We're In This One Together

Alzheimer's is what people fear most in retirement, according to a new Merrill Lynch study conducted in partnership with Age Wave. We fear Alzheimer's more than cancer, stroke, diabetes, arthritis, and heart disease -- combined. And no wonder: the disease is a one-way street with no cure.

Costs of care, too, are breathtaking. According to a recent study by the RAND Institute, annual costs of care for someone with Alzheimer's in America can be up to $56,000 per family. More broadly, at the societal level, Alzheimer's is estimated to consume annually a stunning $604 billion globally, or 1 percent of global GDP.

According to the Bank of America Merrill Lynch survey, it's not just the costs of Alzheimer's that people find so frightening. Equally, people do not want to be a burden on their families. At $56,000 a year for care, it's a sensible fear. And at $604 billion globally, it's more than a fear and even public health crisis -- which the WHO acknowledged last year -- but the impending fiscal nightmare of our 21st century.

But the news is not all bad. While we still have a long way to go with Alzheimer's, we are making progress. Researchers and scientists are learning more than ever about prevention strategies and ways to promote "brain health."

We are also learning more about how to make care more effective, compassionate, and efficient. Solving for care may seem like a "softer" goal than finding the medical breakthroughs, but it isn't. Surely part of what is driving people's fear of Alzheimer's is the long, burdensome journey with care. And at national public policy levels, Alzheimer's care will be a catastrophe without better care delivery models.

So what's the news with "brain health"? A string of recent research and meta-analyses suggest that the long-time paradigm for disease treatment -- finding a "cure" -- may not apply for Alzheimer's. The key may be prevention strategies -- as in learning how to prevent this thing even before we can cure it.

This is a new way of thinking in matters of public health for non-communicable diseases -- and it's also a breakthrough. We've seen it before with communicable diseases -- improvements in sanitation, nutrition, for example, where these preventive public health measures held back diseases as cures were being discovered.

Here's how it would work for Alzheimer's: The just-released annual report by Alzheimer's Disease International (ADI) shows that we can reduce risk by managing "modifiable risk factors" -- like diabetes and hypertension. As ADI says, "What's good for your heart is good for your brain."

This is just the tip of the iceberg. While researchers have been searching for the magic formula to "cure" Alzheimer's, evidence is mounting that prevention may be an equally valuable better angle. ADI's new report should act as a clarion call for R&D departments the world over. According to ADI: "Research should test hypotheses on lifestyle and control of risk." This also takes us down different paths than the traditional clinical trial model which to date for Alzheimer's has been less than productive.

The Karolinska Institute in Sweden has broken open doors with their new research on how to slow cognitive decline with the FINGER study. Released this summer, lead researcher Miia Kivipelto claims that the FINGER study is the first to show that "it is possible to prevent cognitive decline." The recipe: nutrition, physical exercise, cognitive training, social activities, and heart health.

So while we wait for a cure, part of the answer is staring us in the face: eat well, exercise, and a healthier lifestyle generally. There is much to fear with Alzheimer's -- and the respondents in the Bank of America Merrill Lynch survey have warrant for their worries -- but there is also much that -- even now -- can be done.

Prevention, one must concede, only answers part of the question. With 36 million people suffering from dementia worldwide, it is only sensible to ask: What can be done for those already suffering from Alzheimer's?

There are three answers:

First, researchers and scientists agree that the tools of prevention can also apply to slow down rates of deterioration. Healthy diets and exercise and active cognitive engagement won't make things better -- and they won't prevent ultimate deterioration - but they can slow progress at earlier stages of the disease.

Second, technologies can help maintain independence. Can, for example, Google Glass, be used for people with early-onset dementia to provide directions and reminders; Who would not be willing in early phases to try facial-recognition technology to provide names and details of relationships that had been getting harder and harder to catch?

Other technologies are in the pipeline, as well. Here we have a rare case when all serious stakeholders are aligned. Healthcare providers, payers, families, policymakers all want to increase independence for the person with Alzheimer's. If we can lengthen independence, everyone wins. And technology seems to hold many of the answers.

Third, improvements in care can reduce both the "fear factor" and the costs even as it mitigates deterioration in certain stages. And here, again, is a goal everyone can agree, as the current costs overwhelm individuals, family, community, and national budgets. Not to mention that emotional drain. Whether $56,000 annually for the family or $604 billion globally, neither figure is sustainable. There are new models of care through such as the innovative approaches used by Omaha-based and globally deployed Home Instead Senior Care. As part of its advances in 21st century care, this home-based caregiving resource also has an online tool for Alzheimer's caregiving that anyone can access.

Of course, there is more to beating this awful disease than managing one's "modifiable risk factors." As we've seen before, prevention can be the "medical breakthrough" that we're too busy to notice. At least now we've got evidence that it's worked before.