Alzheimer’s: Solving A Global Health and Economic Crisis

Alzheimer’s disease is quietly becoming one of the most devastating global health crises of our time, affecting millions of people and their families worldwide. While the personal toll on those living with Alzheimer’s is profound, the ripple effect on caregivers, families, and healthcare systems is equally staggering. As cases continue to rise, the personal and global burden will intensify, making it essential to address this crisis with the urgency and resources it demands.

Alzheimer’s and Related Dementias

Alzheimer’s disease is a brain disorder that progressively impairs memory, thinking, and behavior and accounts for 60-80% of dementia cases. Dementia is a general term that describes cognitive decline which is severe enough to impact everyday life. Over time, Alzheimer’s dementia can progress from mild memory loss to an inability to carry on a conversation or respond to environmental stimuli. 

As a result of their progressive cognitive decline, people with Alzheimer’s require substantial support from caregivers, family, and healthcare systems. Family members who become their loved one’s caregivers face their own myriad of mental health issues and financial burdens due to the stress of caregiving and the lack of established support systems. The impact of dementia extends far beyond those diagnosed, as it profoundly affects the well-being of their caregivers, families, and society as a whole.

The stigma surrounding Alzheimer’s can often affect the quality of care, amount of research funding, and overall quality of life for those diagnosed. Unfortunately, many people associate Alzheimer’s and dementia with a natural part of the aging process or a disease that only affects the elderly. Although increasing age is the best-known risk factor for Alzheimer’s, this disease is not a normal part of aging and should not be easily dismissed as such. People with Alzheimer’s deserve the same level of care and research funding as young, healthy individuals.

The Global Prevalence of Alzheimer’s Disease

With the world’s aging population, Alzheimer’s and dementia cases are steadily on the rise. Every 3 seconds, someone is diagnosed with dementia, with over 55 million people living with Alzheimer’s and other dementias worldwide. By the year 2030, the number of people with Alzheimer’s and related dementias is expected to reach 78 million. 

Unfortunately, not every case of Alzheimer’s is diagnosed, especially in third-world countries. In developed countries, only 20-50% of dementia cases are diagnosed and documented in primary care. The rate of diagnosis is even lower in developing countries and more difficult to measure accurately. One study in India estimated 90% of cases remain undiagnosed. Without a diagnosis, people are left without access to dementia care and support systems put in place to help those with Alzheimer’s and dementia. 

Despite higher mortality in early life due to infectious disease, poverty, and human conflicts, the developing world is expected to account for three-quarters of the global population aged 60 and older by 2025. People living in developing countries are also disproportionately exposed to additional risk factors for dementia, including air pollution, malnutrition, and lower education. 

As a result, it is projected that by 2040, 71% of the estimated 81.1 million dementia cases will be in the developing world, assuming there are no drastic changes in preventative measures. A study published in The Lancet predicts that dementia cases will increase by 367% in North Africa and the Middle East and by 357% in sub-Saharan Africa by 2050. 

Barriers to Dementia Care in Developing Countries

People living in developing countries face many barriers when it comes to accessing adequate Alzheimer’s care. Lower health literacy in developing countries makes it difficult to distinguish the symptoms of dementia and Alzheimer’s from the typical signs of aging, delaying timely diagnosis and treatment. Additional challenges to healthcare access in these countries include high costs, limited resources, long travel distances, and the social stigma surrounding seeking care for cognitive decline.

Long-term care facilities for dementia patients are almost nonexistent in developing countries, leaving the burden of care on family members who may not know exactly how to treat their loved one. These traditional forms of “informal care” cause more financial strain and stress to caregivers, which are exacerbated by economic migration, illness, and disasters. 

The rising global burden of Alzheimer’s and dementia poses a significant public health challenge, particularly in developing countries. With aging populations and limited access to timely diagnosis and care, millions will face the devastating effects of these diseases without proper support. 

As the number of dementia cases is projected to soar, especially in low-resource settings, it is essential that global health initiatives prioritize prevention, early detection, and comprehensive care systems to alleviate the impending crisis. The future of dementia care must be addressed on a worldwide scale to prevent overwhelming healthcare systems and families alike.

The Economic Burden of Alzheimer’s

Alzheimer’s disease costs victims and their families millions of dollars every year in direct and indirect costs. Medicare does not cover the cost of long-term care, so patients must rely on unpaid caregivers or spend down their assets to qualify for Medicaid coverage. Entire life savings are depleted to provide care for victims, caregivers are forced to reduce work hours or leave their jobs entirely, and capital supply is reduced as dementia care consumes substantial resources. 

Alzheimer’s disease is not only a financial burden on those diagnosed and their families but also a significant economic strain on the healthcare system. The costs associated with treatment, long-term care, and caregiving support place immense pressure on public health resources.

In 2022, the United States spent an estimated $321 billion on Alzheimer’s treatment, with costs expected to exceed $1 trillion by 2050. These cost estimates are based on direct costs and do not consider informal costs such as unpaid care by caregivers, loss in productivity, job loss, etc. The cost of unpaid care for dementia (Alzheimer’s being the most common form of dementia) was estimated at $254 billion in 2020. Globally, the direct and indirect costs of dementia are expected to increase from $1.33 trillion in 2020 to $9.12 trillion in 2050. 

As the global population ages and the number of Alzheimer’s cases rises, healthcare systems worldwide face growing challenges in meeting the demands for specialized care, research, and treatment advancements. This escalating burden emphasizes the need for innovative approaches to both prevention and care.

Opportunities for Alzheimer’s Research and Development

Recent advances in Alzheimer’s research have opened exciting new avenues for both diagnosis and treatment. From the development of immunotherapies and potential vaccines to AI-powered discoveries, these breakthroughs offer hope in combating the disease’s progression. In particular, new diagnostic tools, including blood-based biomarkers and advanced imaging, are revolutionizing the way Alzheimer’s is identified and treated, promising earlier interventions and more effective care.

Advances in Immunotherapy and Vaccine Platforms

In the past, treatments for Alzheimer’s and related dementias were mainly aimed at managing symptoms rather than directly addressing the disease itself or slowing down its progression. More recently, potential has been found in peptide vaccines and immunotherapies with monoclonal antibodies to combat the progressive cognitive decline associated with the disease.

Vaccines work by introducing a small part of a pathogen or molecule related to a disease into a person’s body, which helps train the immune system to recognize and fight the disease by producing antibodies. A peptide vaccine is a vaccine that uses a synthesized peptide (usually a small segment of a protein associated with a pathogen) to trigger this response instead of the actual pathogen. 

Immunotherapies involve introducing externally produced antibodies directly into a person’s system rather than training the immune system to create the antibodies. Monoclonal antibodies (MABs) are artificially created proteins designed to attach to specific targets in the body, aiding in the treatment and diagnosis of diseases, including cancer and COVID-19. 

Alzheimer’s disease is believed to result from the abnormal build-up of proteins in and around brain cells. One of these proteins, known as beta-amyloid, creates plaques around the brain cells, while another protein, called tau, forms tangles inside the brain cells. Fragments of beta-amyloid, tau, and peptides have been used in immunotherapy and potential vaccines to assist the body in recognizing and targeting these proteins, which may help slow the progression of the disease. Although there is promising potential for an Alzheimer’s vaccine and ongoing research in the field, a successful and widely effective vaccine has not yet been developed.

AI and Machine Learning Technology

With their ability to analyze vast databases, modern AI-driven platforms can help to accelerate the discovery of new or innovative vaccine methods that may not be widely used or known. Machine learning can leverage computational predictions to identify specific parts of the proteins involved in Alzheimer’s that the immune system can target, a process known as reverse vaccinology. Discovering these specific protein regions can take significant time and resources, so using computer predictions helps narrow down the choices quickly. This approach is especially useful for developing new vaccines, such as those developed during the recent COVID-19 pandemic.

Biomarkers and Imaging

Early diagnosis of Alzheimer’s is crucial for ensuring access to the best treatment options and outcomes. This is why accurately identifying early signs of the disease through blood-based biomarkers and advanced imaging tools marks such an important breakthrough in diagnosis and care. 

In the past, clinical symptoms have been used as the primary identifier of Alzheimer’s. However, these symptoms can be easily missed or dismissed as normal signs of aging. Dementia due to Alzheimer’s is often a diagnosis of exclusion after other causes have been ruled out. This diagnosis pathway, combined with a limited number of dementia specialists, has resulted in significant delays in diagnosis, limiting access to therapies that are most effective when administered in the early stages of the disease.

The FDA has already approved certain neuroimaging and cerebrospinal fluid biomarkers that can accurately detect Alzheimer ‘s-related changes, enabling diagnosis with a level of accuracy that was not achievable through clinical symptoms alone. The recent development of blood-based biomarkers has proceeded at an unprecedented pace and will likely continue to do so. Identifying Alzheimer’s biomarkers through blood tests provides a cost-effective, widely accessible, and non-invasive diagnostic tool, offering a level of accuracy comparable to more invasive methods like cerebrospinal fluid analysis and neuroimaging.

Barriers to Alzheimer’s Research and Development

Although there have been exciting opportunities to develop revolutionary Alzheimer’s diagnostic tools and treatments, there remain significant barriers to further research and development. 

Lack of Awareness and Funding

Relative to its scope, Alzheimer’s and dementia research remains severely underfunded. Dementia receives eight times less funding than cancer despite contributing eight times more to disability. Cancer research, benefiting from far greater financial support, has over 50 times more interventional clinical trials registered on ClinicalTrials.gov. If dementia received funding comparable to cancer research, it would likely initiate many more significant breakthroughs in treatment and prevention. 

Raising awareness about the profound impact of dementia and Alzheimer’s is essential for mobilizing global efforts and securing the necessary resources to drive breakthrough treatments and research. The COVID-19 phenomenon demonstrated that the global community is able to come together to tackle complex research challenges effectively and quickly when sufficient resources are invested. Pandemics like COVID-19 are designated as high-visibility and low probability, whereas Alzheimer’s is low-visibility and high-probability. By boosting Alzheimer’s visibility, we can motivate similar urgency and focus toward addressing this growing health crisis.

Lack of Collaboration

Collaboration across industries and disciplines is the key to solving the dementia crisis. Efforts must be made to bring together stakeholders from academia, industry, government, and patient advocacy groups to share knowledge and resources and take collective action to prevent a global health crisis.

Siloed disciplines within healthcare prevent vaccine experts who are predominantly in the infectious disease field from exchanging ideas with experts in the neuro-degenerative field, which could delay breakthroughs in developing an Alzheimer’s vaccine. Collaboration between experts and stakeholders can reduce repetition, eliminate gaps in knowledge, and pool resources to speed up progress in the field. 

The growing global toll of Alzheimer’s disease is not just a public health issue but a looming economic crisis. Increased awareness, funding, and collaboration are essential to developing better treatments, improving care, and slowing the progression of this disease. As we face this challenge, the global community must unite to address Alzheimer’s with the same urgency afforded to other major health crises.