Alzheimer's deaths on rise

Deaths related to Alzheimer's disease increased nearly 6% from 2001 to 2002, according to "Deaths: Preliminary Data for 2002," a report published by the National Center for Health Statistics last month. This finding comes on the heels of a 5% increase between 2000 to 2001, and a 9% increase from 1999 to 2000.

Experts blame the phenomenon on the convergence of several trends, including changes in the death certificate system, improvements in medical technology and a shift in demographics. But they also see the numbers as a warning signal about the continuing strain that spiraling rates of Alzheimer's morbidity and mortality will impose on the health care system.

"This is huge," said Andrew Neal Dentino, MD, chief of the section of geriatrics at the Louisiana State University Health Sciences Center in Shreveport. "We are winning the war against some diseases or at least doing better. Hence, Alzheimer's rears it's ugly head."

Heart disease, which remains the No. 1 killer, is down 3% and cancer, the second place holder, is down 1%. But, as inroads are made in treating these illnesses, more people are living long enough to develop Alzheimer's, for which age is the greatest risk factor. In other words, many experts believe the graying of America is leading to the increase.

"A lot of major causes are going down, and you have to die of something," said Ken Kochanek, a NCHS statistician. "Twenty or 30 years ago, you had a heart attack and you died. Nowadays, you live another 20 years and then become old enough to die of something else."

Reading between the numbers

It's a reality that has many Alzheimer's experts nervous. Caring for a heart or cancer patient is very different from caring for an Alzheimer's patient, and concerns are emerging about how the health system may meet the challenge.

"This is just the beginning of the acceleration that we're going to see, and it's a disease that requires a significant utilization of care and medical resources," said Bill Thies, PhD, vice president for medical and scientific affairs at the Alzheimer's Assn. "It'll bankrupt our health care system."

Also, although heart disease deaths have gone down, diabetes and other cardiovascular risk factors have increased and may play a role in Alzheimer's incidence. Most recently, a paper in the Proceedings of the National Academy of Sciences, published online in February and available in print this month, suggested that insulin resistance in brain cells could cause some of the biochemical changes typically associated with Alzheimer's.

"Are we setting up a population that is at increased risk for Alzheimer's disease?" said C. Ronald Kahn, MD, one of the authors on the paper and president of the Joslin Diabetes Center in Boston. "This could be a contributory factor."

Although many physicians believe that there are more cases now than in the past, there are questions pertinent to exactly how significant this increase is because there may be other factors at work. In 1999, for instance, a new cause-of-death classification system led to a 9% leap in cases and shifted Alzheimer's from 12th place to eighth on the list of leading causes of deaths.

Still, this change in reporting is believed to play a much smaller role in the statistical increases seen in the years since. Other factors also may be in play. For instance, awareness of Alzheimer's is at an all-time high, and new medical technology makes diagnosing the disease easier than ever.

"Is it a real true increase in Alzheimer's?" said NCHS statistician Kochanek. "We don't know."

Whatever the reasons driving them, the statistics are fueling the desire for more effective prevention and better treatment. Experts predict there will be a significant role for prevention to alleviate the health system burden in the future.

"Even though we're diagnosing and treating it, we're not fixing the underlying process, so people are progressing and are dying," said Reisa Sperling, MD, director of clinical research in the memory disorders unit at Brigham and Women's Hospital in Boston. "These statistics are telling us that we better get our act together and deal with this disease."

And until prevention is truly possible, many expect Alzheimer's mortality to mirror the arc of AIDS-related deaths and decline dramatically as advances are made in available medical treatments and interventions.