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  • Understanding Alzheimer’s Disease A Review of Medical Advancements and Efforts to Address the Societal, Economic, and Personal Toll of an Impending Public Health Crisis

    california senate office of research

  • Cover photo by Alex Eflon

  • Understanding Alzheimer’s Disease A Review of Medical Advancements and Efforts to Address the Societal, Economic, and Personal Toll of an Impending Public Health Crisis

    by Malaika Singleton, PhD

    June 2013

    california senate office of research

  • Contents

    Executive Summary ......................................................................................................3

    Alzheimer’s Disease: Diagnosis, Prevention, and Treatment .........................7

    DEFINITIONS AND BACKGROUND........................................................................................................ 9 ■ Dementia................................................................................................................................................... 9 ■ Alzheimer’s Disease............................................................................................................................... 9 ■ Alzheimer’s Disease Biomarkers ........................................................................................................ 9 ■ Alzheimer’s Disease Risk Factors .................................................................................................... 11 ■ Prevention of Alzheimer’s Disease .................................................................................................. 12

    NEW CRITERIA FOR DIAGNOSIS: THREE STAGES OF ALZHEIMER’S DISEASE .................. 13 ■ Significance: Early Detection and Treatment ................................................................................ 14 ■ Stage 1: Preclinical ............................................................................................................................... 14 ■ Stage 2: Mild Cognitive Impairment Due to Alzheimer’s Disease ........................................... 15 ■ Stage 3: Dementia ................................................................................................................................ 17 ■ Detection of Alzheimer’s Disease .................................................................................................... 17

    HOW IS ALZHEIMER’S DISEASE TREATED? ..................................................................................... 19 ■ Drug Treatments for Memory Loss and Cognitive Decline ....................................................... 19 ■ Drugs Approved by the Federal Drug Administration ................................................................ 20 ■ Treating Psychiatric and Behavioral Symptoms of

    Alzheimer’s Disease: Nonpharmacological Options ................................................................... 21 ■ American Psychiatric Association’s Guidelines for Alzheimer’s Disease Treatment .......... 22 ■ Antipsychotic Drugs: Off-Label Use for Psychiatric

    and Behavioral Symptoms of Alzheimer’s Disease ..................................................................... 23 ■ Research on the Effects of Antipsychotic Drugs in Dementia Treatment ............................. 24 ■ Safety and Efficacy of Antipsychotic Drugs in Dementia Treatment ...................................... 25

    Alzheimer’s Disease in California: The State’s Changing Demographics, the State Plan, and Other Resources to Address Alzheimer’s Disease ... 27

    CALIFORNIA’S AGING POPULATION AND ALZHEIMER’S DISEASE ........................................ 29 ■ How Many People With Alzheimer’s Reside in California? ........................................................ 29 ■ California’s Demographics and Disparities .................................................................................... 29 ■ Caregivers of Individuals With Alzheimer’s Disease and Other Dementias ......................... 30 ■ Societal and Economic Impact .......................................................................................................... 31 ■ Alzheimer’s Disease and Other Dementias:

    Considerable Contributors to Medi-Cal Costs .............................................................................. 31 ■ Additional Challenges ......................................................................................................................... 33

    HOW IS CALIFORNIA ADDRESSING THE GROWING ALZHEIMER’S DISEASE POPULATION? ............................................................................................. 35 ■ The California Alzheimer’s Disease State Plan: A 10-Year Policy Road Map........................ 35 ■ Alzheimer’s Disease Plans in Other States .................................................................................... 36 ■ California Alzheimer’s Disease Centers ......................................................................................... 36 ■ California’s State Plan to Address Alzheimer’s Disease ............................................................ 37

    ■ California Institute for Regenerative Medicine ............................................................................. 39 ■ Programs and Services ....................................................................................................................... 40

    The Federal Response to Alzheimer’s Disease: A National Plan to

    Prevent and Effectively Treat Alzheimer’s Disease by 2025 ...................... 41

    WHAT IS THE FEDERAL GOVERNMENT DOING TO ADDRESS ALZHEIMER’S?................... 43 ■ National Alzheimer’s Project Act: Public Law 111–375 ............................................................ 43 ■ National Alzheimer’s Project Act: Funding .................................................................................... 43 ■ Advisory Council on Alzheimer’s Research, Care, and Services ............................................. 44 ■ The National Plan to Address Alzheimer’s Disease .................................................................... 46 ■ Immediate Actions Taken: Increased Funding for

    Promising Alzheimer’s Disease Research ...................................................................................... 48

    Conclusion ................................................................................................................... 51

    Endnotes ...................................................................................................................... 53

  • Executive Summary Alzheimer’s Disease: Diagnosis, used “off-label” (that is, for purposes other Prevention, and Treatment than what they were approved for by the

    FDA) to treat behavioral and psychiatric

    ■ In 2011 the criteria for Alzheimer’s problems in some individuals with AD.

    disease (AD) diagnosis were updated

    for the first time in 27 years and now ■ The American Psychiatric Association,

    include three stages: Preclinical, Mild the California Workgroup on Guidelines

    Cognitive Impairment, and Dementia for Alzheimer’s Disease Management,

    Due to AD. The acknowledgment of and the Alzheimer’s Association all have

    AD’s long development and preclinical guidelines that emphasize the use of non-

    phase provides an opportunity for pharmacological approaches to treating

    earlier diagnosis and treatment, which is behavioral and psychiatric symptoms

    projected to significantly reduce health exhibited by AD patients before resorting

    care costs and lead to better health to pharmacological methods of treatment.

    outcomes for individuals with AD. These entities also recommend the use

    of nonpharmacological approaches

    ■ Research suggests that healthy lifestyle along with antipsychotics if the

    choices and increased access to health medications eventually are prescribed.

    care may have an effect on preventing

    AD in some individuals. ■ While some antipsychotics have

    proven helpful in treating clinical

    ■ Treatment for AD includes FDA-approved symptoms associated with AD, the use

    drugs that help address chemical of antipsychotics with elderly dementia

    imbalances to temporarily slow the patients is particularly troublesome

    worsening of memory and cognitive because of adverse side effects,

    function. Antipsychotic drugs also are including an increased risk of death.

    Understanding Alzheimer ’s Disease | 3

  • Alzheimer’s in California: The State’s Changing Demographics, the State Plan, and Other Resources to Address the Disease

    ■ California’s AD population is expected to

    increase by 37.5 percent between 2010

    and 2025, from an estimated 480,000

    to 660,000 people. This increase will

    continue to overwhelm unpaid AD

    caregivers and California’s businesses

    will be negatively impacted from

    continued loss of productivity. Long­

    term care and Medi-Cal costs also are

    increased by the prevalence of AD and

    other dementias, impacting federal and

    state budgets.

    ■ California (as well as at least 40 other

    states) unveiled a state plan for AD, a

    10-year road map t