Alzheimer's Disease: The Economic Toll

Economic Toll of Alzheimer's & Uncorrected Hearing Loss in the Elderly

By Dr. Max S. Chartrand Ph.D. From Hearing Health Magazine, 2000


Exploring the tragic, yet little known impact of Alzheimer's that is
exacerbated by uncorrected hearing loss upon society.

Persons with Alzheimer's disease (AD) cost Medicare approximately 2.6 times more money than those who do not have the diagnosis, according to a recently released study sponsored by the AARP Andrus Foundation. The annual tab for a person with AD was around $18,500 if s/he was living in a community setting versus $33,500 when living in a nursing home.

Researchers at Duke University, under the direction of Donald Taylor, Ph.D., tabulated these figures using information from 18,000 respondents to the 1994 National Long Term Care Survey, a nationally representative sample of persons 65 and over.

The average paid by Medicare in 1994 was determined from the actual fees incurred for inpatient, outpatient, home health, skilled nursing facility, hospice and services such as physician payments and items such as durable medical equipment.

Medicare financed care, the study found, was influenced by how long a person had been diagnosed with AD – the longer diagnosed, the lower the costs. Once diagnosed, costs decreased by 10 percent each additional year, suggesting that fewer medical resources are invested in persons with a formal diagnosis of AD as their life expectancy drops, net of other variables.

Medicare costs represented only one-fourth of the total cost of caring for a person with AD.

Finding the Keys ... and a Cure?

As prognosticators broadcast the potential for disaster in a burgeoning population at greater risk for Alzheimer's, researchers are racing to solve its mysteries. Leaders in the fields of neurology, genetics and medicine are making important discoveries daily. None is yet the definitive solution but each fills in a piece of the puzzle. And the new knowledge has enabled pharmaceutical companies to develop and test new forumlas for treatment and prevention.

Whether any of these breakthroughs can be significant enough and soon enough to avert an Alzheimer's crisis is unclear. There are reasons to be optimistic, however. Among them is a growing collaboration between researchers, practitioners and caregivers. The first ever global summit was held in July 2000, World Alzheimer Congress 2000 (WAC), drew thousands of experts to Wash., D.C. By the time the July 9-18 conference was over, several bold new approaches were on the table.

The most promising research is honing in on the cause, perhaps ending a century-long debate. First identified in 1906 by Dr. Alois Alzheimer, one of two markers in brain tissue damaged by the disease has been considered the culprit. But which is it? Plaque, made up of the protein amyloid, which litters the space between brain cells that control memory and behavior? Tangles of another protein (tau) that aggregate within the cells? Or is it a combination of both?!

The most recent evidence clearly points to plaque, suggesting that it may be toxic to surrounding neurons, and that the amount of amyloid buildup does indeed correlate with the degree of dementia. Basing their work on this research, neurobiologists from Elan Pharmaceuticals reported at WAC that they have developed a vaccine which, in mice, prevents buildup of the protein and decreases existing plaque. Clinical investigations of whether it has the ability to prevent or cure the disease in humans could begin late this year. Meanwhile, a newly developed oral drug has demonstrated the ability to inhibit the buildup of plaque in animals and will also enter human trials soon.

In the therapeutic arena, findings unveiled at the conference offer hope for the first time of slowing the progression of more advanced Alzheimer's. Researchers from the New York Univ. School of Medicine described the effects of a six-month treatment with the drug memantine on people with moderately severe and severe cases. Overall, although the disease was not reversed by the end of the study, those who received the drug performed significantly better in cognition and in daily life activities than those in a control group who had taken a placebo.

Other promising avenues under investigation are:

  • Finding genetic variants that put people at greater risk for Alzheimer's.
  • Utilizing brain imaging technology to identify structural or functional variations which precede symptoms.
  • Investigating the relationship of cardiovascular risk factors with the incidence of Alzheimer's (e.g., whether or not high-fat diets elevate risk or exercise, eating vegetables high in antioxidants or other "heart-healthy" actions decrease risk).

Furthermore, are the myriad studies pointing to a close assocation in the older age-groups between degree of Alzheimer's and unmitigated hearing loss. In fact, the rate of uncorrected hearing loss has been reported to be six times greater among those with Alzheimer's than among the non-AD population, according to a recent study by the University of Pittsburgh. Yet this startling finding has not seemed to move the medical establishment to-date.

Whatever the near future brings, Dr. Dennis Selkoe, a leader in the battle against this elusive disease, predicts that "sooner than one might have dared to hope, Alzheimer's will shed the veneer of invincibility that makes it such a terrifying affliction." He also believes that practitioners will shortly have on hand not one but several drugs capable of slowing and perhaps halting the progress of the disease.

If Dr. Selkoe and others who share his optimism are right, this is heartening news indeed.

Dr. Max Chartrand, a staff writer for Hearing Health, has studied Alzheimer's for almost three decades. He is the founder of DigiCare Hearing Research & Rehabilitation.