Two pieces of news this past week offer a very interesting possibility for coordination of Federal research efforts in improving our diagnosis and treatment of major mental diseases. The first was in an article published in the highly respected New England Journal of Medicine that an extensive study by The University of Michigan, supported by an NIH grant that showed that the aggregate costs of dementia—Alzheimer’s and other dementing illnesses—in elderly Americans was somewhere between $157 billion and $215 billion. The reason for the lack of an exact figure is that some spending on the elderly is difficult to characterize as purely medical, and many patients with dementia have co-existing medical conditions. In any event, even the lower figure shows that dementia is a significant cost to our health care system. As the population ages and the group of “very old” increases, dementia, particularly Alzheimer’s disease, will become more of a financial burden.
Dementia is a general medical term for permanent and progressive loss of mental function, including memory, judgment, and ultimately the ability to perform activities of daily living. About 55% of people with dementia have Alzheimer’s disease, a disorder that progresses over several years. Another 20% have “vascular dementia” which is damage to the intellectual functions of the brain from multiple strokes. Another 20% have mixed Alzheimer’s and vascular dementia, and the remaining 5% have one of several less frequent disorders. Alzheimer’s has a genetic component, with most cases having multiple causative genes. At age 65 about 1% of the population has Alzheimer’s, but the percent doubles about every five years after that. If you live to be 90, you have about a one in three chance of developing Alzheimer’s. Currently there are drugs that improve the symptoms of Alzheimer’s, but their effect is only for a few months and thev disease continues its relentless progression.
The second piece of news was an announcement by President Obama that the administration, under the direction of leading neuro-scientists from NIH, was embarking on a $100 million program to coordinate Federal and private mental health research programs. This will certainly impact Alzheimer’s research, and I predict that since we have already made major progress in understanding the pathophysiology of the disease—a protein called Beta amyloid collects on the axonal projections that connect one brain cell to another, ultimately disrupting the brain function. Better ways to diagnose early Alzheimer’s before the brain has irreparable damage will be a key step in testing drugs that can stop the progression, before the brain function is clinically damaged. The $100 million, could save a hundred times that each year. These potential breakthroughs are very likely to happen in a very few years if research can be better coordinated.
Though, having had a large practice of ageing patients, and observing the dread of Alzheimer’s in many of my ageing acquaintances, personally I view success in developing a drug for that to be one of the great, and possibly near at hand, outcomes of the new coordinated neuro-scientific effort. However, in the long run, the benefit to mankind will be greater as we advance neuro-science in general, and improve our ability to diagnose and treat many mental disorders, including clinical depression, schizophrenia, and the more frequently diagnosed developmental disorders such as the autism spectrum and attention deficit- hyperactivity disorders. Currently, the bulk of non-psychiatric medical diagnostics is much more subjective and less scientific than the rest of medicine. As we get better understanding of the brain and what is happening there I hope we will see a new age of psychiatry. The President’s announcement, for me, was a very welcome step in America’s contribution to humanity.