ALZHEIMER’S DISEASE Dr. Shantel Anderson, DHEd Leadership and Organizational Management MPH 543 Jill Marshall and Tara Sheets February 18, 2014

Alzheimer’s Disease Alzheimer’s Disease is:  a type of dementia that causes problems with  memory,  thinking, and  Behavior. Dementia results in the loss of skills:  Intellectual, and  Social.

Alzheimer’s Disease Alzheimer’s Disease:  is irreversible and progressive;  slowly destroys  Memory,  Cognitive (thinking) skills, and  ability to complete activities of daily living;  causes the brain cells and the connections between them to degenerate and die; and  causes a decline in memory and mental function.

Risk Factors Risk Factors include:  Age  65 and older.  Risk doubles with every 5 years.  After age 85 risk increases to 50 percent.  Family History  Immediate family member with Alzheimer’s increases risk.  Risk is increased if there is more than one relative with the illness.  Genetics  Three Deterministic genes directly cause Alzheimer’s Disease including  Amyloid precursor protein (APP),  Presenilin-1 (PS-1), and  Presenilin-2 (PS-2).

Risk Factors Risk Factors:  Head trauma  Seat belts, safety helmets  Head-Heart connection (high blood pressure, stroke, diabetes, etc.)  Healthy eating, and exercise  Monitor heart health with a physician  General Health  Maintain a healthy weight, limit tobacco and excess alcohol  Myths  Aluminum  Aspartame (equal, nutrasweet)  Flu Shots  Silver dental fillings

Stages  The stages of Alzheimer’s disease include  pre-clinical (mild cognitive impairment),  mild,  moderate, and  severe.

Symptoms and Impact  Preclinical: No Major symptoms  toxic changes are taking place in the brain;  abnormal deposits of proteins;  Forming of plaques and tangles throughout the brain; and  neurons begin to work less efficiently.  Mild: Changes aren’t significant enough to affect work or relationships.  May be changes or issues with:  memory, personality, thinking, organizing, expressing thoughts; and  misplacing belongings, problem solving, and ability to complete complex tasks and make sound judgments  Neurons lose ability to function and communicate with each other and die.

Symptoms and Impact  Moderate: Increased confusion and significant changes in personality and behavior.  May need assistance with activities of daily living and self-care.  Damage spreads to a nearby structure in the brain, more neurons die, and affected brain regions begin to shrink.  Severe: Impact now includes movement and physical capabilities  Require daily assistance with  activities of daily living, and  self-care;  Loss of ability to communicate coherently;  Damage is widespread; and  Brain tissue has shrunk significantly.

Prevalence and Forecast  In 2013:  5.2 million people had Alzheimer’s  Someone develops Alzheimer’s every 68 seconds  One in every three seniors died with Alzheimer’s or other dementia  By 2030 it is estimated:  8.6 million will have Alzheimer’s  By 2050 it is estimated  16.0 million will have Alzheimer’s

Direct Costs  In 2013:  $203 billion was spent on health care, long-term care, and hospice  $142 billion of that was paid by Medicare and Medicaid  By 2050:  Those with Alzheimer’s is projected to triple  Costs are projected to increase to $1.2 trillion

Indirect Costs  $216 billion is spent by the 5 million family and friends that provide 17 billion hours of unpaid care every year.  Many caregivers have to travel away from their families.  Emotional stress, depression, and physical exhaustion.  $9.1 billion is spent on the health care costs of these caregivers.  65 percent of caregivers take time off, come in late, or leave early.  20 percent take leaves of absence.  13 percent switched from full-time to part-time jobs.  11 percent gave up their jobs.

Cholinesterase Inhibitors Benefits:  Cholinesterase inhibitors slow the progression,  Helps brain cells function better, and  May provide improvements in memory and functioning.  Common Cholinesterase inhibitors share these similar benefits to the brain:  Donepezil (Aricept)—treats mild, moderate, and severe stages  Rivastigmine (Exelon)—treats mild and moderate stages  Galantamine (Razadyne)—treats mild and moderate stages Concerns:  Improvements last 6-12 months,  Improvements found in only about half of the participants, and  No current method to identify who will respond to the medications

Side Effects Side Effects with medications:  nausea and vomiting,  loss of appetite,  indigestion and Increased frequency of bowel movement,  pain and headaches, and  shakiness and tremors (Rivastigmine only). Less common side effects:  Insomnia,  Fatigue,  Muscle cramps, and  Stomach ulcers (donepezil only).

Side Effects Uncommon but more serious side effects:  seizures,  bloody coughs, stools, or vomiting,  Painful urination,  Irregular heart rate and  Depression (Galantamine only) NOTE: Currently research has indicated that Donepezil may have less adverse effects than Rivastigmine.

Research Project Agenda Include Cholinesterase Inhibitors as a treatment option for upcoming five year strategic research project agenda to determine:  Long term care costs can be reduced by 30 percent over a five year period. Methodology  Treatment options are:  effective in 50 percent of participants  prolongs deterioration by approximately six months to one year  It is cost effective:  Average annual cost for long-term care $6,833/month.  Stay in long-term care for Alzheimer’s is at least 17 months.  Saves approximately or $81, 996 per year ($40,998 every six months), per person.  Dignity:  Allowing more to age in place for a longer period of time.

References Alzheimer’s Association (2014a). What is Alzheimer’s? Retrieved February 9, 2014 from Alzheimer’s Association (2014b). Alzheimer’s Disease: Risk Factors. Retrieved February 9, 2014 from Alzheimer’s Association (2014c). Alzheimer’s Disease: Alzheimer’s Facts and Figures. Retrieved February 9, 2014 from Alzheimer’s Association (2014d). Alzheimer’s Disease: Treatments: Medications for Memory Loss. Retrieved February 10, 2014 from Ammons Scientific LTD. (2013). Image. Retrieved February 16, 2014 from Birks, J (2006, Jan 25). Cholinesterase inhibitors for Alzheimer's disease. The Cochrane Library, DOI: / CD Retrieved February 10, 2014 from Health Media Ventures (2014). 25 Signs and Symptoms of Alzheimer’s Disease. Image. Retrieved February 15, 2014 from HMBD Insurance Services. (n.d.). Long-term care is the assistance your employees will need for an extended period of time if they develop a chronic illness, disability, or cognitive impairment, such as Alzheimer's disease. Image. Retrieved February 11, 2014 from Centers for Disease Control and Prevention (CDC). (2010). Cholinesterase Inhibitors. Agency for Toxic Substances and Diseases Registry. Image. Retrieved February 16, 2014 from Mayo Clinic (2013). Diseases and Conditions. Alzheimer’s Disease. Retrieved February 9, 2014 From conditions/alzheimers-disease/basics/definition/con http:// conditions/alzheimers-disease/basics/definition/con

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