Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019 Author: Emma Nichols,Jaimie D Steinmetz,Stein Emil Vollset,Kai Fukutaki,Julian Chalek,Foad Abd-Allah,Amir Abdoli,Ahmed Abualhasan,Eman Abu-Gharbieh,Tayyaba Tayyaba Akram,Hanadi Al Hamad,Fares Alahdab,Fahad Mashhour Alanezi,Vahid Alipour,Sami Almustanyir et al. Publication: The Lancet Public Health Publisher: ElsevierDate: February 2022
© 2021 The Author(s). Published by Elsevier Ltd.
Interesting article in yesterday's Daily Mail (see link below), a London-based news organization with a global reach. The headline is a bit sensationalized but it points to the very important topic of the prevalence of Alzheimer's Disease (AD) - and dementia in general - in the US.
Now, we know age is the biggest risk factor for dementia. Baby Boomers are aged 58 to 75, so the increase in cases makes sense. My question is how are they determining death due to Alzheimer's Disease (ALZ/AD)? There are many other types of dementia out there and historically there have been, and continue to be, frequent misdiagnoses by healthcare professionals.
There is no one test to diagnose AD. Typically, during a medical exam, healthcare providers will evaluate signs and symptoms, and have conversations with care partners or families who can provide more insights about symptoms and behavior. Most primary care physicians will commonly refer the patient to a neurologist but may also refer patients to a geriatrician or gerontologist.
Brain imaging (MRIs, CT, PET) offers detailed images of the brain. These tests can show or rule out strokes, tumors, hemorrhages, degree of degeneration change in metabolism, brain atrophy, protein clusters, etc. Lumbar punctures (spinal taps) and recent blood tests can detect amyloid and tau (plaques & tangles) proteins found in the cerebral spinal fluid. These plaques and tangles have historically been the hallmarks of AD. However, the diagnosis of AD is still most often determined through the exclusion of other causes of the patient's symptoms. As I have pointed out in the past, many people with plaques and tangles present with no signs of cognitive impairment or decline.
The other factor to consider is the reporting of diagnosis and causes of death. If a patient dies in a nursing home and the diagnosis was AD, is that what goes on the death certificate? Same question if a person diagnosed with AD dies at home and family says he/she had AD. In essence, these numbers as reported may not be very accurate and can show inflated patterns of AD deaths.
What about the people who do not have access to healthcare, in particular those who live in impoverished communities, the homeless, or those who simply cannot afford to pay for health insurance? These deaths will most likely not include AD on a death certificate. So these numbers may be lower than reported, right?
At the end of the day, what is most important is that if true, there is an increase in deaths from dementia. It does not matter at this stage whether it is AD or another form of dementia. We need to be talking about prevention strategies, healthcare outreach to marginalized populations, reducing caregiver burden, improve the quality of life for those with dementia so they can live as full of a life as possible.
What this report can do, is show us that we need to address dementia as a public health issue and devote the necessary resources to fund education, healthcare, and overall awareness of this disease.
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