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Alzheimer’s Disease and Its Impact

Alzheimer’s Disease is the Most Common Form of Dementia and it Disproportionately Impacts Many Californians.
Dementia is a general term for memory loss and other impairments serious enough to interfere with daily life. Alzheimer’s
accounts for 60 to 80 percent of dementia cases and currently impacts an estimated 610,000 Californians, a number
projected to grow to 840,000 by 2025. Alzheimer’s is the 5th leading cause of death in California and the only condition in the
top 10 without a known cause, cure, or prevention.

More women than men have Alzheimer’s disease and other dementias such as vascular dementia and dementia with Lewy
bodies, among others. Almost two-thirds of Americans with Alzheimer’s are women, as are the majority of family caregivers.
Older African Americans and Hispanics are more likely than older whites to have Alzheimer’s disease and other dementias
with African Americans at twice the prevalence rate and Hispanics one and one-half times the rate.

This 2017 Update Reflects New Evidence, Improved Practice and Changes in Law — This is the 4th edition of the
California Alzheimer’s Clinical Care Guideline, first published in 1998 and revised in 2002 and 2008. The 2017 update
specified in statute (SB 613, Chapter 577, 201 ) addresses changes in scientific evidence, clinical practice, and state and
federal law. Changes include:

NEW GOVERNMENT POLICIES
New Evidence About Antipsychotic Medications
Medicare Reimbursement — The Centers for Medicare and FDA Black Box Warning Labels —In April 2005,
& Medicaid Services (CMS) now reimburses physicians for the U.S. Food and Drug Administration (FDA) notified
annual wellness visits every 12 months and includes health care professionals that both conventional and
payment for a Health Risk Assessment, including atypical antipsychotics are associated with an
reimbursement for a cognitive screen. Medicare will pay for increased risk of mortality in elderly patients treated for
cognitive and functional assessments and care planning for dementia-related psychosis. The FDA notified health
patients with Alzheimer’s disease and other cognitive care professionals that patients with dementia-related
impairments. psychosis treated with atypical antipsychotic drugs are
at an increased risk of death. Since issuing that
Adoption of Physician Order for Life Sustaining notification, the FDA has reviewed additional information
Treatment (POLST) — The POLST form gives patients that indicates the risk also is associated with
more control over their end-of-life care, including medical conventional antipsychotics.
treatment, extraordinary measures (such as a ventilator or
feeding tube) and Cardiopulmonary resuscitation. POLST Gaps in Disclosure and Documentation — Scientists
can prevent unwanted treatments, reduce patient and family who studied patient surveys and Medicare claims data
suffering, and ensure a patient’s wishes are honored. discovered only 45 percent of those billed for
Alzheimer’s-related care were told by their doctors of
their disease. Overlooking or avoiding diagnosis
Social Security Grants Compassionate Allowance Benefit
for Early-Onset Individuals — Individuals under age 65 impedes care and denies access to needed services.
In an era of electronic health records, documenting the
diagnosed with Alzheimer’s disease are eligible for the Social
Security Administration’s compassionate allowance benefit diagnosis is critically important in order to deliver
with minimal objective medical information provided by a person-centered care.
physician.
Lifestyle Modifications — Some risk factors for
Healthy Brain Initiative — The Centers for Disease Control dementia, such as age and genetics, cannot be
and Prevention has mapped out a strategy for state and changed, but the brain can be protected by some of
national partnerships through The Healthy Brain Initiative the same strategies that guard against cardiovascular
emphasizing proven public health strategies such risk, including smoking cessation; keeping blood
as monitoring and evaluation, education and training, policy pressure, cholesterol and blood sugar within
development, and workforce competencies. recommended limits; and, maintaining a healthy
weight. Regular physical exercise may help lower
EMERGING PRACTICE TRENDS dementia risk. Diet may impact brain health through its
effect on heart health. Evidence suggests heart-
Emphasis on Early Detection, Early Diagnosis and Mild healthy eating patterns, such as the Mediterranean
Cognitive Impairment — Mild cognitive impairment can cause diet, which emphasizes eating foods like fish, fruits,
serious cognitive changes noticed by those individuals who vegetables, beans, high-fiber breads and whole grains,
experience changes or by other people, but not severe enough nuts, and olive oil may help protect the brain.
to interfere with daily life or independent function. As with other
chronic diseases, public health experts are focusing on
possible early interventions to delay the onset and slow the
progression of Alzheimer’s disease.

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