America's Frightening Alzheimer's Epidemic

When I was about 11 years old, I saw an advertisement on TV that stayed with me. A beautiful woman in her 40s faces an elderly woman across a coffee table. The older woman beams at the younger and says, "You seem like such a nice girl." The camera shifts its focus to the face of the younger woman, who has tears welling up in her eyes. "Thanks, Mom," she says. The elder woman gives her daughter a quizzical look, and then stares vacantly into the distance.

In 2000, when I first learned my mother had been diagnosed with Alzheimer's, the only thing I knew about the disease was that one day I'd be starring in my own version of that commercial. At that point, my mother was just a bit forgetful. We'd make plans to cook an elaborate meal and, a few hours later, she wouldn't recognize the shopping list. A few months ago, however, I was visiting my parents, and it finally happened. "Who is your mother?" she asked, in a friendly voice, as I helped her dress. "You are," I said, laughing. "Really?" she asked, her English accent magnifying her astonishment. "How old are you?"

One in eight Americans who are 65 years old or older has Alzheimer's disease, according to the Alzheimer's Association's 2008 Facts and Figures Report (www.alz.org). By 2030, due to the aging of our population, that number will have doubled to one in four. There's no cure, and no certain evidence that the current medications -- Aricept, Exelon, Razadyne and Namenda -- which are said to slow the course of the disease, really work. Recent studies pitting Aricept, in combination with vitamin E, against a placebo have had disappointing results.

The costs, financial and emotional, of treating and caring for an Alzheimer's patient are astronomical. Today, the amount of time lost to American businesses by workers being forced to become caregivers of those with Alzheimer's is estimated at 8.4 billion hours a year. The monetary value of this unpaid labor -- often taking place in the caregiver's home -- varies by state, from the lowest, Alaska, at a little above $100,000 a year, to the highest, California, at about $10 billion.

Part of the reason it's difficult for states, and individuals, to estimate the medical costs of caring for someone with Alzheimer's is that the disease doesn't have a clear, predictable trajectory. Unlike, say, cancer, whose stages roughly correlate to a patient's estimated years of survival, Alzheimer's disease varies by patient. The average course of Alzheimer's disease is eight years, but some can have it for 20 years. Those with the early onset form of the disease -- people in their 30s, 40s, and 50s -- tend to decline rapidly, becoming ravaged in a few years. Others, who are older, may already be suffering from ailments like diabetes and heart disease when they receive the diagnosis of Alzheimer's. In these cases, Alzheimer's slowly drones on in the background of the other disorders, until its "side effects" -- the polite term for brain damage -- become so pronounced that the disease takes center stage. Because Alzheimer's takes such a varied and prolonged path, and is often a co-occurring condition, it's hard to parse medical statistics to isolate the costs of Alzheimer's alone. In 2000, for example, Medicare paid an average of $4,207 to treat a person with diabetes; if that same person had diabetes and Alzheimer's, however, the cost increased to $10,943.

For most families, the stress of coping with the disease in real time is compounded by the terror of budgeting for the future. Because patients with Alzheimer's can be ill for a long time and can require elaborate care in skilled and nursing home facilities, health insurance companies are loathe to cover individuals with the disease. Translation -- if your mom, like mine, didn't have long-term health insurance before she received her diagnosis, you can forget it. You can get nailed by home owner's insurance, too, if you decide to move your parent into your home before you put theirs on the market. If the company discovers that your parent's house is vacant, they can cancel the policy.