Some advisors are already familiar with the challenges of cognitive decline, whether they’re helping a client prepare for a time when they won’t be able to make decisions for themselves, or plan for the added responsibilities of caring for an impaired loved one.
If they aren’t already familiar, they will be. According to the Alzheimer’s Association, one in three seniors dies with Alzheimer’s or some other form of dementia. Alzheimer’s is the sixth leading cause of death in the United States, and almost two-thirds of Americans with the disease are women.
Alzheimer’s is the most common form of dementia, estimated to be responsible for between 60% and 80% of dementia cases. Vascular dementia is less common, and often coexists with other forms of dementia. While Parkinson’s disease begins with declines in motor skills ability, as it progresses it often results in dementia due to the accumulation of Lewy bodies, clumps of the alpha-synuclein protein that accumulate in neurons, according to the Association’s “2015 Alzheimer’s Disease Facts and Figures” report.
The Alzheimer’s Association estimates that costs associated with dementia, including Alzheimer’s, will reach $226 billion in 2015. By 2050, that could rise to over $1.1 trillion.
The National Institutes of Health found funding support for dementia research in fiscal year 2014 was $710 million, with an estimated $737 million to be spent in 2015. Support for vascular dementia and Lewy body dementia in 2014, the first year the NIH provided funding data for those conditions, reached $45 million and $15 million, respectively, and are expected to remain level in 2015.
Because the NIH funding categories aren’t exclusive, reported funding for dementia research likely includes support for Alzheimer’s as well. Funding support specifically for Alzheimer’s in 2014 was $562 million and is expected to rise to $586 million in 2015.
The changes in the brain that lead to Alzheimer’s are believed to begin as much as 20 years before symptoms appear. “The accumulation of the protein beta-amyloid (called beta-amyloid plaques) outside neurons and the accumulation of an abnormal form of the protein tau (called tau tangles) inside neurons are two of several brain changes believed to contribute to the development of Alzheimer’s,” according to the Alzheimer’s Association’s report.
Genetic mutations in three specific genes are also believed to be a cause of Alzheimer’s, but it’s estimated that less than 1% of cases can be attributed to genetics.
“These mutations involve the gene for the amyloid precursor protein (APP) and the genes for the presenilin 1 and presenilin 2 proteins. Those inheriting a mutation to the APP or presenilin 1 genes are guaranteed to develop Alzheimer’s. Those inheriting a mutation in the presenilin 2 gene have a 95% chance of developing the disease,” the Association wrote, citing research from the Department of Neurology at Columbia University.
Risk and Protection
Although age is the most common risk factor in an Alzheimer’s diagnosis — most people with the disease are over 65, although some diagnoses are made for younger people — the report noted age alone isn’t responsible.
Family history may also contribute to an individual’s chance of being diagnosed with Alzheimer’s. Cardiovascular disease may also play a role.
“Growing evidence suggests that the health of the brain is closely linked to the overall health of the heart and blood vessels,” according to the report. “Many factors that increase the risk of cardiovascular disease are also associated with a higher risk of dementia,” including smoking; midlife obesity, hypertension and high cholesterol; and diabetes.
Interestingly, some researchers have posited that having more years of formal education builds a “cognitive reserve” in individuals that helps them compensate for brain changes associated with Alzheimer’s, according to the report. However, other researchers have suggested that the increased risk of Alzheimer’s among less educated people is due to other factors: less stimulating occupations, poor nutrition and difficulty obtaining health care.