National Alzheimer's proposal outlines strategy to improve diagnosis and treatment

A draft framework for the nation's first plan to overcome Alzheimer's disease calls for more primary care training in geriatrics and increased public awareness of the neurologic disorder.

The proposal, released Jan. 9 by the Dept. of Health and Human Services, sets a goal of 2025 for developing effective means of preventing and treating Alzheimer's.

Creating a plan to tackle the disease is required by the National Alzheimer's Project Act, which President Obama signed into law Jan. 4, 2011. The strategy is being developed by a 27-member advisory council that consists of Alzheimer's experts, caregivers of those with the disease and other health professionals.

Council members met Jan. 17-18 in Washington to review the draft. They discussed how to measure success in meeting the plan's objectives and debated whether 2025 was a realistic deadline for developing effective Alzheimer's preventions and treatments, said the Alzheimer's Assn., which is involved in the process.

A first draft of the plan will be released in mid-February, and the final plan will be issued in the spring.

"Alzheimer's can't wait," said Harry Johns, president and CEO of the Alzheimer's Assn. He also is a member of the advisory council developing the plan. "For the first time ever, families grappling with this progressive, degenerative and ultimately fatal disease can have real hope that a national strategy addressing the escalating Alzheimer's crisis is coming."

Health professionals agree that action is needed in light of projections that Alzheimer's cases in the U.S. could nearly triple by 2050. But Pierre Tariot, MD, is among those who question whether the national plan will go far enough.

"I'm delighted that people are paying attention to Alzheimer's," said Dr. Tariot, director of the Phoenix-based Banner Alzheimer's Institute, which cares for Alzheimer's patients and their families and conducts research on the disease. "But on the other hand, I have some concerns that, overall, the real urgency of the problem isn't adequately reflected in the draft."

Dr. Tariot said the framework did not include specific recommendations for an increase in Alzheimer's research budgets. "If we don't accelerate the research, the problem isn't going to be dealt with by a year like 2025," he said.

An estimated 5.4 million Americans have Alzheimer's disease, including 200,000 people younger than 65, according to the Alzheimer's Assn. By 2050, as many as 13.2 million people could have the condition, which is the leading cause of dementia.

The projected uptick is predominantly due to the growing elderly population, which is expected to more than double in the next 40 years. In 2050, there will be an estimated 88.5 million Americans 65 and older, up from the 40.2 million today, according to the latest U.S. Census Bureau data.

The burden of caring for Alzheimer's patients will fall largely on primary care physicians, because there are too few specialists to meet the nation's need, Dr. Tariot said. Complicating matters is the fact that primary care doctors have limited time for office visits, and many lack the necessary training to appropriately care for patients with dementia, health experts say.

A step in the right direction

Despite the draft's potential shortfalls, most health professionals agree that developing a national plan is key to addressing the anticipated Alzheimer's epidemic.

The proposal calls for experts to identify Alzheimer's research priorities and accelerate efforts to detect early and presymptomatic stages of the disease. Early identification and treatment are considered key to delaying progression of the condition.

The draft recommends improving assessment tools to help physicians detect symptoms of Alzheimer's disease in their patients. Health professionals also are encouraged to educate patients and their families about the disorder, advise them of local sources for counseling or support, and help them plan for future long-term care as the disease progresses.

William Thies, PhD, chief medical and scientific officer of the Alzheimer's Assn., said: "Alzheimer's disease is the major public health issue of the next 40 years. ... The goal of the [Alzheimer's] plan is to find ways to minimize the impact of the disease."

Thies believes the 2025 goal is realistic, considering that scientists already know a good deal about the disease. But he cautioned the public about thinking that the national plan will lead to a cure for Alzheimer's. Rather, he said, the goal is to develop drugs that change the progression of the disease and enable physicians to better control it.

"When you look at chronic conditions related to aging, we don't cure any of those," Thies said. "We find ways to manage them and minimize their impact."