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A woman, suffering from Alzheimer's desease, walks in a corridor on March 18, 2011 in a retirement house in Angervilliers,...

Why the number of Americans with Alzheimer’s could more than double by 2050

Barring breakthroughs in treatment, the number of Americans living with Alzheimer’s disease is projected to more than double by 2050, rising to 13.8 million Americans age 65 or older from 5.8 million today. That’s according to a new report from the Alzheimer’s Association released Tuesday.

Here’s a closer look at why medical experts are expecting a spike in Alzheimer’s, what we know about associated health costs and what’s next for research and treatment.

Why is the number of people with Alzheimer’s going up?

Today, Alzheimer’s is the sixth leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. In 2017 alone, more than 121,000 people died in the U.S. due to Alzheimer’s.

The growing number of older Americans is one of the factors likely feeding this upward trend, according to the Alzheimer’s Association’s Keith Fargo, director of scientific programs and outreach, and chief program officer Joanne Pike, who contributed to the report. Age remains the greatest risk factor for Alzheimer’s, followed by family history, Fargo said, and as the Baby Boomer generation grows older, the number of cases are likely to rise, too.

This year, 55 million Baby Boomers are expected to turn 65 or older; by 2050, that number is projected to rise to 88 million Americans.

Doctors are also just getting better at identifying the disease in patients and recording its presence on death certificates. Between 2000 and 2017, the Alzheimer’s death rate rose 145 percent nationwide, with Vermont reporting the highest rate and Alaska the lowest. That’s because of better identification and awareness among physicians, but also because of an aging population, Fargo said.

What’s the cost of Alzheimer’s?

The combined cost of health care, long-term care and hospice for all patients with Alzheimer’s and other dementias could add up to $290 billion this year alone, an increase from an estimated $277 billion in 2018, the report said. That is comparable to the economic burden of smoking-related illness in the U.S., according to the CDC.

Fainting and falling are the most frequent reasons people with Alzheimer’s receive medical treatment, and patients with dementia, including this disease, reported twice as many hospital stays as non-Alzheimer’s patients. But who pays the bill? Half of all the money paid for Alzheimer’s and dementia care comes from Medicare. Another 22 percent of costs are paid for out-of-pocket by patients, while Medicaid pays for an additional 17 percent.

Those figures don’t include the cost, in lost wages, of informal caregiving, which adds up to 18.5 billion hours and is roughly valued at $234 billion, according to the report. In 2018, two-thirds of these caregivers were estimated to be women.

What might stem the rise of Alzheimer’s disease?

In its report, the Alzheimer’s Association polled primary care physicians and people age 65 or older about the use of brief cognitive assessments, which focus on how a patient responds to questions and is used to detect symptoms of Alzheimer’s and dementia. The test typically takes less than five minutes, and is part of the Medicare Annual Wellness Assessments, a benefit mandated under the Affordable Care Act. Fargo compared the assessment to getting your blood pressure checked for heart disease or your glucose levels tested for diabetes.

But that doesn’t mean people are getting the test as often as they should. While nearly all primary care physicians — 94 percent — and 82 percent of Americans age 65 or older say they think these assessments are a good thing, only 16 percent of Medicare patients surveyed in the report receive these routine health check-ups each year.

While older Americans said they trust their doctors will raise the need for a cognitive assessment, doctors said they rely on patients to alert them to changes, according to the survey. Pike said that’s a critical juncture where patients and physicians are “missing each other.”

“You can think of it as the most important test that you’re not getting,” Fargo said.

Some people in the early stages of Alzheimer’s are likely falling through the cracks and developing more advanced symptoms because their illness isn’t being caught and treated earlier, medical experts interviewed for this story said.

But by the time a cognitive assessment picks up on symptoms of Alzheimer’s disease and dementia, it’s usually already too late for meaningful treatment, said Rudolph Tanzi, professor of neurology at Harvard University who also co-directs the Henry and Allison McCance Center for Brain Health at Massachusetts General Hospital. Two decades before symptoms of Alzheimer’s reveal themselves, the brain already is changing.

Rather than solely relying on less precise assessments, “we need to know how to treat a person at the right time to stop the disease from becoming symptomatic and leading to brain waste and dementia,” Tanzi said.

What we should be doing, he said, is encourage more cognitive assessments but also further develop tests and medications to diagnose and treat Alzheimer’s before a person loses cognitive abilities.

Tanzi has researched the illness since the early 1980s and was part of the team that discovered the three genes linked to early onset of Alzheimer’s disease. In fact, genes may play a bigger role in the development of Alzheimer-linked plaques and tangles in the brain than previously understood, according to recent research.

Tests that identify those plaques and tangles before the onset of neural degeneration — which leads to real damage in people with Alzheimer’s — and subsequent treatment is what may bring down the projected number of Americans with Alzheimer’s in the coming decades, Tanzi said. Seeing the development of such tests on the horizon, he thinks this moment is the “most exciting time in Alzheimer’s research we’ve ever had.”

The Food and Drug Administration has issued new guidance for what the agency is seeking from new Alzheimer’s medications entering clinical trials. The FDA is willing to work with researchers like Tanzi and his team to develop methods and drugs to identify and treat people at risk of Alzheimer’s before a person loses cognitive ability, he said. Biomarkers that may be linked to Alzheimer’s are being used in more clinical trials to treat the disease, the FDA said.

“It is obvious that delaying, or, preferably, halting or reversing, the pathophysiological process that will lead to the initial clinical deficits of AD is the ultimate goal of presymptomatic intervention, and treatment directed at this goal must begin before there are overt clinical symptoms,” the FDA wrote in a draft guidance issued in February 2018.

There’s little time to spare in the search for tests and treatment of Alzheimer’s disease, says Reisa Sperling, who directs the Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital and is a professor of neurology at Harvard Medical School.

The report’s projections were consistent with what she has tracked in her research, Sperling said. She believes the U.S. health care system is “absolutely not” ready for the anticipated wave of Alzheimer’s cases.

The more the medical community can do to test, intervene and treat people early and prevent them from entering the disease’s devastating late phases, the better, she said.