Cancer and heart disease may be far more prevalent killers, but Alzheimer's disease is certainly no ailment to overlook, considering that it's the eighth leading cause of death in the United States.
According to statistics from the Alzheimer's Association, or AA, one in nine Americans age 65 or older has Alzheimer's. Alzheimer's is a progressive disease that affects all aspects of cognition. Over time, as an Alzheimer's patient's cognitive function declines, they lose all ability to take care of themselves, eventually becoming more susceptible to infections, which are commonly a contributing factor to their death.
As if the disease itself wasn't scary enough, both the number of people dying from Alzheimer's and the disease's direct costs are on the rise. As deaths from a number of other major diseases were on the decline between 2000-2010, Alzheimer's deaths rose by an unfortunate 68%, per the AA. Also, according to the AA, Alzheimer's is the most expensive condition in the U.S., with an estimated $214 billion being spent annually to treat it and other types of dementia (of which $36 billion in paid out of consumers' pockets).
Five states that are expected to see the biggest increase in Alzheimer's diagnoses
While an Alzheimer's diagnosis might seem like it would be at random on a state-by-state basis, there are clearly states whose rate of diagnosis is expected to soar during the coming decade. Based on estimates from the AA in its 2014 Alzheimer's Disease Facts and Figures report, the following five states are projected to see their Alzheimer's diagnoses soar by a minimum of 54.5% between 2014 and 2025:
- Alaska, 80.3%
- Nevada, 73%
- Arizona, 66.7%
- New Mexico, 55.9%
- Vermont, 54.5%
Why are these states leading the pack? It could have to do with the number of retirees in these states since age is a major contributing factor to Alzheimer's, but the truth of the matter is that researchers can't identity, with any certainty at least, why some people develop Alzheimer's and others don't.
What researchers can say is that age, family history, your education level, whether or not you've had a traumatic brain injury, or even the presence of a specific gene (apolipoprotein E-4 gene), can increase your risk of developing Alzheimer's. It's especially important that we address this disease now because the number of people who are 65 and older with Alzheimer's is expected to rise from 5 million to an estimated 13.8 million by 2050.
There's good news, too
Although Alzheimer's diagnoses are clearly on the rise, the percentage of the population poised to develop Alzheimer's, at least within the U.S., is declining, which is great news.
According to Dr. Kenneth Langa at the University of Michigan, "An American over the age of 60 now has a 44% lower chance of developing dementia than a similar-aged person did roughly 30 years ago." Dr. Langa's study of Alzheimer's and other dementias cited improved education of the disease as one of the primary factors that's contributed to this decline, as well as better maintenance of other health factors such as blood pressure and cholesterol.
However, I'd suggest that the introduction of higher-quality medications geared toward slowing the degradation of cognitive function in Alzheimer's patients also have improved quality of life. Let's briefly look at the two most commonly prescribed drugs which are responsible for slowing the progression of this terrible disease.
Two key therapies making a difference
The first important drug, which actually came off patent roughly four years ago, is Pfizer's (PFE 1.77%) Aricept, which is licensed abroad through Eisai (ESALY -2.76%). To be clear, Aricept is in no way a cure for Alzheimer's, but it's unique in that it was prescribed by doctors for both early stage, moderate, and severe forms of Alzheimer's, making it the only one of five Food and Drug Administration-approved therapies that was able to be prescribed in all three stages of the disease. Pfizer still sells Aricept abroad, but it's primarily sold in generic formulations in the U.S. (which is, of course, not a bad thing since generics are cheaper for consumers).
The other key player improving patients' quality of life is Actavis' (AGN) Namenda, which is prescribed to Alzheimer's patients with a moderate to severe form of the disease, and was acquired when Actavis bought Forest Laboratories earlier this year. Namenda is unique in that it's the only Alzheimer's drug designed specifically to treat late-stage disease patients. To add some context as to how many people that encompasses, Namenda and Namenda XR's sales in the fourth quarter of 2013 put the drug on pace for around $1.8 billion in sales in 2014.
While these drugs are the cornerstone of today's treatments, clearly we still have a lot of work to do to improve patients' quality of life.
Could this be the future of Alzheimer's research?
Admittedly, many pharmaceutical companies have tried to develop drugs targeted at Alzheimer's disease only to wind up failing in late-stage trials. The blood-brain barrier is a tricky pathway to master, but researchers have certainly not given up. In fact, one of the most promising therapies could be one that was unsuccessful in late-stage trials.
This experimental drug in question is Eli Lilly's (LLY 1.34%) solanezumab, which actually failed to meet its primary endpoint in phase 3 studies in 2012. However, upon additional review of the data collected from Eli Lilly's studies there's some excitement that solanezumab, which works by attaching to free-floating amyloid in the brain before it has a chance to attach and become plaque (which some suspect is tied to Alzheimer's), could be effective in very early stages of the disease. In October 2012 it was announced that solanezumab would be one of three drugs chosen to take part in an international two-year study in patients who appear genetically predisposed to get the disease, but who aren't currently showing declines in cognitive function. Findings from this study should hopefully be available next year.
Another developing combo may come from Biogen Idec (BIIB 1.80%) and Eisai which are collaborating on a handful of Alzheimer's disease therapies, two of which are in mid-stage studies, E2609 and BAN2401. The idea behind E2609 is that it targets beta secretase and halts the development of beta amyloid altogether, long before it sticks to the brain and becomes plaque. BAN2401 is an immunotherapy agent also geared toward eliminating amyloid beta.
Here's what really matters
Even though we've had far too many drugs fail to make it to pharmacy shelves, the silver lining is that the percentage of people affected by Alzheimer's is declining along with improved education about the disease. In addition, we've seen a handful of pharmaceutical companies take baby steps with regard to slowing the progression of the disease.
Still, it's going to take years of dedicated research and a big amount of cooperation to tackle and beat this disease. I, for one, remain hopeful that pharmaceutical companies can deliver on their goal of improving Alzheimer's patients' quality of life, and look forward to many years of improving research and results.