Documentos de Académico
Documentos de Profesional
Documentos de Cultura
2
Concerns of Mrs. J’s Family
3
Concerns of Mrs. J’s Family
4
Thought Experiment #1
True or False
• Alzheimer’s type dementia (AD) is the most
common form
• AD hits its peak in those 70 – 80 years old
• People do not usually die of AD
5
Aging Population
6
Risk of Alzheimer’s Disease
by Age in 2017
35
30
25
Percent
20
15
10
0
65-74 75-84 85+
Age
Adapted from Hebert, L. et al. (2013).
Neurology, 80:1778-1783.
7
Hallmarks of Alzheimer’s Disease
Pathology
8
Leading Causes of Death,
Adults 65+ Years, 2016
Rank Cause of Death
1 Heart Disease
2 Cancer
3 Chronic lower respiratory diseases Alzheimer’s
4 Stroke disease affects
5 Alzheimer’s disease more than 5
6 Diabetes million
7 Accidents (unintentional injuries) individuals in
8 Influenza and pneumonia the U.S. alone
9 Kidney disease
10 Septicemia
SOURCE: National Vital Statistics Reports, Vol. 67, No. 6, July 26, 2018. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_06.pdf.
9
Thought Experiment #1
True or False
• Alzheimer’s type dementia (AD) is the most
common form
• AD hits its peak in those 70 – 80 years old
• People do not usually die of AD
10
Concerns of Mrs. J’s Family
11
Thought Experiment #2
True or False
• The nation’s investment in AD research has been
constant in the last few years
• There are four known genes associated with AD
• In order to make a definitive diagnosis of AD, there
must be an autopsy
• Most clinical studies focus on the amyloid
hypothesis of AD
12
The National Alzheimer’s Project Act
• Signed into law in January
2011
• Calls for:
– An annually updated
national plan
– Annual evaluation of all
federally funded efforts
– Advisory Council on
Alzheimer’s Research,
Care, and Services
13
AD/ADRD Targeted Increases
$425 M in
additional
*one-year money appropriations
Years displayed are Fiscal Years as of 09/28/18
14
AD and Related Dementias (AD/ADRD) Research
How Much Are We Spending?
$2,000,000
$1,915M
$1,500,000
$1,423M
Dollars in Thousands
$1,000,000 $986M
$631M
$500,000
FY 2015 FY 2016 FY 2017 FY 2018 Estimated (Enacted)
16
Aβ Deposition in Autosomal Dominant AD
Years before Expected Clinical Symptoms
18
Clinical, Cognitive, Structural, Metabolic, and
Biochemical Changes Years Before AD Symptom Onset
Adapted from Bateman, R et al. (2012). N Engl J Med; Aug 30; 367(9): 795-804.
19
Clinical, Cognitive, Structural, Metabolic, and
Biochemical Changes Years Before AD Symptom Onset
Adapted from Bateman, R et al. (2012). N Engl J Med; Aug 30; 367(9): 795-804.
20
Autosomal Dominant
Alzheimer’s Disease Trial
21
Autosomal Dominant
Alzheimer’s Disease Trial
22
Autosomal Dominant
Alzheimer’s Disease Trial
Non-Carriers, late 30’s
23
Autosomal Dominant
Alzheimer’s Disease Trial
Non-Carriers, late 30’s
24
Ongoing NIA AD/ADRD and Related
Intervention and Prevention Trials (~140)
29 Early- 7 Clinical
6 Late-stage
stage Clinical Therapy
Clinical Drug 3 Delirium/
Drug 53 Non- Development
Development 39 Care and Post-
Development Pharma- for the
(Phase II/III Caregiver Operative
(Phase I and cological Neuro-
and Phase III Interventions Cognitive
Phase II Interventions psychiatric
Clinical Decline Trials
Clinical Symptoms of
Trials)
Trials) AD/ADRD
10
0
Drug Discovery Drug Development Phase I/II Trials Phase III Trials
Amyloid Tau
Neurotransmitters Inflammation
Growth factors/hormones Neurogenesis
Metabolism/bioenergetics Synaptic plasticity/neuroprotection
Oxidative stress ApoE/lipids
Vascular targets Proteostasis/proteinopathies
Multitarget drugs Other
14
NIA Pipeline of Discovery
12
0
Drug Discovery Drug Development Phase I/II Trials Phase III Trials
Amyloid Tau
Neurotransmitters Inflammation
Growth factors/hormones Neurogenesis
Metabolism/bioenergetics Synaptic plasticity/neuroprotection
Oxidative stress ApoE/lipids
Vascular targets Proteostasis/proteinopathies
Multitarget drugs Other
Thought Experiment #2
True or False
• The nation’s investment in AD research has been
constant in the last few years
• There are four known genes associated with AD
• In order to make a definitive diagnosis of AD, there
must be an autopsy
• Most clinical studies focus on the amyloid
hypothesis of AD
28
Concerns of Mrs. J’s Family
29
Thought Experiment #3
True or False
• It has been clearly demonstrated that you can
decrease your risk of developing AD
• Tight blood pressure control may reduce the risk of
mild cognitive impairment, often a precursor of AD
30
AHRQ-National Academies Study
• Two-part assessment of interventions to prevent
AD-type dementia, amnestic MCI, and age-related
cognitive decline
• 13 categories of interventions explored
• Final AHRQ evidence report published in 2017:
https://www.effectivehealthcare.ahrq.gov/search-for-guides-
reviews-and-reports/?pageaction=displayproduct&product
ID=2417
31
AHRQ-National Academies Study,
cont’d
Key Messages from AHRQ:
• Most interventions showed no evidence of benefit
• Some forms of cognitive training improve the performance of
the specific target for adults with normal cognition
• Little evidence of transfer to other cognitive areas
• Little evidence of reduction of dementia incidence
• Benefit beyond 2 years less certain
32
AHRQ-National Academies Study,
cont’d
Key Messages of NASEM synthesis:
• Insufficient evidence to justify a public
health campaign
• Encouraging but inconclusive evidence:
• Cognitive training
• Blood pressure management in
hypertensives
• Increased physical activity
www.nationalacademies.org/dementia
National Academies of Sciences, Engineering, and
Medicine (2017). Preventing cognitive decline and
dementia: A way forward. National Academies Press.
33
SPRINT Study
(Systolic Blood Pressure Intervention Trial)
34
SPRINT Study
35
SPRINT-MIND Research Question
SPRINT Memory and Cognition in Decreased Hypertension
36
SPRINT-MIND:
Primary Cognitive Outcome
* Difference not
statistically
significant P= .1
37
SPRINT-MIND:
Secondary Cognitive Outcomes
• 19% reduction in the rate of developing MCI
38
Thought Experiment #3
True or False
• It has been clearly demonstrated that you can
decrease your risk of developing AD
• Tight blood pressure control may reduce the risk of
mild cognitive impairment, often a precursor of AD
39
Concerns of Mrs. J’s Family
40
Thought Experiment #4
True or False
• The prevalence of dementia is decreasing
• The cost of AD is comparable to that of heart
disease and cancer
• Caregiver health can impact that of their loved one
for whom they are caring
• We know what interventions should be
disseminated to help with AD caregiving
41
Cognitively healthy life span has
increased as much as life span
Male Life Expectancy at Age 65 Female Life Expectancy at Age 65
69%
20 65%
2.3
20
71% 2.6
66% 1.4 3.9
15 4.0
15 1.8
Time (years)
Time (years)
3.7
3.7
10 10
14.1
12.5 12.5
5 10.7 5
0 0
2000 2010 2000 2010
Year Year
Predicted Cognitively Intact Years (%)
Cognitively Intact Cognitive Impairment Dementia
without Dementia
Adapted from Crimmins, E. et al. (2016). SSM Popul Health 2: 793-797.
42
The Economic Impact of
Dementia in the U.S.
$s in Billions
600
500
400
Direct Cost
300
Min Ttl Cost
Max Ttl Cost
200
100
0
2010 2040 - projections in 2010 dollars
Hurd, M.D. et al. (2013). NEJM 368(14): 1326–1334.
43
Total Healthcare Spending in Last 5 Years
of Life, by Payer & Disease
$300,000 Total Costs
*
Total Government
$250,000
Medicare
$200,000 Informal Care
Out-of-Pocket
$150,000
*
$100,000
*
$50,000
*
$-
Dementia Cancer Heart Other
Disease Diseases
Adapted from Kelley, A. S., et al. (2015). Ann Intern Med 163(10):729-736.
44
Caregivers have Higher Odds of High
Strain when PWD at End of Life
45
Poor Caregiver Mental Health Predicts Mortality
of Patients with Neurodegenerative Disease
46
A New AHRQ-National Academies
Study on Dementia Care Interventions
• Two parts:
National Academies of Sciences, Engineering, and Medicine:
Expert panel input on questions and study design
www.nationalacademies.org/dementiacare
Agency for Healthcare Research & Quality: Evidence review
• Status:
AHRQ Evidence-Based Practice Center Award – Made to the
Minnesota EPC – Drs. Mary Butler and Joseph Gaugler are leading
the study
NASEM Committee list – posted to:
https://www8.nationalacademies.org/pa/projectview.aspx?key
=HMD-HSP-18-04
47
Save the Date
Dementia Care/Services Summit (II)
March 24-25, 2020
Natcher Conference Center
Bethesda, MD
48
iCare-AD/ADRD Challenge
Improving Care for People with AD/ADRD
Using Technology Challenge
• Technology applications to improve
dementia care coordination and/or care
navigation
• Up to $400,000 in cash prizes
• Submissions - October 1, 2018 through June 30, 2019
• See https://nia.nih.gov/challenge-prize for full prize details
and archived webinar for participants
49
Thought Experiment #4
True or False
• The prevalence of dementia is decreasing
• The cost of AD is comparable to that of heart
disease and cancer
• Caregiver health can impact that of their loved one
for whom they are caring
• We know what interventions should be
disseminated to help with AD caregiving
50
Concerns of Mrs. J’s Family
51
Thought Experiment #5
True or False
• Alzheimer’s trials focus on recruiting individuals
with symptoms of AD
52
Enroll in a Clinical Trial
www.nia.nih.gov/alzheimers/clinicaltrials
53
Take-Aways from Mrs. J
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Ways to Stay Informed and Connected
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Learn More About the NIA
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NIA
The Leader in Aging Research