The Lancet Neurology CommissionDefeating Alzheimer's disease and other dementias: a priority for European science and society
Section snippets
Executive summary
Alzheimer's disease (AD) is the leading cause of dementia, and because the primary risk factor for AD is old age, the prevalence of the disease is increasing dramatically with ageing populations worldwide. Even in high-income countries, the cost of medical care and associated societal burdens of dementia threaten to become overwhelming as more people live into old age. In view of the lack of progress in developing a cure for AD and the rapidly increasing costs of dementia, policy makers and
Health economics of Alzheimer's disease
AD has a substantial economic impact for each person and family affected. A 2011 study8 of a multinational (Spain, Sweden, the UK, and the USA) sample of 1222 patients estimated that societal costs amount to about €14 500 per year in patients at home with a high level of autonomy in activities of daily living (ADL), but rises up to €72 500 per year in patients who need residential care. In 2014, the direct cost of AD for payers in the USA alone was estimated to be $214 billion.9 For comparison,
Epidemiology of Alzheimer's disease and dementia
The burden of AD and other dementias, which is projected to surge in the coming decades, poses a serious threat to the sustainable development of economies and the social welfare systems of Europe. Epidemiological studies generate knowledge about the occurrence (eg, prevalence and incidence), distribution (eg, demographic, geographical, and temporal variations), determinants (eg, genetic and non-genetic risk or protective factors), health economics (eg, costs of health care and
Prevention of cognitive impairment and dementia
WHO3 and health and science ministers of the G8 dementia summit173 have recognised dementia as a public health priority, and prevention has been identified as one of the key elements in addressing the dementia epidemic, as for other major non-communicable diseases (eg, cardiovascular disease). It is estimated that a third of AD cases worldwide might be attributable to seven modifiable risk factors—low education, midlife hypertension, midlife obesity, diabetes, physical inactivity, smoking, and
Genetic risk of Alzheimer's disease: individual susceptibility
Evidence from genetic studies explains how genetic variability, present in DNA from conception, contributes to the development of AD later in life. Genetic epidemiology attempts to understand how genetic make-up lends resistance or vulnerability to environmental exposures, such as lifestyle factors and medical illnesses. The effect of individual genetic susceptibility on the occurrence of AD is substantial, with the heritability of AD usually estimated to be greater than 60% (ie, >60% of
Biology of Alzheimer's disease
In 1906, Alois Alzheimer described the pathological changes present in the brain of the first patient with AD, Auguste D. In the past 110 years, substantial knowledge has been gained about the genetic and environmental factors that contribute to the disease (sections 3, 4). However, what triggers the characteristic pathology of AD and which mechanisms drive the progression of the disease remain unknown. Understanding of the basic biology of AD pathogenesis and the way in which clinical dementia
Diagnosis and clinical assessments in Alzheimer's disease
The consequences of a diagnosis of AD for patients and their families are complex. AD is one of the diseases most feared by the general public, and the disclosure of a dementia diagnosis can result in severe mental distress, with evidence of an increased risk of suicide after diagnosis.319 However, with the right approach, evidence suggests that a diagnosis can relieve symptoms of anxiety in patients because it explains a frightening loss of cognitive capacities.320 At more advanced stages of
Pharmacological treatment of Alzheimer's disease
The increasing number of people with AD is leading to substantially more use of pharmacological treatments and greater medication costs. For example, in Sweden, the total drug costs for people with dementia constituted about 1·1% of the societal costs of dementia in 2000, 1·6% in 2005, and 1·8% in 2012.375 Although drug costs are a small proportion of the total societal cost of dementia (the largest proportion of costs, around 80%, is within the municipal sector, for long-term care), they
Non-pharmacological interventions for dementia and mild cognitive impairment
Although considerable efforts have been made to improve understanding of the neurobiology of AD (section 5) and to identify and evaluate candidate disease-modifying therapies (section 7), far less effort has been focused on the development and implementation of non-pharmacological interventions. Insufficient focus on these approaches represents a missed opportunity, because the identification of effective non-pharmacological interventions for key indications is a much more tractable short-term
Formal and informal care for people with dementia
People with dementia need care and support in many areas of their lives. This support might be provided by health-care, social-care, housing, transport, leisure, or other sectors. Irrespective of the provider, support can be grouped into three main domains: support in basic ADL, support in IADL, and supervision to safeguard individuals from harm.485 In addition to these forms of care and support, individuals with dementia might receive care from specific medical services, such as injections,
Ethical considerations
With expanding knowledge of the genetics (section 4) and biology (section 5) of AD, and innovation in the diagnostic and management options for patients (sections 6–9), new ethical issues require careful attention to ensure improved quality of life and wellbeing for this vulnerable group. These issues—which pertain to prevention, diagnosis, guidance in advanced-care decision making, treatment, and policy making—affect both research and care.
The rapidly growing number of people with AD and other
G8 targets: towards an international dementia data-sharing network
One of the main targets agreed at the G8 dementia summit is for researchers to work together and share data from their studies, including sharing initiatives for so-called big data (ie, the analysis of large datasets, mostly acquired by online tracking of a large population's behavioural patterns).552 However, many obstacles need to be overcome in sharing research and clinical data for dementia research. For example, data sharing demands the safeguarding of relevant privacy and legal issues,
Conclusion and future European perspectives
AD is the leading cause of dementia, and because the primary risk factor for AD is old age, the prevalence of the disease is increasing dramatically as life expectancy increases worldwide. The explosion in care costs and associated societal burdens of AD and other dementias threatens to become overwhelming, even in resource-rich countries. However, AD is not an inevitable consequence of ageing, and further work is needed to identify modifiable risk factors and protective factors—including a
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