The Looming Alzheimer’s Epidemic:
Population Aging and its Effects on
Society and the Economy
Jane A. Driver, MD, MPH
Division of Aging, Brigham and Women’s Hospital
VA Boston Healthcare System
Assistant Professor of Medicine, Harvard Medical School
Catholic University of America April 24, 2013
The Looming Alzheimer’s Epidemic:
Population Aging and its Effects on
Society and the Economy
Jane A. Driver, MD, MPH
Geriatric Research Education and Clinical Center,
VA Boston Healthcare System
Division of Aging, Brigham and Women’s Hospital
Assistant Professor, Harvard Medical School
A Passage to India
“Each human soul is worth more than the entire material
universe.”
-Thomas Aquinas.
What is Dementia?
• Chronic progressive disease of the brain
– Global deterioration in intellect, including
memory, learning, orientation, language,
comprehension, judgment and comportment
• Most common causes
– Alzheimer’s Disease
– Vascular dementia
Stages of Alzheimer’s Disease
•
•
•
•
•
•
•
Stage 1: No impairment
Stage 2: Very mild cognitive decline
Stage 3: Mild cognitive decline (MCI)
Stage 4: Moderate decline (Early AD- IADLs)
Stage 5: Moderately severe (Moderate AD- ADLs)
Stage 6: Severe decline (complete dependence)
Stage 7: Very severe decline (nonverbal)
Grace
• http://www.youtube.com/watch?v=7wbYEK7
O14E
Types of Care for People with
Dementia
• Informal care
– Unpaid care provided by family and others
• Social care
– Community care professionals, nursing home
• Medical care
– Outpatient visits, medications, hospitalizations
Voxel-wise comparison to amyloid negative group
Treatment Trials- 2012
• Bapinezumab- negative trials
• Solanezumab
– 2 large phase III trials were negative
– When results were combined, cognitive decline
was slowed by 34% in those with the mildest
symptoms
– First evidence that a drug targeting B-amyloid
might be useful for prevention
AD Prevention Trials Starting in 2013
Trial Name
Patient Population
Drug Being Tested
A4 Trial- AD
Cooperative Study
1000 patients aged
70-85 with positive
florbetapir scans
Solanezumab
B-secretase inhibitor
Alzheimer’s
Prevention Initiative
(API)
Presenilin mutation
carriers in Columbia
ApoE4 homozygotes
60-80 years old
Crenezumab
Dominantly Inherited
Alzheimer’s Network
(DIAN)
Asymptomatic gene
carriers
Young
Gantenerumab
Solanezumab
B-secretase inhibitor
Epidemiology of Dementia in the US
•
•
•
•
•
•
•
5.4 million Americans have AD; will triple by 2050
65 and older: 1 in 8; 85 and older: 1 in 2
2/3 of people with dementia are women
Average life expectancy after AD diagnosis: 8y
Annual cost of dementia care in 2011: 183 billion
Estimated annual cost by 2050: 1.1 trillion
Medicare spending on dementia will increase by
600% by 2050
Alzheimer’s Disease Facts and Figures, 2011. www.alz.org
Mortality Rates for Common Diseases in
the United States
Source: Alzheimer’s Association
Facts and Figures 2011 Report
Global Economic Impact of Dementia
• 0.5% of the world’s population has dementia
• Total worldwide estimated costs $604 billion
in 2010
– 70% of costs occur in Western Europe and North
America
– 1% of the world’s gross domestic product
• By 2030 costs projected to increase by 85%
World Alzheimer’s Report 2010: The Global Economic Impact of
Dementia
World Alzheimer’s Report 2010: The Global Economic Impact of
Dementia
World Alzheimer’s Report 2010: The Global Economic Impact of
Dementia
Future Projections
• Currently only 6% of people with dementia in
low or middle income countries live in NHs
• Set to expand rapidly due to
– Increase in wages as countries develop
– Rapid societal aging
– Demographic and social changes that reduce
availability of informal caregivers
– Per-person costs of dementia care will increase
Alzheimer’s Disease International, 2009. www.alz.co.uk
Speed of Population Aging
Number of years for % of population aged 65 and over to rise from 7% to 14%
Colombia
Brazil
Thailand
Tunisia
Sri Lanka
Jamaica
Chile
Singapore
China
Azerbaijan
Japan
Spain
United
Poland
Hungary
Canada
United
Australia
Sweden
France
20
21
22
23
23
24
25
27
27
41
26
Source: US Census Bureau, 2000
45
45
47
53
65
69
73
85
115
Urgent Need for Action
• Government must make dementia a health care
priority and develop a plan to provide and
finance dementia care
• Need to re-design health care systems to deal
with chronic, age-related diseases
• Increase funding for research and prevention
– Currently about 10% of that spent on cancer research
• Adequate support for family caregivers and care
of vulnerable elderly
Dementia Awareness
China
Dominican Republic
Peru
Sri Lanka
Margaret Sanger
• "The most merciful thing
that a large family does to
one of its infant members
is to kill it."
Women and the New
Race
• "More children from the
fit, less from the unfit -that is the chief aim of
birth control." Birth
Control Review, May
1919,
Margaret Sanger (1879-1966)
Margaret Sanger
•
•
•
•
Committed neo-Malthusian
Overpopulation is the world’s biggest problem
Contraception is the solution
People who are unfit should not procreate
– The poor, physically disabled, mentally disabled
• “Quality not quantity”
• New world order: birth control, population
control, eugenic control
• Eugenic control + sexual libertinism
The Enemy: Female Fertility
“Possible drastic and Spartan methods may be
forced upon society if it continues complacently
to encourage the chance and chaotic breeding
that has resulted from our stupidly cruel
sentimentalism.”
Forced sterilization legalized by the U.S.
supreme court in 1927 in Buck v. Bell.
Margaret Sanger, The Eugenic Value of Birth Control
Propaganda, Birth Control Review, October 1921.
Expenditure on Grant-Financed Development Activities
of the United Nations System by Sector
20
15
10
5
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
0
19
90
Percentage of Total
25
Year
Population
T ransport
Science and T echnology
Energy
Communications
Employment
Industry
T rade and Development
Dark Days in India
• 1975-1977 Indira Gandhi suspended
democracy for 21 months
• Her son Sanjay organized a nationwide
compulsory sterilization campaign
• Mandated vasectomies or tubal ligations in
families of 2 or more children
• Widespread fear and resistance
• Thousands were forcibly sterilized
Continued Coercion
• Forced sterilization is now recognized as a
crime against humanity
• In 2004, Uttar Pradesh’s population policy
called for 930,000 sterilizations, paid for by
$360m from USAid.
• Shift from force to coercion
• Guns for sterilization
– Shotgun=2 sterilizations
– Revolver=5 sterilizations
Randeep Ramesh, The Guardian, November 2004
Anti-U.S. mob attacks Hillary Clinton's convoy
armed with eggs, paintballs and rocks in the
Philippines. November 17, 2011
Human Population Growth
Population Growth 1775–2000
Japan’s Age Pyramid
Population Implosion
• A smaller younger population has to support a
growing number of elderly people
• By 2035 even China will have a reversed age
pyramid
• From 2000 to 2025, people above 65 will
triple while those under 15 will increase by
only 6%
China’s One Child Policy
• Has prevented more
people than the US
population
• Population will peak at
1.5 B at
• Within 15 years it will be
short of 30 million brides
• The first country that will
grow old before it grows
rich
China
120
115
110
105
100
95
90
Girls
Boys
1980
1990
2000
Today
Human Capital Nobel Laureates
• “No discussion of human capital can omit the
influence of families on the knowledge, skills, values,
and habits of their children and therefore on their
present and future productivity.” -Becker (1992)
 “The human development approach must tale full
note of the robust role of the human capital, while at
the same time retaining clarity about what the ends
and means respectively are. What needs to be
avoided is to see human beings as merely means of
production and material prosperity.” -Sen (1998)
Food for Thought
• How will countries that get old before they get
rich care for their oldest members?
• Can government or hired caregivers replace the
informal care formerly provided by larger
families?
• What are the long term effects of rapid declines
in birth rates on society and the economy?
• When will US development policy catch up with
reality?
Dementia: The Unsung Heroes
• 15 million Americans provide 17 billion hours of
unpaid care for people with dementia yearly
• The economic value of this care is $202.6 billion
• 80% of care at home is provided by family
• 63% of caregivers have high levels of emotional
stress and 43% have high levels of physical stress
• 1/3 of caregivers report symptoms of depression
Alzheimer’s Disease Facts and Figures, 2011. www.alz.org