More on the 2019 Facts and Figures Report

In my last post, we discussed a couple of new points of information in this year's report.  But here are some more.

There is discussion of the number of Americans who have or will develop AD.  This points generally to people over 65, and the oldest Baby Boomers turn 73 this year.  The report estimates that 5.8 million Americans have Alzheimer's dementia.  Of those, about 200,000 have the younger-onset form of the disease, and are likely in their 40s and 50s. 

The report provides interesting charts and infographics for seeing the prevalence of Alzheimer's dementia among different populations and different American states.  The study looks forward to better diagnostic tools that would also yield values for the incidence of MCI in the different segments of the population.  Hope for better tools for assessing biomarkers appears throughout the report.  (We discuss the prospects for new blood tests in a couple of posts.)

There is a discussion regarding how estimates of the number of cases of Alzheimer's dementia may be skewed high due erroneous diagnoses.  Too often, diagnoses rely entirely on cognitive assessment, but it is accepted that a diagnosis should be based on a combination of cognitive assessment and biomarker evidence.  Now autopsies sometimes fail to find evidence of AD in people who were diagnosed with AD.  This may occur when cognitive assessment found cognitive decline, but there was a misdiagnosis, when biomarker evidence was not assessed. 

(My first diagnoses of "possible early stage senile dementia of the Alzheimer's type" was based entirely on the results of a mini-mental state exam.  This appears to be fairly common.  When I was subsequently referred to Harborview in Seattle, they then performed in-depth cognitive testing and the brain MRIs that found biomarker evidence of the type associated with AD. ) 

The report discusses the incidence of AD by ethnicity.  The best data indicated African Americans have the highest incidence, Latinos and whites are intermediate, and Asian Americans have the lowest incidence of Alzheimer's disease (based primarily on autopsy results in California).

Like last year, the report goes into our prospects for the future.  They project a 27% increase in the number of persons over 65 with Alzheimer's dementia between 2019 and 2025.  There are other bleak statistics, made even more bleak by the lack of progress in finding effective interventions.

The report addresses routine screening for MCI and dementia.  I've been asked to speak on this at a state advisory panel meeting in April.  From age 65 on, all of us should be screened annually for emerging cognitive issues.  This is paid for by Medicare and private insurance.  But it's not done often enough, and there are two reasons for this.

First, primary care providers often don't feel comfortable administering either the Mini-Mental State Exam or the Montreal Cognitive Assessment.  The report points out that there are lots of resources available to help primary care providers with this -- and it just ain't that hard.  But people need to ask for it. 

But there's another problem.  A lot of us just don't want to know and won't submit to the test.  I suppose this will change if and when we find better interventions.  There would then be better reasons to know.

On the other hand, if someone is tested now and found to have MCI due to Alzheimer's disease, there is more motivation to apply the strategy we discuss in Beating the Dementia Monster.