Alzheimer's Disease Research Brief
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Research Brief
Alzheimer’s Disease
JUNE 2022
Alzheimer’s disease is the most common form Tangles occur when the protein tau causes
of dementia, constituting 60‐80% of all neurons to twist, resulting in tremendous
dementia cases. The fifth edition of the neuron damage (Mayo Clinic, 2022).
Diagnostic and Statistical Manual of Mental
ALZHEIMER’S CONTINUUM
Disorders (DSM‐5) by the American Psychiatric
“The progression of Alzheimer’s disease from
Association includes two dementia categories
brain changes that are unnoticeable to the
in the diagnostic classification of
person affected to brain changes that cause
neurocognitive disorders:
problems with memory and eventually physical
Major neurocognitive disorder classification
disability is called the Alzheimer’s disease
requires that an “individual must have
continuum” (Alzheimer’s Association, 2022a, p9).
evidence of significant cognitive decline,
1. Preclinical Alzheimer’s disease. In this
and the decline must interfere with
stage, there are no symptoms but there are
independence in everyday activities (for
measureable changes in the brain,
example, assistance may be needed with
cerebrospinal fluid and/or blood evidenced
complex activities such as paying bills or
by biomarkers. It is estimated that brain
managing medications)”
changes occur as many as 20 years before
Mild neurocognitive disorder classification
symptoms are evident.
requires that “individual must have
2. Mild Cognitive Impairment (MCI) due to
evidence of modest cognitive decline, but
Alzheimer’s disease. Includes individuals
the decline does not interfere with
who have mild but measureable changes in
everyday activities (individuals can still
thinking abilities that do not affect the
perform complex activities such as paying
ability to carry out everyday activities. It is
bills or managing medications, but the
estimated that 15‐20 percent of people age
activities require greater mental effort)”
(Alzheimer’s Association, n.d.)
65 and older have MCI.
3. Dementia due to Alzheimer’s disease.
Alzheimer’s disease is a degenerative brain Cognitive impairment interferes with an
disease where nerve cells in the brain are individual’s ability to function in daily life
damaged and no longer function properly and is caused by Alzheimer’s disease‐
(Alzheimer’s Association, 2022a). Plaques represent a related changes in the brain. This phase is
type of physical abnormality seen in brains of further broken down into three stages:
people with Alzheimer’s disease. Plaques occur a. Mild – symptoms interfere with some
when the protein amyloid‐beta builds up everyday activities but may still be able
between neurons, causing the neurons to to drive, work, and participate in
clump and die. Another brain abnormality in favorite activities
Alzheimer’s patients is the presence of tangles. b. Moderate – “individuals experience
more problems with memory and
Page 1 of 6Alzheimer’s Disease Research Brief June 2022
language, and are more likely to Significant personality changes
•
become confused, and find it harder to Difficulty recalling personal history
•
complete multistep tasks such as Tendency to wander and become lost
•
bathing and dressing. They may become Impaired ability to execute common
•
incontinent at times, and they may start actions such as dressing oneself
having personality and behavioral Stage Seven: Very severe cognitive decline
changes” • Little to no ability to speak
c. Severe – individuals need assistance • Failure to recognize objects and people
with daily living activities and around- • Loss of voluntary muscle control
the-clock care • Assistance required for all daily functions
(Alzheimer’s Association, 2022a, p.10)
(Alzheimer Society Canada, 2016)
THE PROGRESSION OF ALZHEIMER’S DISEASE Patients may not exhibit all signs and symptoms
Alzheimer’s disease progressively affects of each stage, nor does the disease progress at
memory, thinking, and behavior. The Global an equal rate in every patient. The Alzheimer’s
Deterioration Scale, also called the Reisberg Association reports “studies indicate that
Scale, divides the progression of Alzheimer’s people age 65 and older survive an average of 4
disease into seven key stages of development: to 8 years after a diagnosis of Alzheimer’s
Stage One: No cognitive impairment disease, yet some live as long as 20 years with
• No memory problems evident Alzheimer’s dementia” (Alzheimer’s Association,
Stage Two: Very mild cognitive decline 2022a, p.35).
• Memory lapses for familiar words and PREVALENCE AND RISK FACTORS
names Currently, an estimated 6.5 million people in
• Lapses not evident to friends, family, co‐ the United States are living with Alzheimer’s
workers, or doctors disease. The majority, 6.47 million, are over age
Stage Three: Mild cognitive decline 65, while only 200,000 are younger than 65.
• Friends, family, and co‐workers begin to 72.6% of seniors with Alzheimer’s disease are
notice deficiencies in memory age 75 or older (Alzheimer’s Association, 2022a, p.19).
• Problems with memory, retention, and The single greatest known risk factor for
concentration Alzheimer’s disease is age. Approximately 11%
• Difficulty naming objects or people of Americans over the age of 65 have
• Decreased performance of daily activities Alzheimer’s disease with higher incidence as
• Decline in ability to plan or organize age increases. Approximately 33% of seniors 85
Stage Four: Moderate cognitive decline and older have Alzheimer’s disease (Alzheimer’s
• Clear cut deficiencies in knowledge of Association, 2022a).
recent events It is estimated that Alzheimer’s disease effects
• Decreased capacity to perform complex approximately one in ten people aged 65 and
tasks such as planning Thanksgiving older. As a result of a longer life expectancy,
dinner or managing finances women are more likely to develop Alzheimer’s
• Demeanor may be subdued or withdrawn disease than men and currently two‐thirds of
Stage Five: Moderately severe cognitive decline Alzheimer’s patients are women. Alzheimer’s
• Major gaps in memory and cognitive disease and dementias account for
functioning approximately 12 percent of women as
• Need for assistance with daily functions opposed to only 9 percent of men over age 65.
• Confusion about location and date Of this age group, women represent 4 million of
Stage Six: Severe cognitive decline Americans with Alzheimer’s, men represent 2.5
• Increased memory deficits million but there is no indication that women
were more likely than men to develop the
Page 2 of 6June 2022 Alzheimer’s Disease Research Brief
disease at any given age (Alzheimer’s Association, conditions such as smoking, obesity (especially
2022a). in midlife), diabetes, high cholesterol in midlife,
“In 2011, the largest ever demographic and hypertension in midlife may be linked to
generation of the American population — the the onset of Alzheimer’s disease (Alzheimer’s
Association, 2022a, p. 82).
baby boom generation — started reaching age
65, the age at which the risk for Alzheimer’s Recent research suggests that the prevalence
and other dementias begins to increase. By and risk of Alzheimer’s disease is higher in both
2030, the segment of the U.S. population age Hispanics and African Americans, as compared
65 and older will have grown substantially, and with other Americans, perhaps due to
the projected 74 million older Americans will socioeconomic factors as well as higher rates of
make up over 20% of the total population (up cardiovascular diseases. Specific prevalence
from 18% in 2022” (Alzheimer’s Association, 2022a, rates among each racial and ethnic group
p.27). As Americans live longer and the baby remain unclear. This ambiguity is largely
boomer generation ages, rates of Alzheimer’s attributable to African Americans and Hispanic
disease are also projected to grow Americans avoiding or delaying treatment,
exponentially: causing the disease to go undiagnosed
(Alzheimer’s Association, 2022a).
PROJECTED # OF INDIVIDUALS AGE 65 AND OVER
YEAR
WITH ALZHEIMER’S DISEASE (IN MILLIONS) “Most people with Down syndrome develop
2020 6.1m Alzheimer’s. This may be because people with
2030 8.5m Down syndrome have an extra copy of
2040 11.2m
chromosome 21, which contains the gene that
2050 13.8m
generates harmful amyloid” (National Institute on
(Alzheimer’s Association, 2022a, p. 26)
Aging, 2021).
Other risk factors for Alzheimer’s disease
Additionally, new research has linked fewer
include family history, genetics, environmental
years of education to an increased risk of
factors, and history of severe head injury. It is
developing Alzheimer’s disease. The exact
believed that certain genetic factors may
cause of this association remains unclear. Some
increase the potential for developing
researchers theorize that additional years of
Alzheimer’s disease. For example, the genetic
education allow for the development of more
presence of particular forms of the protein
brain synapses resulting in a greater reserve as
Apoliprotein‐E (ApoE4) gene, which occurs in
individuals age while others believe that those
people with late‐onset Alzheimer’s disease, has
with lower education also are subject to other
been identified as a potential risk factor. Early‐
risk factors common to lower socioeconomic
onset Alzheimer’s disease has been linked to
groups including increased risk for disease in
mutations in three genes. “A blood test can
general and less access to medical care
identify which APOE alleles a person has, but (Alzheimer’s Association, 2022a).
results cannot predict who will or will not
develop Alzheimer’s disease” (National Institute on TREATMENT
Aging, 2019). Except for research (clinical trials) No known cure for Alzheimer’s disease exists,
and to help doctors diagnose early-onset but there are two types of FDA approved drugs
Alzheimer’s, genetic testing is not which can delay its progression:
recommended. Other risk‐factor genes are 1. Cholinesterase inhibitors
under investigation. a. Prevent the breakdown of the chemical
acetylcholine (which aids memory and
Researchers are also investigating the
thinking)
association between various lifestyle factors
related to the cardiovascular system and their b. Delay symptoms for 6‐12 months in
influence on Alzheimer’s disease. Because the approximately half of patients.
brain contains numerous blood vessels,
Page 3 of 6Alzheimer’s Disease Research Brief June 2022
c. Used for those with mild to moderate These health issues are often directly related to
Alzheimer’s disease the stress and anxiety that comes with caring
for a loved one with Alzheimer’s disease
2. N-methyl D-aspartate (NMDA) antagonists (Alzheimer’s Association, 2022a). Fortunately, there
a. Help regulate the activity of glutamate are several types of services that exist to
(which aids information processing) support caregivers.
b. Used for those with moderate to severe One option available to caregivers is in‐home
Alzheimer’s disease care services, which involves a professional
coming to the home to assist the caregiver and
“Because NMDA antagonists work very
individual suffering from dementia with a
differently from cholinesterase inhibitors, the
variety of tasks. The following are common in‐
two types of drugs can be prescribed in
home care services:
combination” (National Institute on Aging, 2018, p.3).
Companion services: assist caregiver with
Several drugs targeting beta-amyloid, the chief supervision, recreational activities, and
component of plaques, are under investigation. visiting
“While scientists aren’t sure what causes cell Personal care services: provide help with
death and tissue loss during the course of bathing, dressing, toileting, exercising, or
Alzheimer’s, amyloid plaques are one of the other personal care needs
potential contributors, and preventing beta- Homemaker services: provide assistance
amyloid buildup may provide benefit (Alzheimer’s with housekeeping, shopping, and meal
Association, 2022e). preparation
Other medical treatments seek to alleviate Skilled care: assists with wound care,
Alzheimer’s symptoms beyond cognitive injections, physical therapy and other
impairment such as sleeplessness, agitation, medical needs, usually conducted by a
wandering, anxiety, aggression, and depression licensed health professional
(National Institute on Aging, 2021). (Alzheimer’s Association, 2022c)
RESPITE SERVICES Outside of the home, adult day services provide
Proper care and support is essential to reduce those suffering from dementia or Alzheimer’s
the complications common to Alzheimer’s, disease opportunities for social interaction and
including pneumonia, infections, falls, fractures, a safe environment to participate in activities.
and malnutrition (Mayo Clinic, 2022). Currently, These adult day programs provide a variety of
over 16 million Americans, usually relatives or services, including meals, social and
friends, provide unpaid care for individuals educational activities, exercise, various types of
suffering from dementia or Alzheimer’s disease. therapy, counseling, and medical treatment.
“In 2021, caregivers of people with Alzheimer’s Typically, these services are available daily and
or other dementias provided an estimated 16 most programs are flexible with attendance
billion hours of informal (that is, unpaid) requirements. “Over 80% of participants attend
assistance, a contribution to the nation valued full days and 46% attend five days per week,
at $271.6 billion” (Alzheimer’s Association, 2022a, enabling family caregivers to remain in the
p38). In Texas, 1.1 million caregivers provided workforce” (National Adult Day Services Association,
over 1.8 billion hours of unpaid care in 2021. n.d.). Most adult day centers also provide a
Because it is possible for a patient to live with variety of caregiver support programs including
the disease for many years, the emotional and education, support groups, and counseling.
financial burden on caregivers can be Locating respite services for adults can be
overwhelming. Consequently, it is common for challenging for caregivers. There are several
the caregivers themselves to suffer from online locator services that can help. The Texas
illnesses such as heart disease, high‐blood Health and Human Services (HHS) website lists
pressure, and poor mental health (depression).
Page 4 of 6June 2022 Alzheimer’s Disease Research Brief
51 respite care providers in Bexar County. (HHS, statistics, provided by the Alzheimer’s
n.d.). Association (2022a, p. 69-70), represent typical
costs associated with Alzheimer’s care.
Long‐term respite care facilities include assisted
living facilities, residential care facilities, and Average costs for Alzheimer’s services:
nursing homes. These programs provide • Adult day care service – $75 per day
overnight, weekend, or long‐term stays when a • Assisted living – approximately $4,429
caregiver experiences illness or other per month or $53,148 per year (dementia
emergency situations. Services include meals, care often results in additional charges)
daily living help, therapeutic activities, and a • Nursing Homes – about $299 per day or
safe setting to reduce wandering (Alzheimer’s $109,135 per year (for a semi‐private
Association, 2022d). room the cost is around $263 per day or
For those individuals who need specialty care, $95,995 per year)
there are several different kinds of facilities • Home care – cost for a nonmedical home
which assist in care for different stages of health aide was $24 per hour or $4,652
Alzheimer’s. These facilities include: per month
Retirement housing for early stage The high costs incurred from Alzheimer’s
Alzheimer’s patients who are still able to disease are also reflected on United States
care for themselves and require no more businesses due to caregiver absenteeism, loss
than limited supervision, social activities, of productivity, and employee turnover.
and transportation Independent businesses accrue additional costs
Assisted living (also called board and care, from health care, long‐term care, and hospice
adult living or supported care) offers for people with Alzheimer’s disease and other
moderately independent Alzheimer’s dementias. The total estimated cost for health
patients housing, meals, supportive care and long‐term care for people aged 65 and
services, and health care (these facilities are older with Alzheimer’s disease and other types
not government regulated) of dementia totaled $321 billion for the year
Nursing homes (also called skilled nursing 2021. By the year 2050, the cost is expected to
facility, long‐term care facility or custodial rise to just under $1 trillion (Alzheimer’s
care) offer around‐the‐clock care and long‐ Association, 2022a, p. 79).
term medical treatment for mid to late‐
MORTALITY
stage Alzheimer’s patients (these facilities
are regulated by both state and federal Through advancements in research and
governments) technology, there are ways to diagnose
Alzheimer’s special care units (SCUs) (also Alzheimer’s such as blood tests that measure
called memory care units) assist those with beta-amyloid levels. The disease used to be
dementia or Alzheimer’s disease and can be definitively diagnosed through an autopsy
found in many types of care facilities (National Institute on Aging, 2021). In any given year,
Continuing care retirement communities one‐third of all seniors who die are found to
(CCRC) give either independent, assisted have Alzheimer’s or some form of dementia.
living, or nursing home levels of care For people aged 65 and older, Alzheimer’s
depending on individual need disease is the fifth‐leading cause of death in the
(Alzheimer’s Association, 2022d) United States, and the sixth‐ leading cause of
death across all age groups (Alzheimer’s
THE HIGH COST OF ALZHEIMER’S DISEASE
Association, 2022a).
Alzheimer’s disease also creates an enormous
economic responsibility for caregivers, the For the year 2019, Alzheimer’s disease was the
government, through Medicare and Medicaid, underlying cause of death for 10,101
and independent businesses. The following individuals in Texas. The U.S. annual
Alzheimer’s death rates show that deaths
Page 5 of 6Alzheimer’s Disease Research Brief June 2022
attributed to the disease increase drastically REFERENCES
with age. The increase in deaths attributed to Alzheimer’s Association. (n.d.). In brief for healthcare
Alzheimer’s disease over time has professionals: Differentiating dementias. Retrieved April 27,
disproportionately affected the oldest 2022, from https://www.alz.org/media/documents/inbrief-
differentiating-dementias.pdf
populations: “Between 2000 and 2019, the
Alzheimer’s Association. (2022a). 2020 Alzheimer’s disease
death rate from Alzheimer’s increased 33% for facts and figures. Retrieved from
people aged 65 to 74, but increased 51% for https://www.alz.org/media/Documents/alzheimers-facts-
people age 75 to 84 and 78% for people age 85 and-figures.pdf
and older” (Alzheimer’s Association, 2022a, p.34). Alzheimer’s Association. (2022b). In‐home care. Retrieved from
https://www.alz.org/help-support/caregiving/care-
“Scientists have developed methods to options/in-home-care
measure and compare the burden of different Alzheimer’s Association. (2022c). Residential Care. Retrieved
diseases on a population in a way that takes from https://www.alz.org/care/alzheimers-dementia-
into account not only the number of people residential-facilities.asp
with the condition, but also the number of Alzheimer’s Association. (2022d). Treatment horizon. Retrieved
years of life lost due to that disease and the from
http://www.alz.org/research/science/alzheimers_treatmen
number of healthy years of life lost by virtue of t_horizon.asp
being in a state of disability. One measure of Alzheimer’s Association. (2022e). COVID-19, Alzheimer’s and
disease burden is called disability-adjusted life dementia: what you need to know. Retrieved from
years (DALYs), which is the sum of the number https://www.alz.org/alzheimers-dementia/coronavirus-
covid-19
of years of life lost (YLLs) due to premature
mortality and the number of years lived with Alzheimer Society Canada (2016). Progression. Retrieved from
https://alzheimer.ca/sites/default/files/documents/Progres
disabilities (YLDs), totaled across all those with sion-overview--Alzheimer-Society.pdf
the disease or injury…Alzheimer’s disease rose
Mayo Clinic. (2022). Alzheimer’s disease: causes. Retrieved from
from the 12th most burdensome disease or http://www.mayoclinic.org/diseases-
injury in the United States in 1990 to the sixth conditions/alzheimers-disease/symptoms-causes/dxc-
20167103
in 2016 in terms of DALYs. In 2016, Alzheimer’s
disease was the fourth highest disease or injury National Adult Day Services Association. (n.d.). About adult day
services. Retrieved April 27, 2022, from
in terms of YLLs and the 19th in terms of YLDs” http://www.nadsa.org/learn-more/about-adult-day-
(Alzheimer’s Association, 2022a, p35). services/
COVID-19 CONSIDERATIONS National Institute on Aging. (2018). Alzheimer’s disease
Services and programs for Alzheimer’s medications fact sheet. Retrieved from
https://order.nia.nih.gov/sites/default/files/2018-
Dementia patients have been impacted by the 03/alzheimers-disease-medications-fact-sheet.pdf
COVID-19 Pandemic. Patients with Alzheimer’s,
National Institute on Aging. (2019). Alzheimer’s disease genetics
while not at an increased risk to contract the fact sheet. Retrieved from
virus, can find themselves at higher risk of https://www.nia.nih.gov/alzheimers/publication/alzheimer
being impacted by it. Through things like s-disease-genetics-fact-sheet
forgetting to wash hands and take necessary National Institute on Aging. (2021a). Alzheimer’s disease fact
sheet. Retrieved from
precautions, people with Alzheimer’s may be at https://www.nia.nih.gov/health/alzheimers-disease-fact-
higher risk. Similarly, “COVID-19 may worsen sheet#causes
cognitive impairment due to dementia National Institute on Aging. (2021b). How is Alzheimer’s disease
(Alzheimer’s Association, 2022e). Local organizations diagnosed? Retrieved from
like the Alzheimer’s Association in San Antonio https://www.nia.nih.gov/health/how-alzheimers-disease-
diagnosed
are offering virtual services and services over
the phone as well as other safety precautions Texas Health and Human Services (HHS). (n.d.). Respite provider
search. Retrieved May 2, 2022, from
on site (Alzheimer’s Association, 2022e). https://apps.hhs.texas.gov/taketimetexas/search.cfm
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