Few diagnoses incite as much fear and helplessness as one of Alzheimer’s disease (AD). And it’s easy to understand why. According to the Alzheimer’s Association AD is the sixth-leading cause of death in the United States and the fifth-leading cause of death for people over age 65. Moreover it’s “the only disease among the top 10 causes of death in America that cannot be prevented cured or even slowed.” (Although there is promising work that suggests otherwise.) While mortality from many other conditions—such as heart disease AIDS and certain forms of cancer—has decreased mortality from this most dreaded form of neurodegeneration has increased. In fact the BBC recently reported that dementia including Alzheimer’s has overtaken heart disease as the leading cause of death in England and Wales.

In 2015 more than 61000 people died of dementia in England and Wales accounting for 11.6% of all recorded deaths. Women are afflicted by AD more than men and this is reflected in the statistics: of the 61000 deaths from dementia 41283 were women (about 67%) compared to 20403 men (33%). Dementia as a category including Alzheimer’s accounted for 15.2% of all female deaths up from 13.4% in 2014. For men in England and Wales however heart disease remained the leading cause of death in 2015. (The most common cause of death overall was all types of cancer taken as a group.) 

The numbers are no less grim in the U.S. More than 5 million people are currently living with AD with projections for this to reach a staggering 13.8 million people by 2050. Of the 5.4 million Americans with AD an estimated 5.2 million people are age 65 or older and about 200000 are under age 65 having been diagnosed with “early onset” Alzheimer’s. And this doesn’t account for the potentially millions who are undiagnosed but may be living with the signs and symptoms of the condition. Right now one in nine people age 65 or older has Alzheimer’s and in the absence of a miracle medical breakthrough by mid-century someone in the U.S. will be diagnosed with AD every 33 seconds.

Alzheimer’s disease affects far more people than the afflicted individual. Loved ones and caregivers shoulder emotional and financial burdens in the course of looking after the AD patient. In 2015 15.9 million family and friends provided 18.1 billion hours of unpaid care to those with AD and other dementias for an estimated price tag of $221.3 billion with a B. Family members who provide care may have to reduce their working hours or stop working outside the home entirely in order to provide round-the-clock care. Moreover “one in five care contributors cut back on their own doctor visits because of their care responsibilities. And among caregivers 74 percent report they are ‘somewhat’ to ‘very’ concerned about maintaining their own health since becoming a caregiver” and 40 percent experience depression.

Total payments for health care long-term care and hospice for individuals with AD and other dementias are estimated to be $236 billion for 2016. The Alzheimer’s Association reports that close to one in every five Medicare dollars is spent on care for Alzheimer’s and dementia patients; in 2050 it will increase to one in every three dollars. By the same year—again barring a medical breakthrough—total costs associated with Alzheimer’s are projected to reach more than $1 trillion – trillion with a T. 

Why is this happening? Why are the incidence of and mortality from Alzheimer’s and other dementias rising when the death rate from other common causes has fallen. 

One factor is that people are living longer so it makes sense that a condition that preferentially strikes in older age would be on the rise. Perhaps in the past people who lost their lives to complications from heart disease type 2 diabetes or even infectious disease might have developed dementia had they lived longer. But Alzheimer’s and other dementias don’t only strike our elders. In fact “mild cognitive impairment” a precursor to AD may affect people in their forties and fifties. No longer can we use the flippant term “old timer’s disease.”

Another factor may be the increasing evidence that Alzheimer’s is among the ever-growing list of conditions driven by the highly refined calorie-dense but micronutrient-poor modern Western diet combined with lifestyle parameters that are at odds with human physiology (e.g. altered circadian rhythms decreased physical activity). Specifically links between chronic hyperinsulinemia insulin resistance and Alzheimer’s disease are increasingly difficult to deny. If it’s the case that AD is related to peripheral and/or brain insulin resistance and can be called “type 3 diabetes”—and a growing body of evidence suggests it is—then it’s no surprise that morbidity and mortality from AD are increasing.

Some of the most promising pharmaceutical drugs for AD have failed in clinical trials. Considering that older individuals with higher cholesterol have a reduced risk for AD (and there may be an inverse relationship between LDL and all- cause mortality in the elderly) it may be time to rethink “standards of care” that automatically call for cholesterol-lowering medications with potentially fatal side-effects when total cholesterol is above a certain level. Moreover small but very promising studies indicate that dietary and lifestyle interventions may be effective for slowing the progression of and possibly even reversing AD and mild cognitive impairment.    

It is time for healthcare professionals and patients alike to empower themselves with information regarding controllable risk factors for cognitive decline. As a spokesperson for Alzheimer’s Research UK said “Dementia is not an inevitable part of aging it’s caused by diseases that can be fought through research and we must bring all our efforts to bear on what is now our greatest medical challenge.” But with one “wonder drug” after another failing to deliver it may be time to turn attention—and research dollars—to other avenues that hold more promise such as ameliorating insulin resistance and the reduced cerebral usage of glucose potentially by employing ketogenic therapies as at least one part of what will surely be a multifaceted strategy to tackle this mystifying and frightening condition.

By Amy Berger MS CNS NTP