2018 Alzheimer's Disease Facts and Figures Report

2018 ALZHEIMER'S DISEASE FACTS AND FIGURES

Includes a Special Report on the Financial and Personal Benefits of Early Diagnosis

About this report

2018 Alzheimer's Disease Facts and Figures is a statistical resource for U.S. data related to Alzheimer's disease, the most common cause of dementia. Background and context for interpretating the data are contained in the Overview. Additional sections address prevalence, mortality and morbidity, caregiving and use and costs of health care and services. A Special Report discusses the financial and personal benefits of diagnosing earlier in the disease process, in the stage of mild cognitive impairment.

Alzheimer's Association. 2018 Alzheimer's Disease Facts and Figures. Alzheimers Dement 2018;14(3):367-429.

Specific information in this year's Alzheimer's Disease Facts and Figures includes:

? Brain changes that occur with Alzheimer's disease (page 8).

? Revised guidelines for diagnosing Alzheimer's disease (page 15).

? Number of Americans with Alzheimer's dementia nationally (page 17) and for each state (page 19).

? Proportion of women and men with Alzheimer's and other dementias (page 18).

? Lifetime risk for developing Alzheimer's dementia (page 22).

? Number of deaths due to Alzheimer's disease nationally (page 25) and for each state (page 27), and death rates by age (page 29).

? Number of family caregivers, hours of care provided, and economic value of unpaid care nationally and for each state (page 34).

? The impact of caregiving on caregivers (page 34). ? National cost of care for individuals with Alzheimer's or

other dementias, including costs paid by Medicare and Medicaid and costs paid out of pocket (page 43). ? Medicare payments for people with dementia compared with people without dementia (page 46). ? Benefits of earlier detection of Alzheimer's disease. (page 62). ? Cost savings of diagnosing during the earlier mild cognitive impairment stage rather than the dementia stage (page 64).

The Appendices detail sources and methods used to derive statistics in this report.

When possible, specific information about Alzheimer's disease is provided; in other cases, the reference may be a more general one of "Alzheimer's or other dementias."

What Is "Alzheimer's Dementia"?

A Note About Terminology

As discussed in the Overview (page 4), under the 1984 diagnostic guidelines, only individuals with symptoms such as significant problems with learning, thinking or memory could receive a diagnosis of Alzheimer's disease. Under the 2011 guidelines, however, individuals could receive a diagnosis of Alzheimer's disease if they had the brain changes of Alzheimer's that precede the onset of symptoms; if they had the subtle symptoms of mild cognitive impairment due to the brain changes of Alzheimer's; and if they had significant problems with learning, thinking or memory (dementia) due to the brain changes of Alzheimer's. The 2011 guidelines build upon research suggesting that Alzheimer's disease encompasses a continuum beginning with the initial brain changes of Alzheimer's that start years before symptoms appear, continuing with years of symptoms that affect cognitive and physical function, and ending with severe Alzheimer's, when brain changes are so extensive that individuals can no longer walk and struggle to communicate. As a result, what was "Alzheimer's disease" under the 1984 guidelines is called "dementia due to Alzheimer's" or "Alzheimer's dementia" under the 2011 guidelines -- one stage in the continuum of the disease.

This edition of Alzheimer's Disease Facts and Figures reflects this change in understanding and terminology. That is, the term "Alzheimer's disease" is now used only in those instances that refer to the underlying disease or the entire continuum of the disease. The term "Alzheimer's dementia" is used to describe the dementia stage of the continuum. Thus, in most instances where past editions of the report used "Alzheimer's disease," the current edition uses "Alzheimer's dementia." The data examined are comparable across editions -- only the way of describing the affected population has changed.

2018 Alzheimer's Disease Facts and Figures

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CONTENTS

Overview

Dementia

5

Alzheimer's Disease

5

Symptoms of Alzheimer's Dementia

5

Diagnosis of Alzheimer's Dementia

8

Brain Changes Associated with Alzheimer's Disease

8

Mild Cognitive Impairment: A Potential Precursor to Alzheimer's and Other Dementias

10

Genetic Abnormalities Associated with Alzheimer's Disease

10

Risk Factors for Alzheimer's Disease

10

Treatment of Alzheimer's Dementia

13

Living with Alzheimer's Dementia

14

A Modern Diagnosis of Alzheimer's Disease: Revised Guidelines

15

Prevalence

Prevalence of Alzheimer's and Other Dementias in the United States

17

Estimates of the Number of People with Alzheimer's Dementia by State

21

Incidence of Alzheimer's Dementia

21

Lifetime Risk of Alzheimer's Dementia

22

Trends in the Prevalence and Incidence of Alzheimer's Dementia

22

Looking to the Future

22

Growth of the Oldest-Old Population

23

Mortality and Morbidity

Deaths from Alzheimer's Disease

25

Public Health Impact of Deaths from Alzheimer's Disease

26

State-by-State Deaths from Alzheimer's Disease

26

Alzheimer's Disease Death Rates

28

Duration of Illness from Diagnosis to Death

28

Burden of Alzheimer's Disease

28

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Alzheimer's Association. 2018 Alzheimer's Disease Facts and Figures. Alzheimers Dement 2018;14(3):367-429.

Caregiving

Unpaid Caregivers

31

Who Are the Caregivers?

31

Caregiving and Women

32

Caregiving Tasks

32

Duration of Caregiving

34

Hours of Unpaid Care and Economic Value of Caregiving

34

Impact of Alzheimer's Caregiving

34

Interventions Designed to Assist Caregivers

39

Paid Caregivers

40

Direct-Care Workers for People with Alzheimer's or Other Dementias

40

Shortage of Geriatric Health Care Professionals in the United States

40

Enhancing Health Care for Family Caregivers

41

Trends in Dementia Caregiving

41

Use and Costs of Health Care, Long-Term Care and Hospice

Total Cost of Health Care and Long-Term Care

43

Use and Costs of Health Care Services

44

Use and Costs of Long-Term Care Services

48

Use and Costs of Health Care and Long-Term Care Services by Race/Ethnicity

55

Avoidable Use of Health Care and Long-Term Care Services

55

Projections for the Future

57

Potential Impact of Changing the Trajectory of Alzheimer's Disease

57

Special Report -- Alzheimer's Disease: Financial and Personal Benefits of Early Diagnosis

An Evolving Understanding of Alzheimer's Disease

59

Changing Diagnostic Criteria

60

Benefits of Early Detection and Diagnosis for People Living with Alzheimer's and Caregivers

62

Financial Benefits of Early Diagnosis

64

Conclusions66

Appendices

End Notes

68

References71

Contents

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