Mounting toll of Alzheimer's in lives, dollars in San Diego spelled out in reports

April 20--More than 84,000 people in San Diego County are living with Alzheimer's and related dementias, a figure that will reach 115,000 by 2030, according to two reports released by the county Friday.

The lifetime cost of care for San Diegans with these dementias now exceeds $38 billion and is expected to surpass $52 billion by 2030.

The reports update a 2015 report on an ambitious county program to cope with the rising toll of dementia. One report focuses on the prevalence of these diseases. The other examines the cost.

Together, the reports cast a sharper focus on the social and economic burdens and consequence of these incurable and progressive illnesses. Unless something is done, that toll will continue to grow as people live longer, baby boomers age and more people are diagnosed with the fatal neurological diseases.

San Diego County is disproportionately affected by Alzheimer's, the third leading cause of death in the county. Nationwide, it ranks sixth. This appears to be an effect of the county's older-skewing population, said Leslie Ray, the county's senior epidemiologist

Countywide, 10.7 percent of those 55 and over are living with these dementias, the reports say.

East County is the most heavily burdened region. Of nearly 131,000 residents age 55 and older, nearly 17 percent had Alzheimer's disease or a related dementia. That's the part of the county represented by Supervisor Dianne Jacob, a driving force behind the county's efforts to address these diseases.

"Clearly, we're facing an epidemic, and we're not prepared," Jacob said.

The 2015 report only included Alzheimer's disease, the most common of age-related dementias. But the new reports expanded the definition to include other related dementias, such as Lewy body dementia, because they produce similar symptoms, Ray said.

All these dementias cause destruction of neurons in the brain. This produces a gradual deterioration in the ability to remember and think, ultimately robbing the patient of personal identity. This is often accompanied by agitation and outbursts that are hard to control.

A long, slow decline

Well before death, those with Alzheimer's and related dementias must endure years of increasing debilitation. To watch over these patients, nearly 300,000 caregivers will be needed in the county by 2030, the reports say. Most of the time, these are family members, who can become overburdened.

The reports say the work required of caregivers "can lead to increased stress, depression, financial hardships and poor health."

In 2015 in San Diego County, the health care costs to unpaid caregivers attributed to their role's physical and emotional toll, was approximately $134 million. By 2030, that number could rise to $183 million.

One way to help is to provide a break, or "respite care," Jacob said. It can be as simple as taking the afternoon off or a formalized schedule that provides a substitute caregiver.

Since no treatment exists that can slow or stop this decline in cognition, the reports emphasize three things:

1: Preparation to help deal with this increased burden

2: Prevention, by maintaining healthy brain habits associated with a lower risk of these dementias

3: Research, to find new approaches to treatment and prevention

The reports mesh with the work of the county-led Alzheimer's Project and a spinoff, Collaboration4Cure, that draws from the community's large biomedical community to find better treatments.

Bolstering the research initiative, a team of scientists has received a $1.3 million grant from the National Institutes of Health, said Michael Jackson, a scientist at Sanford Burnham Prebys Medical Discovery Institute. He is teaming up with SBP colleagues Huaxi Xu and Eduard Sergienko for what could be a project spanning many years.

Jacob called the grant "a validation," of the county's efforts to bring together local researchers to tackle the problem.

The project will explore an entirely new way to address Alzheimer's, Jackson said. It builds on two studies, one led by Xu, that found how immune cells in the brain can reduce levels of a toxic protein called amyloid beta, believed to help cause Alzheimer's.

The second study, led by a professor at UCLA, found that targeting these immune cells reversed the cognitive loss of Alzheimer's, in a mouse model.

From mice to humans will take several years if all goes well, Jackson said. But since no treatments to date have proven effective, research must continue until a cure is found.

Cutting the risk

The report on prevalence of dementias recommended what it called "healthy brain strategies" to reduce the risk. These include adding dark-skinned vegetables in the diet, social and physical activity, and taking care to manage chronic conditions such as heart disease and type 2 diabetes.

Keeping the mind active can help by making the best use of neurons that are constantly generated in the brain, said Fred "Rusty" Gage, a neuroscientist at the Salk Institute. Gage was a leader in proving that this process, called neurogenesis, exists in adults, and that the neurons also play a functional role.

Numerous studies in animals have shown that these neurons help distinguish between familiar objects and things that are seen for the first time, Gage said. This is particularly important if the things are closely related to each other.

"With age, neurogenesis declines," he said. "This explains why with age it's harder to remember where we left our keys, or exactly the path to get to the place we were going."

On the other hand, new experiences, or "environmental enrichment," have been demonstrated to increase neurogenesis, Gage said.

The hypothesis is that new neurons are kept in waiting, ready to latch on to new experiences. But without proper mental stimulation, these cells die for a lack of something to do.

"If you are not active, and you're bedridden, and you're stressed, then neurogenesis declines dramatically," Gage said. "This has been demonstrated experimentally in animals for 15 years."

These varying responses reflect the plasticity of the brain, or neuroplasticity, which allows it to adapt to changing environments, he said.

But that capacity is limited, and outside influences, including stress, injury, and genetic predisposition, can put the brain into decline. That's where the biomedical industry can help.

"There are several pharmaceutical companies working on drugs to activate neurogenesis." Gage said. "The idea is to improve the ability to remember these short-term memory events."

Related reading

Alzheimer's $27 billion toll in county

Alzheimer's Project takes shape

The brain's immune system may be key to new Alzheimer's treatments

The Alzheimer's Project

Collaboration4Cure

bradley.fikes@sduniontribune.com

(619) 293-1020

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