Early diagnosis and treatment of Alzheimer’s disease could save millions or even billions of dollars while simultaneously improving care, according to new work by University of Wisconsin-Madison researchers.

Patients with Alzheimer’s disease and other dementias are heavy users of long-term care services, especially nursing home care, with estimated annual costs upward of tens of billions of dollars nationwide.

Much of the fiscal burden is borne by state and federal governments — and thus taxpayers — through the Medicaid and Medicare programs. For example, the Wisconsin Medicaid program spends almost half a billion dollars each year on nursing home care for just 11,000 dementia patients — a tiny fraction of the estimated 160,000 affected people in the state, says Mark Sager, director of the Wisconsin Alzheimer’s Institute of the UW-Madison School of Medicine and Public Health.

These costs could be greatly reduced by earlier diagnosis and treatment, he says in a new study co-authored by La Follette School of Public Affairs professor David Weimer. The research, a cost-benefit analysis of the social and fiscal impacts of early identification and treatment of Alzheimer’s disease, using Wisconsin as a model, appears in the May issue of Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

“The future of this disease is to intervene decades before someone becomes symptomatic. This analysis says you can save literally billions of dollars in long-term care costs if you can intervene at an earlier stage,” Sager says. “What you don’t know costs a lot of money when it comes to this disease.”

The issue is becoming more pressing as the population ages, with some estimates placing the incidence of Alzheimer’s disease in the U.S. around 1 million cases by 2050, the authors say.

“We need to begin now to make the public-policy changes that will allow and encourage early recognition and intervention,” says Sager. “This article says to all the legislators facing deficits, ‘here’s a way to save money, and you can do it by providing better care.’ It’s a win for legislators, it’s a win for patients, it’s a win for families.”

The analysis considers two types of interventions following diagnosis: patient drug treatment and caregiver-support programs. Each would provide positive net savings, with the greatest benefits achieved using a combination of both.

“Even just with currently available drug treatments, [early diagnosis] seems to offer positive social benefits. If we had a stronger caregiver-support network, it could be even greater,” Weimer says.

They predict even larger benefits if more effective drug treatments are developed and if public policy supported caregiver benefits, such as counseling and support groups.

Currently, Medicare does not support caregiver-intervention programs. Even accounting for implementation costs, the new analysis suggests that they would result in net savings to governments by reducing the care burden on medical systems.

“It does take some investment early on, and of course this is a time when all state dollars are tight. But from the long-run perspective, it looks like it’s a clear winner,” says Weimer.

In addition to substantial financial savings — on average $10,000 net savings to the state alone per patient diagnosed in Wisconsin — their analysis showed that early identification and intervention would lead to positive social outcomes, including slower disease progression and improved quality of life for the patients’ families and caregivers. These combined social benefits would total around $100,000 for the typical patient, Weimer says, and could climb to five times that with the development of drugs that could stop disease progression.

A major challenge to reaping these potential savings is the current lack of mechanisms for screening and early diagnosis, allowing the vast majority of affected people to go unrecognized, Sager says. “We will have to develop systems of cognitive screening if we are going to eventually identify people at early stages when future medications and caregiver interventions are most likely to be helpful.”

“There are many physical, emotional and social benefits of early detection, diagnosis and intervention for people with Alzheimer’s and their caregivers,” says Shelley Morrison Bluethmann, director of early stage initiatives at the Alzheimer’s Association, a health advocacy organization. “Early detection empowers people with the disease to participate in decisions about their treatment and future care, as well as consider clinical trial opportunities. Being diagnosed early is vital to receiving the best help and care possible.”

The work was partially supported by the Institute for Clinical and Translational Research at UW-Madison.

Source: University of Wisconsin-Madison

Alzheimer Progressive and Degenerative Disease Of the Brain

It is a disease that attacks the brain and causes problems of memory, thought and conduct. This disease gets worse with time. In his first stage, the people express frustrations by the difficulty to formulate and to express their thoughts. Others of the first symptoms are: the lost one of the memory that affects the abilities in the work; difficulty in the execution of daily tasks, difficulty in the learning of new tasks; lost of the sense of the time and problems with the language.

Alzheimer Is a disease that attacks the brain is progressive and degenerative cause problems of memory, thought and conduct. It affects in the attention, decision making, judgment, language and personality. This disease gets worse with time. In addition to the disease of Alzheimer, there are other types of dementia, including vascular dementia (cerebral paralysis), dementia with bodies of Lewy, disease of Pick and others. Different types from dementia require different treatments.

Causes, Incidence And Factors Of Risk:

The cause of the disease of Alzheimer is not known, but it is not part of the process of normal aging. The previous theories have discarded on the accumulation of aluminum, lead, mercury and other substances in the organism. The diagnosis of the disease of Alzheimer is made on the base in the symptoms characteristic of the disease and after excluding other possible causes from dementia.

It can be confirmed with microscopic studies of a cerebral weave sample after the death. The cerebral weave naked sample “neurofibrilares” (coiled protein fragments within the neurons that obstructs them), “neuritic plates” (abnormal agglomerations of nervous cells died and that is dying, other cerebral cells and protein) and “senile plates” (areas where accumulated products of neurons died around proteins are had).

Although these changes happen in certain degree in all the brains with the age, appear many more in the brains of the people with disease of Alzheimer. The destruction of the nervous cells (neurons) takes to a diminution of the neurotransmitters (substances secreted by a neuron to send the messages to another neuron), whose correct balance is critical for the brain. The three neurotransmitters commonly affected by the disease of Alzheimer are acetylcholine, serotonin and Norepinefrina; the acetylcholine is affected.

Symptoms:

The disease of Alzheimer has a gradual progress. In his first stage, the people express frustrations by the difficulty to formulate and to express their thoughts. Others of the first symptoms are: the lost one of the memory that affects the abilities in the work; difficulty in the execution of daily tasks (such as the balance of the book of accounts or to prepare the food); difficulty in the learning of new tasks; lost of the sense of the time and problems with the language.

As the disease progresses, a person with the disease or some related disorder, can experience problems with the direction sense, poor man or diminution of the judgment, problems with the abstract thought, problems with the location of the objects, changes in the behavior, changes in the personality and loss of the initiative.

These severe changes interfere in daily the labor and social activities. The seconds affected by the disease are the members of the family that help the people who suffer of Alzheimer. These can experience emotional stress, blames, familiar fatigue, fury, isolation, conflicts, anxiety and depression.

Diagnose:

At the moment there is no an only clinical examination to identify the disease of Alzheimer, although this is an area in which intense studies are made. Before diagnosing the disease other conditions must be excluded, which can be potentially reversible. One is not due to assume that a person has the disease of Alzheimer. The person must be examined completely, which includes physical examinations, neurological, psychological and psychiatric, as well as laboratory studies. This entailed to I diagnose enough precise. The only way to confirm I diagnose of the disease is examinee woven cerebral with a microscope, which single can become when a autopsy is made.

Treatment With Medicines:

Medicine table Moderate of the Disease Alzheimer
Four of these medicines are called “inhibitors of colinesterasa.” They are prescribed for the treatment of the symptoms of slight degree to moderate of the disease of Alzheimer. These medicines can help to delay the symptoms or to prevent that they get worse by a limited time and can help to control some symptoms of behavior. The medicines are: Reminyl® (galantamina), Exelon® (rivastig-mine), Aricept® (donepezilo), Cognex® (tacrina).

There is no published study that compares these medicines directly. Since the four work of a similar way, it does not hope that the change of one from these medicines to another one produces significantly different results. Nevertheless, a person who suffers of the disease of Alzheimer can respond better to a medicine than to another one. Cognex® (tacrina) no longer is commercialized actively by the manufacturer. One thinks that it is possible to be dealt to these people with antidepressants and one of medicines, like donepezil, at the present time used for the Disease of Alzheimer.

The antidepressants known like reabsorbing inhibitors of selective serotonin (SSRI, pos abbreviations in English) can be particularly effective in alleviating the depression, irritability and the excitation associated with the Disease of Alzheimer. These symptoms and the most severe symptoms, including verbal or physically aggressive behavior and rambling, have traditionally dealt with antipsicóticos medicines like haloperidol (Haldol) and the antidepressant desyrel (Trazodone).

The disease of Alzheimer is a chronic upheaval neuro degenerative; of heterogeneous etiology and clinical presentation that has become a gigantic problem of health in the last fifty years. Nevertheless, most of the experts they agree in which most of the patients never they are not diagnosed, and only one minimum fraction receives the suitable treatment, although the investigations in the etiology and the pharmacotherapy of the disease have provided us therapeutic and preventive strategies that improve the symptoms and reduce the risk of suffering the disease.

Sleep, as it turns out, is far more complicated than we thought. And the brain not only doesn’t turn off, but appears to help keep itself healthy.

We’ve all heard of REM — rapid eye movement — discovered by the late physiologists Eugene Aserinsky and Nathaniel Kleitman at the University of Chicago in 1953. Scientific American has the story:

During REM sleep, our brain waves—the oscillating electromagnetic signals that result from large-scale brain activity—look similar to those produced while we are awake. And in subsequent decades, the late Mircea Steriade of Laval University in Quebec and other neuroscientists discovered that individual collections of neurons were independently firing in between these REM phases, during periods known as slow-wave sleep, when large populations of brain cells fire synchronously in a steady rhythm of one to four beats each second. So it became clear that the sleeping brain was not merely “resting,” either in REM sleep or in slow-wave sleep. Sleep was doing something different. Something active.

Discovering REM sleep was the first clue that sleep didn’t just help keep our bodies healthy, but our minds as well. And while many studies have been conducted on sleep since 1953, it’s only been in the last decade where we’ve begun to appreciate the complexity and importance of sleep for our minds. In 2000, researchers discovered that people that received more than 6 hours of sleep during an experiment helped improve their performance on tasks designed to tax the memory.

The key came in the discovery that participants didn’t just require REM sleep to improve their performance — they needed all that other sleep time too (what scientists call ’slow-wave’ sleep).

The long article also provides a nice description of our current understanding of how memory works:

To understand how that could be so, it helps to review a few memory basics. When we “encode” information in our brain, the newly minted memory is actually just beginning a long journey during which it will be stabilized, enhanced and qualitatively altered, until it bears only faint resemblance to its original form. Over the first few hours, a memory can become more stable, resistant to interference from competing memories. But over longer periods, the brain seems to decide what is important to remember and what is not—and a detailed memory evolves into something more like a story.

The researchers also discovered that sleep helps stabilize memories — sleep changes our memory, “making it robust and more resistant to interference in the coming day,” as the article notes.

But wait, sleep does more! It may not just stabilize our memories, it may actually help our brains process the memories, keeping the bits we need for long-term memories (especially the emotional components), and dropping the extraneous details that would clog our limited storage capacity:

Over just the past few years, a number of studies have demonstrated the sophistication of the memory processing that happens during slumber. In fact, it appears that as we sleep, the brain might even be dissecting our memories and retaining only the most salient details. [...] Instead of deteriorating, memories for the emotional objects actually seemed to improve by a few percent overnight, showing about a 15 percent improvement relative to the deteriorating backgrounds. After a few more nights, one could imagine that little but the emotional objects would be left. We know this culling happens over time with real-life events, but now it appears that sleep may play a crucial role in this evolution of emotional memories.

But wait, sleep does even more!

Even more recent research suggests that sleep helps our brain to process the information of the day and solve problems.

The upshot is that sleep is far, far more important than most of us realize and few of us appreciate. We miss it and think nothing of chopping off a few hours here or there. But the emerging research suggests that when we cut out sleep, we may be actually harming our formation of new memories for the recent past, and our ability to perform up to our usual standards. The researchers sum it up best:

As exciting findings such as these come in more and more rapidly, we are becoming sure of one thing: while we sleep, our brain is anything but inactive. It is now clear that sleep can consolidate memories by enhancing and stabilizing them and by finding patterns within studied material even when we do not know that patterns might be there. It is also obvious that skimping on sleep stymies these crucial cognitive processes: some aspects of memory consolidation only happen with more than six hours of sleep. Miss a night, and the day’s memories might be compromised—an unsettling thought in our fast-paced, sleep-deprived society.

Read the full (albeit long) article at Scientific American: Sleep on It: How Snoozing Makes You Smarter