What Is the Economic Impact of Alzheimer's Disease in the United Kingdom

B33CNS Essay: What is the economic impact of Alzheimer's disease in the United Kingdom

Alzheimer’s disease (AD) is a progressive physical disease that affects the brain. People with age over 65 have a greater risk of developing AD. The risk is doubled for every five years above this age. Early-onset Alzheimer’s at young age might be linked to the genetic factors and the risk will increase if someone’s parent or siblings has AD. People with Down’s syndrome possess a higher risk too. The health status and lifestyle are modifiable risk factors. Medical conditions like stroke, diabetes, high blood pressure and obesity and those who are smoker or heavy drinker are at particular risk of developing AD1.

Early stage of AD causes memory lapses. People find hard to recall the recent event and conversation. They become less capable of learning new things. As the disease progresses, they will experience disorientation and deterioration of visuospatial skills. They are unable to judge the distance and get lost easily in the familiar environment. They might encounter sleeping disturbance and lose concentration. Most people at this stage will become anxious, depressed and apathy. In later stage, all the symptoms become more severe and people might have delusion and hallucination1.

AD predominantly affects people with age over 65. Currently, about 62% of approximately 820,000 people in UK who suffer dementia also diagnosed with AD. Most of them are over 65; only 2.2% of sufferers are younger people. In UK, AD is more commonly found in women (about 67% of those with dementia also having AD) than men (about 55%)2.

AD will affect more than one body system. It principally affects central nervous system and is the most common cause of dementia. People with dementia will suffer most of the symptoms explained above. In later stage of dementia, they will also suffer muscle weakness and weight loss. AD will affect digestive system too. Patients will encounter swallowing difficulty and choking. If there is any accidental entry of food into the airways, pneumonia will be the common result. AD patients will eventually lose their bowel control which leads to fecal incontinence. Neuromuscular system of AD patients will be impaired in later stage of AD.  They will encounter limitations to use their muscle voluntarily such as inability to walk, difficulties in maintaining the sitting posture on the chair and involuntary twitching. AD will eventually lead to death3. The average time from diagnosis to death of AD sufferers in UK is about 10 years although this value is varied by different factors such as the quality of care2. The quality of life (QoL) of both the patients and their carer will diminish dramatically. All the symptoms explained above will extensively affect the daily life of the patients. At the later stage of AD, they will need carer to take care and support them as they gradually lose their cognitive and physical abilities. The carer will experience high level of stress due to physical, psychological and financial factors while taking care of AD patients. Some of the carers will even suffer depression9.

Mini Mental State Examination (MMSE) is a cognitive test that used to assess the orientation, memory, concentration and language of AD patients. However, there is limitation in this test. The result is insensitive to the change or improvement of cognitive abilities over time. Hence, this test cannot be used to identify the effectiveness of medicines used by AD patients. Besides, the result will be affected by patient’s education level. Neuropsychiatric Inventory (NPI) is a proxy-rated scale used to measure the behavioural and mood outcomes such as anxiety, irritability, apathy, delusions and hallucinations. In terms of QoL, Instrumental Activities of Daily Living (IADL) Scale is commonly used to assess the instrumental competence such as housekeeping and telephoning in elder patient. There is another test called Patient-rated QoL Scale which measures the feelings of well-being of patients in relationship, leisure activities, social activities, eating and sleeping. Clinical Dementia Rating (CDR) Scale is a global rating scale that focuses on cognition assessment about personal care, judgement, problem-solving and memory4. There is assessment for caregiver burden called Zarit Burden Interview (ZBI). This test is used to identify those are at risk of experiencing significant burden. The score of the test is proportional to the burden9.

There are three types of cost incurred by AD. The direct cost is the main cost. This includes the cost of diagnosis, drugs, treatment monitoring visit and treatment for comorbidities which are complicated by AD, residential care home, nursing home, day care service and hospitalisation. All these are categorised as direct medical cost. Travelling costs to hospital or care home is an example of direct non-medical costs. In terms of indirect cost, AD sufferers especially those young ages are unable to work which results in reduced income in their family. Most of the carers of AD sufferers are family members who might reduce their working hour or resign just to take care of their sick family member. This will further reduce the capacity to earn a living and cause low productivity in the company they work with. This type of cost is very difficult to measure. People with AD will have shorter life expectancy and reduced QoL. Feeling of anxiety, disutility and distress might be experienced by patients after they are diagnosed with AD. These are categorised as intangible cost. The total cost incurred by AD is largely contributed by the cost of care as AD patients require long-term care of their daily life. In UK, the overall cost of care for AD patient is over £14 billion per year, approximately £27,647 for each AD patient per year. The family of AD patients bear the greatest burden of cost (55%) while the rest of cost are funded by social service (40%) and National Health Service (5%)2. In addition, NHS Continuing care is a healthcare programme fully funded by NHS to provide free care outside the hospital, such as in patients’ home or residential care homes. AD patients will be assessed by a multidisciplinary team to identify whether or not they are eligible to the free care. Even though they are eligible, a regular review will be carried out every three months and there after every year to assess if the patients are still eligible to this free care6.

Acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine are used to manage the symptoms of mild to moderate AD. It inhibits the enzyme AChE to increase the concentration of acetylcholine at the synaptic cleft to improve neurotransmission. N-methyl-D-aspartate (NMDA) receptor blocker memantine is another anti-dementia option for moderate AD patients who are intolerant to the AChE inhibitors listed above or for severe AD patients. It blocks the glutamate levels from elevating excessively or otherwise will lead to neuronal dysfunction. Currently there is no cure for AD. Anti-dementia drugs are aimed to improve or at least stabilise the cognitive and behavioural as well as functional and global symptoms of AD. It is intended to slow down the progression of AD. The treatment needs to be initiated by psychiatrists, neurologists and physicians. It is recommended to start the treatment with lowest acquisition cost of AChE inhibitors but factors such as patients’ adherence, adverse reaction profile, patients’ comorbidities and potential drug interactions should be taken into account. The treatment option of AD patients should be reviewed regularly through cognitive, behavioural, functional and global assessments. Some of these assessments are explained above. The treatment should be continued if the assessment results prove that there is improvement or stabilisation of symptoms in AD patients5.