Alzheimers Dement. 2022 Apr;18(4):700-789. doi: 10.1002/alz.12638. Epub 2022 Mar 14.
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.
本文描述了阿尔茨海默病(AD)对公共卫生的影响,包括发病率和患病率、死亡率和发病率、护理的使用和成本,以及对家庭照顾者、痴呆症护理人员和整个社会的总体影响。特别报告讨论了消费者和初级保健医生对轻度认知障碍(MCI)的认识、诊断和治疗的看法,包括与阿尔茨海默病相关的 MCI。目前,约有 650 万 65 岁及以上的美国人患有阿尔茨海默病痴呆症。如果没有预防、减缓或治愈 AD 的医学突破,到 2060 年,这一数字可能会增长到 1380 万。在有数据可查的 2019 年,官方死亡证明记录了 121499 例 AD 死亡。2019 年,AD 正式被列为美国第六大死因,2020 年和 2021 年,COVID-19 进入十大死因之列,AD 成为第七大死因。AD 仍然是美国 65 岁及以上人群的第五大死因。在 2000 年至 2019 年期间,中风、心脏病和艾滋病毒的死亡人数有所下降,而 AD 的报告死亡人数增加了 145%以上。2021 年,超过 1100 万家庭成员和其他无薪照顾者为患有阿尔茨海默病或其他痴呆症的人提供了约 160 亿小时的护理。这些数字反映了与十年前相比,照顾者人数的减少,以及每个剩余照顾者提供的护理量的增加。2021 年无薪痴呆症护理的价值为 2716 亿美元。然而,其成本还包括家庭照顾者情绪困扰和负面心理及身体健康结果的增加风险——这些成本因 COVID-19 而加剧。痴呆症护理人员也受到了 COVID-19 的影响。作为基本护理人员,一些人选择换工作以保护自己和家人的健康。然而,这是在需要更多痴呆症护理人员的时候发生的。医疗保险向 65 岁及以上患有 AD 或其他痴呆症的受益人的服务支付的人均费用几乎是向没有这些疾病的受益人的支付费用的三倍,而向 Medicaid 的支付费用则超过 22 倍。2022 年,估计 65 岁及以上患有痴呆症的人的医疗保健、长期护理和临终关怀服务的总支出为 3210 亿美元。阿尔茨海默氏症协会委托进行的一项最新调查揭示了消费者对 MCI 理解的几个障碍。该调查显示,美国人对 MCI 的认识较低,美国人在注意到 MCI 症状后不愿去看医生,初级保健医生在诊断 MCI 方面仍然存在挑战。调查结果表明,需要提高对 MCI 的认识和诊断,特别是在服务不足的社区,并鼓励更多人参与 MCI 相关的临床试验。