is going up and up and up. We’re paying over $200 billion a year to care for people with Alzheimer’s disease. And this is just a third statistic to wake people up, you know, open their eyes that the burden on our society is a lot greater than we’re giving it credit for, and perhaps we need to allocate more resources, more funding to research and treatment in this area.

HARI SREENIVASAN: Is there a difference in how the government, say, supports funding of Alzheimer’s vs. cancer?

DR. BRYAN JAMES: Well, there is a discrepancy in funding.

I mean, I would never say that cancer should be funded any less than it is, but cancer is funded at about 10 times the rate that Alzheimer’s is. And that’s including the $100 million that the current administration just gave to Alzheimer’s disease, which is fantastic, but it’s just a first step. And there are only three times as many people with cancer as in Alzheimer’s disease.

HARI SREENIVASAN: And so what does this mean for funding? Is this the type of information that changes policy?

DR. BRYAN JAMES: Well, we certainly hope it is.

You know, we know that diseases that kill people get a lot of attention, as they should, that we want to bring down the amount of suffering that people have while they’re living with this disease, but also we wanted people to acknowledge that this will ultimately lead to people passing away.

HARI SREENIVASAN: I’m also thinking, beyond Alzheimer’s, does this call into question other diseases that death certificates may be underreporting?

DR. BRYAN JAMES: You know, most of the other major killers, we think that the death certificates are pretty accurate.

If you die of cancer in this country, for example, it’s pretty accurately going to be marked on your death certificate. It’s just that Alzheimer’s takes so long, through such a long chain of events, a long cascade that can take up to a decade or more for some people, that it’s so often left off of the death certificate.

HARI SREENIVASAN: So what are the sort of next steps going forward?

DR. BRYAN JAMES: Yes, the next steps going forward, well, we need other research, large cohorts of older people to corroborate these findings, support them.

But, more, we just — policy-wise, we think that this hopefully can open the eyes of lawmakers and policy-makers and private and public funders, and just the public in general that this is, you know, a very burdensome disease on our society.

HARI SREENIVASAN: Already, Dr. Bryan James from Rush University, thanks so much.

DR. BRYAN JAMES: Thank you very much.