Alzheimer's disease is a degenerative disease of the brain that impairs mental skills and abilities and undermines independent living. It is estimated to affect over 44 million people worldwide, and 5.3 million in the US at an estimated cost of $226 billion. The numbers of people affected are expected to increase dramatically over the next few decades along with increased life expectancy, and costs are expected to be over $1 trillion by 2050. There is currently no cure, and accurate diagnosis in primary care is hampered by a lack of widely available, reliable, and specific forms of assessment. Accurate diagnosis is essential to avoid inappropriate and expensive clinical follow-up, to evaluate new treatments when these become available, to avoid underestimating or overestimating prevalence of the disease, and to inform policy priorities on resource allocation for health care and for research. We argue that the cognitive and behavioral sciences offer an important route to developing widely available, inexpensive, reliable and specific assessment tools for the disease.
3What is Alzheimer's Disease and why is it a policy issue?Alzheimer's Disease (AD) is the most frequent form of dementia that occurs mainly, but not exclusively, in older adults. It is a degenerative disease of the brain that affects mental skills and abilities, in particular memory function, as well as behavior, emotion and personality. As the disease progresses, it presents significant challenges for independent living, placing a major burden on families and the healthcare system. With increased life expectancy across the population comes an increased number of people suffering from the disease. Addressing the current and future massive personal, societal and financial burdens of AD raises a wide range of major policy issues. These include how to set priorities within political agendas, how to support families and individuals affected at home and in the workplace, and how projected costs may be met. Equally important are questions about how to facilitate the development of treatments, and how to develop accurate and reliable assessments for diagnosis and for evaluations of the effectiveness of proposed treatments. This last issue might sometimes be seen as less salient when setting policy priorities. However, accurate and reliable assessment of AD is crucial to avoid (a) under-estimating or over-estimating its prevalence in society, (b) the serious consequences of misdiagnosis and inappropriate treatment, and (c) the adoption and costs of proposed treatments that in reality fail to offer the claims for prevention or slowing of disease progression. In this article we discuss examples of how the behavioral and cognitive sciences can inform policy by generating evidence-based assessments that are inexpensive as well as accurate and reliable as aids to AD diagnosis.The Challenges for Clinical Practice and Policy