Alzheimer’s Death Rate Steadily Increasing; FDA Offers New Guidance
Mortality from Alzheimer’s disease has steadily increased during the last 30 years based on data compiled by the Centers for Disease Control and Prevention (CDC). In 2010, Alzheimer’s disease was the underlying cause for a total of 83,494 deaths and was classified as a contributing cause for an additional 26,488 deaths.
An estimated 5.4 million Americans have Alzheimer’s disease. The cost of health care for people with Alzheimer’s disease and other dementias was estimated to be 200 billion dollars in 2012, including 140 billion dollars in costs to Medicare and Medicaid. This cost is expected to reach up to 1.1 trillion dollars in 2050.
The risk of dying from Alzheimer’s disease significantly increases with age. Alzheimer’s disease is the sixth leading cause of death in the U.S. and is the fifth leading cause among people over the age of 65 years. Data from the National Vital Statistics System demonstrates that age-adjusted death rate from Alzheimer’s disease increased by 39% from 2000–2010 in the U.S.
In 2010, the population aged 85 years and older was 50 times more likely to die from Alzheimer’s disease than individuals aged 65–74 years. Americans 85 years and older were five times more likely to die from Alzheimer’s disease than those between the ages of 75 and 84 years.
Overall, women had a 30% higher risk of dying (27.3 per 100,000 population) from Alzheimer’s disease than men (21). The highest mortality rate from Alzheimer’s disease was observed in non-Hispanic white women (28.9) and non-Hispanic white men (22) compared to other races of the same gender. Among the non-Hispanic white population the risk of dying from Alzheimer’s disease is 26% higher than among the non-Hispanic black population. Similarly, the age-adjusted death rate is 43% higher for the non-Hispanic white population compared to the Hispanic origin population.
Alzheimer’s disease death rates vary widely across states. In 2010, among all the states and the District of Columbia, thirty one states showed death rates from Alzheimer’s disease that were above the national rate (25.1). States with the highest age-adjusted death rates were Washington (43.6), Tennessee (38.5), and North Dakota (37.2).
According to data collected from 2000–2010, Alzheimer’s disease mortality varies by age, sex, race, Hispanic origin, and geographic area.
Currently there is no cure for Alzheimer’s disease but there are pharmacological treatments to help with cognitive and behavioral symptoms. Reversible cholinesterase inhibitors such as Aricept, Exelon, and Razadyne increase the levels of acetylcholine in the brain by inhibiting acetylcholinesterase. Namenda, an N-methyl-D-aspartate receptor antagonist, is approved to treat moderate to severe Alzheimer’s disease. Keeping in mind the different needs for this population, these medications are available in other formulations besides pills such as the Exelon Patch and Namenda Oral Solution.
With regards to early detection, In April 2012, the FDA approved Eli Lilly and Company’s Amyvid (florbetapir F 18 injection), a radioactive diagnostic agent indicated for brain imaging of beta-amyloid plaques in patients with cognitive impairment who are being evaluated for Alzheimer’s disease and other causes of cognitive decline. A positive Amyvid scan indicates moderate to frequent amyloid plaques are present; this amount of amyloid plaque is present in patients with Alzheimer’s disease, but may also be present in patients with other types of neurologic conditions and in older people with normal cognition.
Despite this progress more measures need to be taken for this patient population. The FDA recently issued a proposal to assist companies developing new treatments for patients in the early stages of Alzheimer’s disease, before the onset of noticeable (overt) dementia. The new guidance explains the FDA’s current thinking about the way researchers can identify and select patients with early Alzheimer’s disease, or those who are at risk of developing the disease, for participation in clinical trials.
In recent years, the research community has tried to find ways to identify these patients using criteria that are based on biological indicators. Researchers have also tried to develop sensitive clinical measures that can detect subtle mental decline. However, because patients with early Alzheimer’s disease have little-to-no impairment of global functioning, it is difficult to assess changes in function in these patients. This can make it difficult to determine if a given treatment’s effect is clinically important.
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True Story
In care homes in the bayarea, I have experienced and saw how Alzheimer’s disease (AD) condition worsens each day. Seniors with AD have an average of 8 medications per day. Agitation and mental decline are prevalent. Some of them have problems sleeping while some of them have limited body movements depending on the severity of their condition. Some of the male AD clients have more adverse effects with medications. Before being admitted to a carehomes, most of them have been living at their homes with chronic issues such as constipation, sleep disorders, obesity, skin problems and heart and vascular-related problems.
Connie Dello Buono, Motherhealth Inc, caregiving for bayarea homebound seniors 408-854-1883