Researchers around the world are scrambling to save your clients from dementia, protect your clients’ financial resources, keep government health programs from going broke, and (indirectly) make issuers of private long-term care insurance (LTCI) look beautiful.
The National Institute on Aging (NIA), a federal agency that supports research on increasing Americans’ healthy, active years of life, has just published a major update on the current state of U.S. dementia science: “2014-2015 Alzheimer’s Disease Progress Report: Advancing Research Toward a Cure.”
Many families affected by dementia have complained that, up till now, research has rarely produced any results that have done much to help prevent or treat dementia. The dementia drugs now on the market have only modest effects and work only for some patients.
One example is cholinesterase inhibitors. They can keep levels of a nerve-cell learning chemical high. But they work for only about half of the people who take the drugs, according to the Alzheimer’s Association. Even for the people who benefit, the drugs put off the worsening of symptoms for only about six to 12 months.
The situation is so dire that some prominent members of the dementia community want the world to spend less money on efforts to detect, prevent and treat dementia and more on efforts to support the families already affected by dementia.
Meanwhile, because people with severe dementia need so much attention, dementia accounts for a huge percentage of your clients’ catastrophic LTC risk. About 60 percent of the people in U.S. nursing homes suffer from dementia.
The number of people who have dementia is likely to rise simply because the baby boomers are aging, but there are some studies suggesting that the likelihood that relatively young people, including people in their 30s and 40s, will develop dementia might be rising.
Private long-term care insurance (LTCI) issuers pay about $8 billion in benefits per year for insureds with all kinds of conditions getting all kinds of LTC services. That’s a huge amount, but not compared with what this country actually spends on dementia care. This year, we will spend about $226 billion on nursing home care and hospice care for people with dementia, according to the Alzheimer’s Association.
Clearly, the best solutions for your clients, for the insurers on the hook to pay dementia-related claims and for the governmental agencies that believe they have a moral obligation to try to keep uninsured and underinsured people with dementia off the sidewalk would be scientific breakthroughs that help prevent or treat many cases of dementia.
The best way to support the patients who need dementia-related LTC services and the families struggling to provide informal care would be to eliminate the need for all that care.
The world has done that with polio, and mostly that with tuberculosis. Why not with dementia?
For a look at five things LTC planners, and, really, anyone with ambitions of living past age 35, ought to know about research to relegate dementia to the medical history museums, read on.
1. NIA managers say they have an obvious need for more money for dementia research.
The NIA is an arm of the much better known National Institutes of Health (NIH).
The NIA controls $1.2 billion of the $30 billion NIH research budget. Congress has been cutting medical research funding in recent years, not increasing it, but it has increased NIH Alzheimer’s funding to $469 million for the current federal fiscal year, from $422 million.
NIH managers are lobbying for $323 million in extra funding for fiscal year 2017, saying that would help accelerate the war against dementia.
NIH managers say the extra funding would speed up the process of developing better dementia diagnostic criteria and tools; discovering and testing markers researchers can use to track the severity of dementia; seeing how dementia affects various populations; and studying the genetics of dementia.
2. Since 2009, researchers have learned a lot more about which genes are associated with a higher risk of developing dementia.
Just seven years ago, researchers knew about exactly one gene that would result in developing ordinary late-onset Alzheimer’s disease: APOE4.
Since then, researchers have used expensive but powerful new DNA analysis machines to read genes as if they were getting information off of computer hard drives.
Every time they find another genetic risk factor, they get more information about why dementia occurs and how they might be able to attack it.
In 2012, researchers began transcribing the entire genomes of 580 people. The researchers are now analyzing the “nucleotides,” or genetic letters, in the participants’ genes to see if they can find patterns related to dementia.
3. Researchers have learned more about how a natural DNA editing system influences dementia.
One thing researchers have discovered is that what people do while they’re already alive can affect their health, through a “methylation” process that, in effect, controls how the body processes the DNA in the cells.
Methylation seems to give the body the equivalent of Post-It notes that tell cells what to do with certain stretches of DNA.
One team backed by the NIA studied 708 brains and found that 71 of the 400,000 epigenetic Post-It notes they found seem to correlate with Alzheimer’s risk.
The Post-It notes seem to account for twice as much Alzheimer’s risk as the known Alzheimer’s risk genes do.
4. This year, a team discovered a major new “debris drainage system” in the brain.
For years, one of the fundamental rules that shaped brain health research was the principle that the brain is not hooked up to the same lymphatic system that drains cellular debris from the rest of the body.
Researchers backed by NIH grants recently discovered that the brain does actually have hard-to-see lymphatic vessels. The vessels look different in older mice than in younger mice.
“In the case of Alzheimer’s disease, the investigators theorize that the vessels may not efficiently remove abnormal proteins,” NIA officials say.
That has given researchers a giant new field of opportunities for attacking dementia. They’re hoping they may be able to attack dementia-causing conditions by improving the health of the lymphatic vessels in the brain, or, possibly, by using the lymphatic vessels to get helpful drugs into the brain.
5. Projects involving new strategies for fighting dementia with drugs are in the pipeline.
One challenge is that many of the visible new dementia research projects involve efforts to study the effects of exercise, crossword puzzles and a healthy diet on Alzheimer’s.
Those studies may document that healthy habits protect people against dementia, but they do nothing for the people who live healthy lives but end up suffering from dementia, anyway.
But researchers are also studying a number of other drugs that could clear out substances related to dementia, or could fight dementia in other ways.
Some of the potential dementia fighters now under review in NIH-funded research labs include saracatinib, a cancer drug that blocks Fyn, which is an enzyme associated with Alzheimer; microtubule stabilizing chemicals, which could help researchers get other useful drugs past the barrier that keeps most drugs out of the brain; MW181, a drug that fights brain inflammation; APE1, an enzyme that helps brain cells repair DNA; and Citalopram, an antidepressant already on the market that might keep beta-amyloid plaques from coating neurons.
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