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Alzheimer's: Are We Ready for the Coming Epidemic?

A native of the South American country of Guyana, Ramnarine Ramnarine is 78 years old and lives in Bronx, New York with his wife and son.

Man with Alzheimer
Christian Martinez Kempin | Vetta | Getty Images
Man with Alzheimer

With no history of dementia in the family, relatives thought his growing memory loss was the result of heart problems. But five years ago he was diagnosed with Alzheimer's.

Now bed ridden, Ramnarine, receives daily home health care from VNSNY Choice for medication, case monitoring as well as for family support and counseling.

For those close to him, watching their father and husband waste away is a painful process despite this care.

"We have not seen any improvement in his mental condition," said his daughter, Daiwattie Ganase, who lives nearby and helps with his care. "The medications will help slow down the disease but they won't cure it. His prognosis is poor."

Ramnarine is just one of 5.3 million Americans who are currently diagnosed with Alzheimer's (AD). That number is expected to triple by 2050, by which time one person in 85 around the globe will be diagnosed with AD.

"We would call it an epidemic," said Dr. Maria Carrillo, senior director of medical and scientific relations at the Alzheimer's Association. "Alzheimer's has been here for a long time but it's going to get worse in terms of the number of cases."

Usually diagnosed in people 65 or older, AD is increasing as the world ages. The vast number of Baby boomers in the U.S. are reaching their golden years and people around the world are living longer, as percentages of older citizens are growing in many countries.

Some analysis also points to other factors including obesity and vascular diseases as possible contributors to dementia, while some target a possible link to diabetes. But in general, the cause and progressive nature of Alzheimer's remains mostly a mystery.

"We need to develop therapies to prevent the disease," said Dr. Marc Gordon, chief of neurology at Zucker Hillside Hospital in New York City. "Right now, there are no medications to alter the natural history of AD."

Attempts to find causes and solutions have been difficult and costly. There have been no new AD drugs on the market in ten years and at least five trials in the past five years have delivered disappointing results.

Among them, Pfizer's Dimebon treatment — at a reported cost of $750 million — as well wasEli Lilly's solanezumab drug failed to show any impact on symptoms.

"It is difficult to engage pharmaceutical companies in long term projects due to the fact that they are meant to be profit generating entities," said Dr. Tanvir Hussain, a cardiologist and a former adjunct professor of bioethics of the Pepperdine University School of Law.

"Pharmaceutical companies usually come in at a 'translational research' stage, translating what is being done in the lab to animals and/or humans in early experiments," Hussain said.

Despite the setbacks, Big Pharma firms say they will continue to fund AD research.

"Eli Lilly remains committed to finding medicines that alter the underlying pathology for Alzheimer's disease," said Stefanie Prodouz, manager of Lilly Bio-Medicines Communications.

"Studies with other compounds in earlier stages of development in the Janssen Alzheimer Immunotherapy/Pfizer portfolio are continuing and future development strategies will be discussed jointly," said Dr. Husseini K. Manji, of Janssen Research & Development, the research division of Johnson & Johnson .

Without any clear path for answers, smaller firms are jumping in to fill the void.

"We're developing a precision imaging agent to aid in the diagnosis of AD," said Dr. Mark Pykett, president and CEO of Navidea, a biopharmaceutical company based in Dublin, Ohio.

"It will highlight the regions of the brain for the protein called beta amyloid, the hall mark of AD. We think it's an investment for the future," said Pykett.

Alzheimer
Source: Caring Senior Service
Alzheimer

While pharma firms spend and lose money to find answers, costs keep rising for patients, their families and the U.S. government.

The U.S. spends $172 billion a year treating AD sufferers with about one in six Medicaid dollars going to AD patients, according to the Alzheimer's Association. By 2050, that $172 billion will become $1 trillion. Care for AD patients in the U.S. can average between $18,000 and $77,000 a year.

""It's difficult and costly for families who have to put mom and dad in a nursing home because they can't take care of them or take time off from the job," said Jeff Salter, CEO of Caring Senior Service, a national home health care service. "And families are devastated by the emotional side of this and patients know their life's end is going to be just sitting in a chair."

To help stem or at least slow the tide of AD,the U.S. government has vowed to spend more money. President Obama has asked Congress for $80 million dollars — in addition to the $450 million the National Institutes of Health already spends — on AD research in 2013. The NIH will immediately devote an extra $50 million this year.

Henglein and Steets | Getty Images

But that's not enough, even in an era of cutbacks, said Dr. Maria Carrillo.

"Government funding levels for other diseases, like cancer and heart disease are much higher. What's being spent on AD far too low," Carrillo said.

Another low point is a lack of foresight from his own colleagues, said Dr. Marwan Sabbagh, director of the Banner Sun Health Research Institute.

"The medical community is not ready for the increase in dementia patients as reflected in the fact that too many psychiatrists, neurologists and geriatricians are under-trained in this area," Sabbagh said.

If the more traditional methods aren't up to speed, alternative medicine advocates say their ideas should be put to the test.

"The old masters from China were concerned about how to lead a healthy lifestyle and its good effect on aging," said Joseph Douat, a faculty member at the Pacific College of Oriental Medicine. "Good food, no excessive drinking and good mental perspectives help. These are keys to postponing physical and mental deterioration."

Alzheimer's or dementia has been around for centuries but the disease got its name when it was first described in 1906 by German psychiatrist Alois Alzheimer. Symptoms include, mood swings, memory loss, confusion, irritability. On average, the life expectancy for a diagnosed patient is seven years.

In spite of the dire outlook, there are fleeting glimmers of hope.

Recent data on Pfizer and Johnson & Johnson's drug, bapineuzumab, suggest the previously failed medication might work at an earlier stage of Alzheimer's. Reversing earlier setbacks, Eli Lilly said at the Alzheimer's Disease Cooperative Study this Monday that its solanezumab drug has shown it slows the progression of Alzheimer's in people with mild cases.

AndRoche recently doubled the size of its clinical trialon the experimental drug gantenerumab—claiming the it will put the Swiss drugmaker at the "forefront of the race to develop an Alzheimer's drug."

Finding a remedy, however, won't happen soon.

"I'm hopeful there will be a cure. I'm 59 years old and I want one." said Dr. Marc Gordon. "But it won't be today or tomorrow or next week. There's a lot to be done."

For Daiwattie Ganase, any cure will come to late for her father.

"We think the medical community is doing all it can. We're just not hopeful anything will be found in the near future," said Ganase.