[ed. note: Michael Jorrin is a longtime medical writer who writes about health and medicine a couple times a month for our readers, usually without a specific investment focus — though it so happens that today’s topic, Alzheimer’s, is also subject to at least one current heavily-hyped investment pitch. I like to call him “Doc Gumshoe” (he’s not a doctor), he chooses his own topics, and his words and opinions are his own.]
This is not primarily going to be about drugs currently in development by small biotechs – or by Big Pharma, for that matter – that promise to cure Alzheimer’s disease or even significantly reverse the consequences of the disease. I’m aware that many individuals and organizations are looking for ways to do precisely that, and I’m optimistic – but modestly optimistic. This post will stick to what’s known about the fundamentals of Alzheimer’s disease (AD) and what new information has been gained on that front. Then, we’ll survey some specific candidates for treating AD in another post in the next few weeks.
First, let’s see if there are any important changes in the AD landscape since Doc Gumshoe first wrote about it back in 2013. The short answer is, not much. Here are the numbers:
- 5.3 million persons in the US are currently diagnosed with AD. That’s diagnosed with AD; an equal number are thought to have undiagnosed AD, perhaps in the early stages.
- This includes 200,000 persons under 65 years of age.
- About two-thirds of Americans with AD – 3.2 million – are women. The chief reason for this large imbalance is that women’s life expectancy is about 5 years greater than men’s life expectancy, and it’s in those 5 years that the incidence of AD increases steeply.
- AD prevalence is expected to increase as our population ages. By 2025, 7.1 million Americans are predicted to have AD, and by 2050, the number is predicted to be 13.8 million.
- The prevalence of AD and other dementias is about twice as high in African Americans and about one-and-one half times as high in Hispanic Americans as it is in non-Hispanic whites. The reasons for this are not entirely clear. The disparity is not thought to be due to genetic differences, rather to higher prevalence of conditions which contribute to AD and dementia. We’ll go into some of those later in this post.
- According to the Alzheimer’s Association, the 2015 costs to the nation associated with AD will be about $226 billion. About half of this cost will be paid by Medicare, and another significant chunk by Medicaid. Unless there is a treatment breakthrough, total costs may reach $1.1 trillion by 2050.
- These costs don’t figure in the huge economic impact of AD on caregivers, often the immediate family members of the person with AD.
- AD is the 6th leading cause of death in the US.
- At present, there is no cure, and the most effective treatments do nothing to stop the progress of the disease. At best, they slow it. This, may I note, is not unlike some cancer treatments that have been deemed moderately successful.
The health-care community obviously recognizes the impact of AD, not only on individual patients and their caregivers, but on the commonwealth. At the same time, equally obviously, the health-care community recognizes the opportunity for – may we put it delicately? – significant financial benefits accruing to whatever entity comes up with treatment modalities that are genuinely effective. This applies especially to pharmaceutical companies, that are inevitably aware of the more than 5 million Americans, as well as many millions more on the planet, who are eagerly waiting for something – anything! – that will slow their cognitive decline. Witness the 1,765 clinical studies currently registered with the National Institutes of Health Clinical Trials Registry, ranging all the way from recently instituted trials, some of which are not yet recruiting subjects, all the way to trials that have been completed and are now in the process of evaluating and releasing their results.
Do we know any more about the disease process?
We know a great deal about what happens in the brains of people with AD. What we don’t know for sure is which of the changes that are observed in the brains that have been examined, either on autopsy or by neuroimaging, are the underlying causes of the changes in cognition and beha