By Bernadette Keefe MD
All of us have personally known or heard the familiar drill. Dad couldnʼt find his way home. Mom didnʼt recognize her best friend. More and more memory lapses are occurring. Thereʼs a kitchen mishap. Finally the trip to family doc with the dreaded questions: Is It Alzheimerʼs? Is It Dementia?
The answer is yes, and they have a lot of company.
4.5 Million in the US are currently living with Dementia. The estimated prevalence of dementia among persons older than 70 years in US was nearly 15% in 2010. It is estimated that by 2050 there will be 13 Million people in the US living with dementia. There was hope that the incidence might be tapering off and even declining (from data comparing 1993 to 2002), however with the recent sharp increases in prevalence of diabetes and obesity over the past decade, it is feared that the numbers may rise precipitously.
Monetary costs of dementia are considerable. Yearly costs per person vary are between $40,000-60,000. Data from 2010 showed total US costs that year between $157-215 Billion with Medicare paying 11 Billion.
Source: “Monetary Costs of Dementia in the United States”, Hurd, Martorell, Delavande, et al, New England Journal of Medicine 2013:368:1326-1334, April 4 2013, http://www.nejm.org/doi/full/10.1056/NEJMsa1204629
The personal cost to the patient and their family is however the most destructive aspect of the disease. People lose their ability to function, to recognize others, to self care, indeed to do anything for themselves. Family are left to pick up the pieces, try desperately to communicate with their loved one and seek information and help where ever they can get it.
Additionally End Stage Dementia is a terminal disease with 55 % dying within 18 months of the diagnosis. Intervening illnesses are common and when occur signal death much earlier.* Hospice remains underutilized with only 30% of patients with dementia getting hospice care and 1/4 of these for less than one week.
Currently, there is not an effective treatment for Alzheimerʼs disease. The best advice that is given is to avoid the “lifestyle” diseases of diabetes, obesity, cardiovascular disease. Some cite exercise, which increases blood flow to the brain, as an effective preventative measure.
When a loved one does have dementia there are multiple online sites, chatrooms and support groups as well as many local community groups throughout the country for families to get support. There are strategies to keep the patient with dementia more engaged and w/ some memory for longer by using pets, favorite scents or stories. A social connection is felt important.
On June 24, 2014 the #hcldr community discussed the following related to the blog post:
T1: Drawing from personal/professional experiences w/ someone with dementia what insights can you share?
T2: What can governments do to prepare/handle this impending epidemic (public health, insurance reform, etc)?
T3: What is your personal feeling about at home care for a family member with severe dementia?
CT: What’s one thing you learned tonight that you can take back & use to help a patient or your organization tomorrow?
Facts about Alzheimerʼs and Dementia:
- Dementia is the term used to describe loss of memory and other mental capabilities, enough to interfere with activities of daily living. (ADLs)
- Dementia is caused by various physical derangements within the brain,depending on specific cause.
- Alzheimerʼs Disease is most common form of dementia, comprising 60-80% cases. The hallmark physical change in the brain is deposition of beta amyloid protein fragments called plaques and twisted strands called tangles. There is accompanying nerve cell damage and death.
- Other causes of dementia include vascular (micro infarct), Parkinsonʼs Disease, thiamine deficiency in alcoholism and others.
- Unfortunately high levels of glucose such as seen in diabetes is associated with dementia.
- Some early signs of dementia which one may not be aware of include: problems with walking and balance, slips and falls, inability to detect sarcasm or lies, staring, strange eating habits, being hurtful and compulsive behavior.
Resources
“New Insights into the Dementia Epidemic”, Eric B Larson, Kristine Yaff, Kenneth M Langa, New England Journal of Medicine 2013: 369:2275-2277, December 12 2013, http://www.nejm.org/doi/full/10.1056/NEJMp1311405, accessed June 21 2014
“Types of Dementia”, Alzheimer’s Association, http://www.alz.org/dementia/types-of-dementia.asp, accessed June 21 2014
“End Stage Dementia: A Terminal Disease Needing Palliative Care”, Ken Covinsky, GeriPal-A Geratrics and Palliative Care Blog, October 18 2009, http://www.geripal.org/2009/10/there-is-important-article-in-current.html, accessed June 21 2014
“Glucose Levels and Risk of Dementia”, Paul K Crane, Rod Walker, Rebecca Hubbard et al, New England Journal of Medicine 2013;369:540-548, August 8 2013, http://www.nejm.org/doi/full/10.1056/NEJMoa1215740, accessed June 21 2014
“Early Signs of Dementia that May Surprise You”, Diane Walker, Griswold Home Care Blog, March 29, http://www.griswoldhomecare.com/blog/early-signs-of-dementia-that-may-surprise-you/, accessed June 21 2014
“Monetary Costs of Dementia in the United States”, Michael D Hurd, Paco Martorell, Adeline Delavande, et al, New England Journal of Medicine 2013:368:1326-1334, April 4 2013, http://www.nejm.org/doi/full/10.1056/NEJMsa1204629, accessed June 21 2014
Image Credit
“Marble Madness #7: Stranded” by Peter Lee, link here
Bernadette Keefe MD 