Road Map to a Healthy Brain: Alzheimer’s Disease, Public Health, and an Action Agenda

The United States is not ready for the looming Alzheimer’s disease and dementia crisis. Called the “defining disease of the baby boom generation” by U.S. Senator Susan Collins in 2014 (1), Alzheimer’s disease is the sixth leading cause of death in the U.S. (2). By 2050 nearly 14 million Americans will be living with the disease (2). The disease is not just for older people as it also affects an estimated 200,000 people younger than age 65 (2). A staggering quarter of a trillion dollars is spent on caring for people with Alzheimer’s disease and other dementia every year (2) and it will cost Medicare an estimated one dollar for every three dollars it spends by 2050 (2). My review of available information does not show any difference between political parties in developing Alzheimer’s disease or dementia, but there is clear evidence that women, African Americans, and Hispanics tend to be most affected by the disease. Almost two-thirds of Americans with Alzheimer’s disease are women (2), due in part to their longevity. African Americans and older Hispanics appear to be at elevated risk due to health disparities of socioeconomics (2).

These numbers should be disturbing to the public and, therefore, to policymakers because the majority of funds expended in caring for persons with the disease come from Medicaid (state funds) and Medicare (federal funds) (3). With more than 95% of those living with Alzheimer’s disease and dementia also experiencing one or more chronic condition (4) and increased hospitalizations (5) there is a need for a public health approach to preparing for a future where so many will be affected the terminal illness.

The Centers for Disease Control and Prevention (CDC) and the Alzheimer’s Association has published its third in a series of publications on a Healthy Brain Initiative. The report provides a fresh perspective on Alzheimer’s disease and other dementia from a life course perspective in which dementia occurs along a continuum.

Using the figure above we can consider the progression of normal versus non-normal cognitive decline over the course of time. In the beginning the majority of us have healthy cognitive functioning. But over time, as we age, we may experience physiological changes in the brain that provide minor disruptions to our memory, which is the “pre-symptomatic” stage. While many will remain in this stage for the duration of their life, others may develop “mild cognitive impairment” which reveals itself in ways that others (e.g., family, friends, colleagues) may take notice. Some of those experiencing mild cognitive change will go on to experience dementia in which Alzheimer’s disease is most prevalent. Signs and symptoms of the disease include memory loss that disrupts daily life, difficulty planning, solving problems, or completing familiar tasks, such as housework. Confusion about where one is at what time of day it is, challenges with words, problems, or poor judgement that had not been previously experienced are also signs of the progression of dementia.

The Healthy Brain Initiative authors recommend a four-pronged action agenda to combat Alzheimer’s disease and dementia from a public health, life-course perspective: 1) Educate and empower; 2) Develop policies and mobilize partnerships; 3) Assure a competent workforce, and 4) Monitor and evaluate. An informed public is better aware of ways to improve cognitive function and brain health for themselves and for their loved ones. It is important to raise awareness of physical and behavioral activities that might negatively impact brain health. You’ve heard these before: exercise and maintain a healthy diet. This is as important to brain health as it is to physical health and optimal aging. Developing effective, long-term policies is not a simple chore if it is not informed by science. Encouraging research that can be translated into practice for medical providers, family caregivers, and aging communities will help promote effective integration of policies into practice. Promoting a competent workforce through Geriatric Workforce Enhancement Programs (see University of Iowa’s program), healthcare curricula that adds emphasis to prevention and care for Alzheimer’s disease and prevention, statewide initiatives (see Iowa’s Prepare to Care Program), gerontology programs, such as those at each of Iowa’s regent universities (Iowa State, Northern Iowa, and Iowa), and non-profits focused on caregiver workforce issues (see Iowa Caregivers) all contribute to the success of this particular action item. Finally, authors of the report encourage the strengthening of the national Behavioral Risk Factor Surveillance System to include modules for cognitive decline and caregiving as well as better national data collection on caregiving and dementia.

Iowa’s Area Agencies on Aging (AAAs) are well positioned to contribute to this public health agenda. The AAAs provide important public awareness activities through local events and social media. They strive to provide timely and supportive information and assistance to individuals, family caregivers, and their community. Each AAA provides programs related to family caregiving, healthier living through evidence-based activities, and nutrition support through their meal programs. Iowa’s AAAs are experts at mobilizing partnerships. They each have connections with their local government agencies, county public health offices, regional Mental Health &  Disability Services offices, and other health, human services, and education organizations throughout their service areas. As advocates and experts in aging, Iowa’s Area Agencies on Aging are important allies in navigating the public health crisis of Alzheimer’s disease and dementia.

*Go to Iowa’s Alzheimer’s Association website for additional resources for Iowans dealing with Alzheimer’s disease and other dementia.

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1. The state of play: Brain injuries and diseases of aging. Opening statements by Senator Susan M. Collins before the Special Committee on Aging (2014, p.3). https://www.aging.senate.gov/imo/media/doc/Collins_6_25_141.pdf.
2. Alzheimer’s Association (2018). 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 14(3), 367-429.
3. Alzheimer’s Association (2015). Changing the trajectory of Alzhimer’s disease: How a treatment by 2025 saves lives and dollars.
4. Centers for Medicare and Medicaid Services. Chartbook and charts.
5. Lin, P.J., Fillit, H.M., Cohen, J.T., Neumann, P.J. (2013). Potentially avoidable hospitalizations among Medicare beneficiaries with Alzheimer’s disease and related disorders. Alzheimer’s & Dementia, 9(1), 30-38.