In just the past few years, billions of dollars have been put toward ending cancer. We know the importance and urgency of achieving this goal. We accept it and support it. What we are less aware of and engaged in is the equally vital need to find an effective treatment for another devastating disease: Alzheimer's. Each year, it kills more people than breast cancer and prostate cancer combined. Multiple trials have failed to find drugs that prevent, reverse or slow this disease. According to the Alzheimer's Association, a leading voluntary health organization in Alzheimer's care and research, in 2019, health care costs for Alzheimer's and other dementias are estimated to reach $290 billion. If a cure or effective treatment is not found by 2050, these costs could rise to as high as $1.1 trillion. Currently, an estimated 5.8 million Americans are living with Alzheimer's. Every 65 seconds, someone in the United States develops the disease. By 2050, this number is projected to rise to nearly 14 million.
Some good news in confronting this disease arrived last month at the Alzheimer's Association International Conference, where scientists revealed they are closing in on a long-sought goal: a blood test to screen people for possible signs of Alzheimer's disease and other forms of dementia. A tiny drop of blood could be enough to predict the onset of Alzheimer's and facilitate better care and preventative measures. It would be nothing short of revolutionary.
As noted in an Associated Press report, doctors are desperate for something to use during routine exams where dementia symptoms are evaluated in order to effectively gauge those who need more extensive testing. At the conference, half a dozen research groups gave new results on experimental tests to provide such a means. One study published last year by researchers in Japan correctly identified 92% of people who had Alzheimer's and correctly ruled out 85% who did not have it. It had an overall accuracy rate of 88%.
To date, dozens of hoped-for treatments have failed miserably in clinical studies. It's believed that part of the problem was that people were enrolled in the trials after too much brain damage had occurred. In addition, too many subjects had health problems other than Alzheimer's. Diagnosis of this disease traditionally relies on looking for the visible symptoms of Alzheimer's. At this stage, the disease is well developed. Doctors hope that a blood test might get the right people into studies sooner. This simple test could provide people a much-needed warning system decades before the onset of the disease.
It's speculated that blood tests will soon start being used to choose people for federally funded studies and monitor them. Before we get too excited, we should also note that, even on a fast track, such screening studies could be up to three years away. Medical science remains unsure as to exactly how Alzheimer's starts and develops. Abnormal levels of certain proteins seem to play a big role. At present, costly and invasive brain scans and intricate spinal fluid extractions are the go-to tools to measure the levels of these proteins. Both procedures are too expensive, problematic and impractical for regular doctor checkups.
These procedures present other issues as well. Shortly after positron emission tomography (PET) brain scan imaging became available in 2013, Medicare officials determined they lacked evidence of its health benefits. As a result, Medicare does not cover the scans' substantial costs, and according to the Alzheimer's Association, private insurers don't either.
As public knowledge mounts about the fact that brain damage from Alzheimer's begins years before people develop symptoms, concern is also mounting that worried patients and their families may start turning to PET scans to learn if they have these biological markers. An Associated Press poll conducted last year found that most Americans would want to know if they carried a gene tied to a disease, even if it was incurable.
Here's the thing: These indicator proteins or neural structures occur commonly in older people as a byproduct of aging. Not everyone with them will develop dementia. Nor does a negative PET scan mean someone will not develop dementia.
"If we start treating everyone with preclinical Alzheimer's, we'll treat a lot of people who would never have gone on to have dementia at all," Dr. Kenneth Langa, a researcher at the University of Michigan and author of a recent article on the diagnosis of early Alzheimer's disease, recently explained to The New York Times. "My hope is we'll think hard about the unintended downsides."
It is also a fact that the two main drugs approved for Alzheimer's have been shown to have only modest benefits in some patients for a limited time. Neither drug has been shown to be effective for mild cognitive impairment, often a precursor to dementia. A recently published Medicare study shows that positive PET scans lead to far greater use of these and other medications, regardless of their limited or negligible benefit.
We cannot let all the noise this discussion generates cause us to lose sight of the hope that a tiny drop of blood could be enough to predict the onset of Alzheimer's and be the pathway to better care and preventative measures. Knowing an effective treatment is on the way can help trigger lifestyle changes with regard to sleep, diet and exercise that might help reduce or forestall Alzheimer's onset. At least one recent study shows the benefits of such changes.
As reported by Time magazine, scientists at Rush University Medical Center in Chicago followed nearly 2,500 people for almost a decade. They found that people who reported healthier lifestyles overall — those who stuck to a low-fat diet, did not smoke, exercised at least 150 minutes each week at moderate-to-vigorous levels, drank moderately and engaged in some late-life cognitive activities — had lower levels of Alzheimer's dementia. The more healthy activities the people adhered to the lower their risk. As we age, we should follow this prescription as though our lives depended upon it.
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