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New estimate says 46 million Americans headed to Alzheimer’s

Close to 50 million Americans could be in the early stages leading to Alzheimer’s disease right now, according to a new forecast.

And 6 million people likely have it now, the team at the University of California Los Angeles calculated.

The forecast is based on a lot of supposition as well as some hard data, but it’s the best estimate of how badly Alzheimer’s will affect the country in the coming years, said Keith Fargo of the Alzheimer’s Association, who was not involved in the research.

e2c28_20171207-alzheimers_842ece9a1ddb6a678eb6d18559826e76.nbcnews-fp-360-360 New estimate says 46 million Americans headed to Alzheimer's


e2c28_20171207-alzheimers_842ece9a1ddb6a678eb6d18559826e76.nbcnews-fp-360-360 New estimate says 46 million Americans headed to Alzheimer's

“To our knowledge, this is the first time someone has done this type of estimate,” said Fargo, director of scientific programs and outreach at the Alzheimer’s Association.

For the unusual study, Ron Brookmeyer, a biostatistician at the University of California, Los Angeles and colleagues collected all the data they could find from studies of Alzheimer’s disease.

To calculate who was at risk of Alzheimer’s they used measures including a buildup of a protein in the brain called amyloid, the loss of brain cells, and the loss of memory and skills such as reading and writing.

Related: Here’s how to prevent Alzheimer’s

They used other studies including a look at 1,500 volunteers who live around the Mayo Clinic in Minnesota, which included healthy people who have no particular risk of Alzheimer’s. They used studies of people with mild cognitive impairment — memory loss that can lead to Alzheimer’s — and people diagnosed with Alzheimer’s dementia.

And they looked at actual reports of people who have Alzheimer’s disease now.

Then they made calculations to predict how many people are likely progressing to Alzheimer’s right now, although they may not know it.

“It’s virtually all extrapolation. It’s looking at some real community-based cohorts that have been studies,” said Fargo.

“But it’s not a matter of going systematically through the population. It’s very much a model-based estimate.”

But it uses solid data and methods that should at least be a start at predicting the future toll of Alzheimer’s, said Fargo.

“For the first time, scientists have attempted to account for numbers of people with biomarkers or other evidence of possible preclinical Alzheimer’s disease, but who do not have impairment or Alzheimer’s dementia,” the National Institutes of Health, which helped pay for the study, said in a statement.

“People with such signs of preclinical disease are at increased risk to develop Alzheimer’s dementia.”

Related: Sleep loss may affect Alzheimer’s

The results?

“An estimated 46.7 million American adults over age 30 are in this hypothetical preclinical stage of Alzheimer’s disease and another 2.43 million have mild cognitive impairment due to Alzheimer’s disease, although many will not progress to dementia during their lifetimes,” Brookmeyer and colleagues wrote.

“In 2017, there were 3.65 million cases of clinical Alzheimer’s in the United States,” they wrote in their report, published in the journal Alzheimer’s Dementia: The Journal of the Alzheimer’s Association.

“We estimate that approximately 1.54 million (42 percent ) of the 3.65 million cases living today have late-stage clinical Alzheimer’s disease who need level of care equivalent to nursing homes,’ they added.

“We predict by 2060, U.S. prevalence of clinical Alzheimer’s disease will grow to 9.3 million.”

e2c28_20171207-alzheimers_842ece9a1ddb6a678eb6d18559826e76.nbcnews-fp-360-360 New estimate says 46 million Americans headed to Alzheimer's


e2c28_20171207-alzheimers_842ece9a1ddb6a678eb6d18559826e76.nbcnews-fp-360-360 New estimate says 46 million Americans headed to Alzheimer's

By 2060, they predict, more than 75 million people will have pre-clinical Alzheimer’s disease — meaning the disease is developing in their brains but hasn’t caused enough symptoms to be diagnosed.

Alzheimer’s is the most common form of dementia. There’s no cure for it and no good treatment.

So why even try to calculate the extent of an incurable disease?

“There are things that you can do,” said Fargo. “These are the numbers of people we could potentially intervene with.”

Although there’s no good treatment now, several studies have shown that Alzheimer’s can be prevented in some people with better diet, more exercise and other healthy habits.

And the hope is to develop drugs that can prevent Alzheimer’s, just as statins and blood-pressure-lowering drugs prevent strokes and heart attacks now.

Related: Researchers Seek Test to Predict Alzheimer’s

Plus, not everyone with Alzheimer’s-associated brain damage develops the disease. “There is a group of people that have the brain changes but never experience dementia symptoms,” the Alzheimer’s Association said in a statement.

“It shouldn’t be scary. It should be seen as pointing to the future where we have a window of opportunity for prevention just like we do with cholesterol and heart disease today,” said Fargo.

“Even if this estimate turns out to be reality, that does not mean that those 46 million people will develop dementia from Alzheimer’s disease,” Fargo added.

“Just like you can have high cholesterol today and not develop heart disease, heart attack or stroke, you can be in this pre-clinical state but not go on later to develop Alzheimer’s disease dementia.”

Brainstorm Health: Alzheimer’s Cases to Skyrocket, Medical ‘Virtualists’, Sage Depression Drug

Hello, readers! This is Sy.

A National Institutes of Health-funded (NIH) study presents a sobering projection: The number of Americans with Alzheimer’s or cognitive impairment will hit 15 million by 2060, fueled by an aging population. And, by using a new kind of methodology which incorporates people at risk of developing Alzheimer’s, the researchers determined that about 6 million U.S. adults have Alzheimer’s or mild cognitive impairment.

The new method of calculation may be more precise than current tactics and could present an opportunity to assess Alzheimer’s-prevention techniques. “For the first time, scientists have attempted to account for numbers of people with biomarkers or other evidence of possible preclinical Alzheimer’s disease, but who do not have impairment or Alzheimer’s dementia. People with such signs of preclinical disease are at increased risk to develop Alzheimer’s dementia,” wrote the NIH in a press release. “The researchers say they factored those rates of transition in their multi-state model; further, the model can estimate the impact of some possible prevention efforts on the number of future cases.”

Alzheimer’s is the 6th leading cause of death in the United States, according to the Centers for Disease Control (CDC). In America and abroad, the condition (and other dementia and cognitive decline conditions) are expected to balloon in the coming decades—an ironic side effect of growing life expectancy across the globe. The trouble is that there aren’t really any drugs that tackle the root of Alzheimer’s rather than just its symptoms. Companies attempting to innovate in the space, like Eli Lilly and Merck, have been hit with costly failures (although Biogen is still marching forth in its efforts). And some scientists even disagree with each other about what, exactly, it is that should be targeted in the hunt for a cure.

The dearth of treatment options ups the ante for finding effective prevention techniques, whether they be diet, exercise, “brain games,” or other activities; but the first step in assessing those options is getting the numbers right—which is the broader goal of this new methodology.

Read on for the day’s news.

If An Alzheimer’s Drug Succeeds, Could Our Health System Handle It?

A woman, suffering from Alzheimer’s disease, walks in her room on March 18, 2011 in a retirement house in Angervilliers, eastern France. (SEBASTIEN BOZON/AFP/Getty Images)

Microsoft founder and billionaire philanthropist Bill Gates made news this week by vowing more than $50 million to fund Alzheimer’s research. But in making that generous move he expressed a concern, which was echoed today in a new report from the Rand Corporation: Due to the aging of the population, the population of Alzheimer’s patients is growing so rapidly the healthcare system isn’t equipped to handle it, Gates warned.

Even if the research dollars being spent by Gates and others translates into an effective, disease-modifying treatment for Alzheimer’s, the task of diagnosing patients in the earliest stages of the disease and delivering the drug could still be too much for society to bear, the Rand report suggests. That’s because the number of Americans living with Alzheimer’s is predicted to more than double to 11.6 million by 2040. And there aren’t enough doctors who specialize in geriatrics, or PET scanners to diagnose the disease or infusion centers to deliver any drugs that must be given intravenously, Rand estimates.

There is one caveat that’s important to mention up front, however. The Rand study was sponsored by Biogen, which is developing an Alzheimer’s treatment. Biogen’s experimental treatment aducanumab is in phase 3 testing that’s expected to be completed by the end of 2019. A handful of other pharma companies are also in late-stage trials of their Alzheimer’s drugs or vaccines, including Eli Lilly and Merck.

Watch on Forbes: One Doctor’s Hopeful Plan To Eradicate Alzheimer’s

Rand’s conclusion that the healthcare system won’t be ready for these drugs if they’re approved by the FDA starts with the estimate that in 2020, around 15 million Americans will have mild cognitive impairment—an early sign of Alzheimer’s. But the only FDA-approved way to confirm the diagnosis of the disease is a PET scan to look for deposits of amyloid in the brain, which has long been considered to be the main culprit for the memory-robbing effects of Alzheimer’s.

Using a variety of data sources, Rand estimated that the demand for geriatricians to diagnose the disease and PET scanning facilities to do the necessary testing would quickly outstrip the supply. What’s more, some of the experimental drugs, including Biogen’s, require regular infusions at centers with limited capacity.

The bottom line Rand prediction: In 2020, the average Alzheimer’s patient will have to wait more than 18 months to be treated, and more than 2 million people will descend into full-blown dementia over the following two decades while they’re on waiting lists for diagnostic procedures and reservations at infusion centers.

It may be a bit premature to assume this is going to be a problem for the study’s sponsor, Biogen. Recently disclosed data from a phase 1 trial showed the company’s drug produced a reduction in amyloid plaque, but exactly how that translates into symptom relief won’t be clear until results from the larger late-stage trials become available.

Biogen, which is in late-stage testing of an Alzheimer’s drug, sponsored a Rand Corp. study questioning the health system’s readiness for effective cures for the disease. (Photographer: Scott Eisen/Bloomberg)

Furthermore, the notion that amyloid is the main culprit in Alzheimer’s has come under question recently. Earlier this year, Merck discontinued one trial of its experimental Alzheimer’s drug verubecestat, which is known as a BACE inhibitor. These drugs work upstream of amyloid, blocking the process by which the toxic form of the protein is made. But in an announcement, Merck said there was “virtually no chance of finding a positive clinical effect” from verubecestat. Another trial of the drug continues and results are expected in early 2019.

Biogen is also working on a BACE inhibitor, in partnership with Eisai. Phase 3 results are expected in 2020. Gates, meanwhile, is supporting efforts to look beyond amyloid, investing his money in the Dementia Discovery Fund, which is seeding companies pursuing entirely different theories about what drives the disease.

The uncertainty surrounding the prospects for these experimental drugs doesn’t necessarily negate concerns about whether the healthcare system is adequately equipped to treat Alzheimer’s patients. In fact, Gates expressed concerns of his own when he announced his latest funding for research. Even now, with no cure in sight, he pointed out, Americans spend $259 billion a year caring for patients with Alzheimer’s.

“Absent a major breakthrough, expenditures will continue to squeeze healthcare budgets in the years and decades to come,” he predicted.

If An Alzheimer’s Drug Succeeds Could Our Health System Handle it?

Biogen, which is in late-stage testing of an Alzheimer’s drug, sponsored a Rand Corp. study questioning the health system’s readiness for effective cures for the disease. (Photographer: Scott Eisen/Bloomberg)

Microsoft founder and billionaire philanthropist Bill Gates made news this week by vowing more than $50 million to fund Alzheimer’s research. But in making that generous move he expressed a concern, which was echoed today in a new report from the Rand Corporation: Due to the aging of the population, the population of Alzheimer’s patients is growing so rapidly the healthcare system isn’t equipped to handle it, Gates warned.

Even if the research dollars being spent by Gates and others translates into an effective, disease-modifying treatment for Alzheimer’s, the task of diagnosing patients in the earliest stages of the disease and delivering the drug could still be too much for society to bear, the Rand report suggests. That’s because the number of Americans living with Alzheimer’s is predicted to more than double to 11.6 million by 2040. And there aren’t enough doctors who specialize in geriatrics, or PET scanners to diagnose the disease or infusion centers to deliver any drugs that must be given intravenously, Rand estimates.

There is one caveat that’s important to mention up front, however. The Rand study was sponsored by Biogen, which is developing an Alzheimer’s treatment. Biogen’s experimental treatment aducanumab is in phase 3 testing that’s expected to be completed by the end of 2019. A handful of other pharma companies are also in late-stage trials of their Alzheimer’s drugs or vaccines, including Eli Lilly and Merck.

Rand’s conclusion that the healthcare system won’t be ready for these drugs if they’re approved by the FDA starts with the estimate that in 2020, around 15 million Americans will have mild cognitive impairment—an early sign of Alzheimer’s. But the only FDA-approved way to confirm the diagnosis of the disease is a PET scan to look for deposits of amyloid in the brain, which has long been considered to be the main culprit for the memory-robbing effects of Alzheimer’s.

Using a variety of data sources, Rand estimated that the demand for geriatricians to diagnose the disease and PET scanning facilities to do the necessary testing would quickly outstrip the supply. What’s more, some of the experimental drugs, including Biogen’s, require regular infusions at centers with limited capacity.

The bottom line Rand prediction: In 2020, the average Alzheimer’s patient will have to wait more than 18 months to be treated, and more than 2 million people will descend into full-blown dementia over the following two decades while they’re on waiting lists for diagnostic procedures and reservations at infusion centers.

It may be a bit premature to assume this is going to be a problem for the study’s sponsor, Biogen. Recently disclosed data from a phase 1 trial showed the company’s drug produced a reduction in amyloid plaque, but exactly how that translates into symptom relief won’t be clear until results from the larger late-stage trials become available.

Furthermore, the notion that amyloid is the main culprit in Alzheimer’s has come under question recently. Earlier this year, Merck discontinued one trial of its experimental Alzheimer’s drug verubecestat, which is known as a BACE inhibitor. These drugs work upstream of amyloid, blocking the process by which the toxic form of the protein is made. But in an announcement, Merck said there was “virtually no chance of finding a positive clinical effect” from verubecestat. Another trial of the drug continues and results are expected in early 2019.

Biogen is also working on a BACE inhibitor, in partnership with Eisai. Phase 3 results are expected in 2020. Gates, meanwhile, is supporting efforts to look beyond amyloid, investing his money in the Dementia Discovery Fund, which is seeding companies pursuing entirely different theories about what drives the disease.

The uncertainty surrounding the prospects for these experimental drugs doesn’t necessarily negate concerns about whether the healthcare system is adequately equipped to treat Alzheimer’s patients. In fact, Gates expressed concerns of his own when he announced his latest funding for research. Even now, with no cure in sight, he pointed out, Americans spend $259 billion a year caring for patients with Alzheimer’s.

“Absent a major breakthrough, expenditures will continue to squeeze healthcare budgets in the years and decades to come,” he predicted.

Bill Gates, Alzheimer’s and an Aging Health Agenda

As usual, Bill Gates gets it – that the megatrend of population aging in many ways brought about by the 20th-century miracles of good and widespread hygiene, modern innovative medicines, and broad-based healthier lifestyles – must now in our 21st century be joined by what Mr. Gates himself calls the next “frontier where we can dramatically improve human life. It’s a miracle that people are living so much longer, but longer life expectancies alone are not enough.” That frontier will be to find the cures for the diseases of long lives, starting with the scourge of Alzheimer’s, which takes tens of millions of loved ones from us, costs trillions, and reframes social engagement, as the character of the disease is so devastating in its length and personal impact. Of all diseases, it is Alzheimer’s (and, technically, other dementias), which is nearly perfectly correlated with aging that has therefore turned it from a rare disease, when most of us died too young to get it, into an epidemic that is ravaging us all.




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