Politicians, scientists, health officials and advocates working to improve the lots of an estimated 5.7 million Americans living with Alzheimer's disease met in Washington Tuesday for a Senate Special Committee on Aging hearing on legislation promoting better management of the condition. If enacted, The Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act, first introduced late last year, would create a nationwide framework in which to implement Alzheimer's interventions focused on public health issues, such as increasing early detection and diagnosis, reducing risk, and preventing avoidable hospitalizations. With 35 co-sponsors, it's moving through the Senate Health Committee.
In the U.S. alone, total annual payments for health care, long-term care and hospice care for people with Alzheimer's or other dementias are projected to increase from an estimated $277 billion in 2018 to more than $1.1 trillion in 2050, according to the nonprofit Alzheimer's Association. Underscoring the need for a government-led public health effort to stay that growth, today's AD care expenses include $186 billion in costs to Medicare and Medicaid, or about 67 percent of the total.
The CDC is "already doing tremendous work to combat Alzheimer's" within the Public Health Road Map of the Healthy Brain Initiative, said Sen. Susan Collins (R-Maine), a co-sponsor of the bill with Sen. Catherine Cortez Masto (D-Nev.). The bipartisan BOLD Act, she said, would both help implement the CDC's road map and help public health departments "take key steps, including education, early diagnosis, risk reduction, care management and caregiver support."
Earlier detection of AD symptoms could not only help individuals and families better prepare for facing the challenges of dementia, but could also lead to substantial future savings, Collins suggested. Assuming a scenario in which about 88 percent of Americans receive diagnosis early, during the mild cognitive impairment stage rather than the dementia stage, total savings could reach $31.8 billion in 2025 and $231.4 billion in 2050, according to a recent study by Precision Health Economics, and commissioned by the Alzheimer's Association.
The materialization of substantive savings would be a welcome development for the government, especially in light of the Congressional Budget Office projection that, by 2026 under current law, Medicare spending will reach almost $1.3 trillion. Conversely, earlier diagnosis could also drive significant technological change, a factor that was identified by the Government Accountability Office as accounting for anywhere from 36 percent to 55 percent of the increases in overall U.S. health care per capita spending over the past several decades.
BOLD would also direct CDC to expand its data collection of cognitive decline, care-giving, and health disparities, something that has already begun happening under a state program in Maine, Collins said.
The causes of Alzheimer's disease remain hotly debated. But researchers are finding evidence that some of the risk factors for heart disease and stroke, such as high blood pressure and high cholesterol, may increase the risk of AD, said Lisa McGuire, lead for the CDC's Alzheimer's Disease and Healthy Aging Program. As various work streams under the center's umbrella move ahead, she said it is also planning later this year to release a new road map outlining actions that "speak to critical issues of disease risk identification and risk reduction, diagnosis, education and training, caregivers, and evidence on impact of the disease."
Meanwhile, at the Bar Harbor, Maine-based Jackson Laboratory, work is ongoing to identify genetic factors that drive both susceptibility and resilience to AD, as well understanding how modifiable risk factors and co-morbidities contribute to AD, Gareth Howell, an associate professor at the lab, testified.
In collaboration with Indiana University, Sage Bionetworks, and the University of California Irvine, he's working on MODEL-AD, an effort to create new mouse models for Alzheimer's disease, "staging and matching the changes we see in the mice to those seen in humans, and testing potential new therapies," he said.
Publicly available datasets help MODEL-AD get a jump on deciding which mouse models to create, Howell said, and the project is attempting to repay that debt by publishing and promoting the data it generates. It's also pursuing efforts to get its mouse models to pharmaceutical companies such as Indianapolis-based Eli Lilly and Co. as soon as possible, as some companies have struggled to get the latest models in a timely fashion in the past, he said.
In looking ahead Tuesday, Sen. Cortez Masto said she thinks that the BOLD Act really "sets the tone that this is a public health crisis and that we are creating an infrastructure for a coordinated care plan."