A Focus on Dementia’s Epidemiology and Population-Level Interventions

A Focus on Dementia’s Epidemiology and Population-Level Interventions

Dementia is a neurocognitive disorder (NCD) that affects a patient’s cognitive functioning. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the key domains of cognitive function include complex attention, executive function, learning, memory, language, perceptual-motor control, and social cognition (Möller, 2018). This paper focuses on dementia in the United States, specifically in Florida, and presents an overview of dementia and its significance based on national and state data.

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Overview and Background of Dementia

Dementia is a collection of symptoms representing a mental disorder that includes the loss of cognitive functioning. The symptoms include the inability to think, remember events and reason. These symptoms severely impact the individual’s social abilities and the ability to engage in daily life activities fully. Consistently, the causes of dementia vary based on changes in the various parts of the brain and how they affect cognitive functioning. Various neurodegenerative disorders lead to the progressive and irreversible degeneration of neurons and sections of the brain, hence dementia (Gamble et al., 2022). This underlying neuropathology makes dementia more of an acquired neurocognitive disorder than a developmental disorder.

Manifestations of dementias are majorly psychological and behavioral. The symptoms occur when the rate of neurodegeneration occurs faster than the average neuron loss that comes with age. Significant dementia symptoms include loss of all types of memory, functional judgment, speech, reading, and writing capabilities. Others include confusion, delusions, and inability to manage emotions, thus making them easily irritable (Gamble et al., 2022). Progressive dementia further risks personality change. The effects of dementia on brain function can only be managed; however, some symptoms are reversible.

Types of Dementias

Based on the DSM-5 classification, the common types of diagnosed dementias include Alzheimer’s disease, Frontotemporal dementia, Lewy body dementia, Vascular dementia, and Mixed dementia. Alzheimer’s disease is the most diagnosed form of dementia. It is common among the aged population. Alzheimer’s disease develops due to changes that occur in an aging brain. Central brain changes due to age include an abnormal build-up of amyloid plaques and tau tangle protein, leading to multiple anatomical alterations of the hippocampal formation (Möller, 2018).

Frontotemporal dementia is another type of dementia that shares the same manifestations as Alzheimer’s disease. It is caused by the abnormal build-up of the tau and TDP-43 (Transactive response DNA binding protein 43) proteins as a sporadic process or by autosomal dominant mutations leading to frontotemporal lobar degeneration (Heuer et al., 2020). Subsequently, vascular dementia develops when blood vessels supplying the brain get damaged, interrupting the blood flow within the brain, hence oxygen supply to the brain. A patient may be diagnosed with different types of dementia, leading to mixed dementia.

Significance of Dementia

Dementia affects a huge section of the aging population. However, it is not presented as a normal part of aging. Research has noted that people may live beyond 90 years without manifesting any signs of dementia. Dementia has significant physical, psychological, social, and economic impacts on the patients, their caregivers, and society. Dementia is currently among the leading causes of disability and dependency among the elderly. Cognitive decline and loss of daily functioning in dementia patients are linked to increased care dependency and an overall reduction in quality of life (Henskens et al., 2019). According to Alzheimer’s Disease International (ADI), the Adjusted Life Years (DALYs) due to dementia are expected to rise to 82.6 percent by 2030.

Dementia is linked to severe frailty among patients, leading to an increased physical and psychological burden on family caregivers. Dementia expenses are 32% of family assets as compared to 11% of the expenditure on other health conditions in the long term. Typically, dementia care costs $25,213 per person, with the cost of care and cost of living expected to rise beyond US$2.8 trillion by 2030 globally (World Health Organization (WHO), 2021).

Epidemiological Analysis of Dementias

Descriptive epidemiology utilizes statistical references to describe a health condition or disease clearly. Descriptive epidemiology includes prevalence and incidence rates, mortality rates, costs, at-risk populations, and other statistics such as survival rates. Over 6.5 million people above 65 years old in the U.S. are expected to have age-related dementia in 2022 (Alzheimer’s Association, 2020). The fast-aging population and lifestyles among adult Americans are expected to increase that number. The total prevalence of dementia is expected to reach over 40 million Americans by 2050. These statistics show the total number of cases of dementia in the U.S.  Dementia affects women more than men; an estimated a sixth of women and one-tenth of men over 55 are more likely to develop dementia. These statistics describe the incidence rates based on gender.

Dementia mortality is higher in women than in men; an estimated 70% of dementia deaths are women. The prevalence and incident rate vary across race, ethnicity, and level of education. A quarter of the reported deaths were majorly among Black people and were attributed to dementia compared to 20.7 and 12.2 percent of deaths among Hispanic and white backgrounds, respectively (Stokes et al., 2020). The study also links lower education levels to a higher risk of dementia-attributable death.

Over 580,000 people aged above 65 years in Florida have been diagnosed with Alzheimer’s disease. Furthermore, 13.6 percent of the Florida population aged above 45 currently have symptoms of subjective cognitive decline. These statistics present the incidence rates of dementia within the U.S. and Florida populations attributed to dementia based on demographic data.

Characteristics of At-Risk Population Using Healthy People 2020 Criteria for Dementias

Only 38.4 percent of dementia are diagnosed. This means that a large number of the population in the U.S. living with dementia remain undiagnosed. In most cases, the diagnosis of dementia is delayed and occurs late after the severe manifestations have occurred (Gamble et al., 2022). The Healthy People 2020 has provided criteria for characteristics of the at-risk population of dementia.

According to Healthy People 2020 (HP2020), adults above 65 years are at a higher risk of dementia. Women also have a higher risk of Alzheimer’s disease and other dementias than men. Genetics is also a risk factor for dementia. A family history of dementia predisposes an individual to dementia. As per Healthy People 2020 (HealthyPeople.gov, n.d.), other characteristics of at-risk populations include people from rural areas and minority backgrounds.

Application of HP2020 in the Case of Dementia

HP2020 Goals and Objectives

HP2020 has 42 goals and over 500 objectives that provide guidelines for disease prevention and promotion of health for a decade (Institute of Medicine (U.S.) Committee on Leading Health Indicators for Healthy People 2020, 2011). It supports healthcare system planning, budgeting, and health programming decisions in the U.S. The main goal of HP2020 is to support the achievement of high-quality, extended living for the population by preventing diseases, disability, injury, and early death. HP2020 prioritizes testing to develop early community-level prevention interventions. Therefore, HP2020 promotes quality living through healthy development and adopting population-wide healthy behaviors.

HP2020 Goals and Objectives for Dementias

HP2020 included Alzheimer’s disease and other types of dementias in its health objectives due to the risk dementias pose to the U.S. population (HealthyPeople.gov, n.d.). The specific goals and objectives for dementia focus on reducing the impacts of dementia on the socioeconomic aspects of the U.S. population. The first goal and objective for dementia is to improve the level of dementia diagnosis and awareness of the disorder.

The second objective is to significantly reduce preventable dementia-related hospitalizations, including identifying risk populations and promoting early interventions for dementia cases (Alzheimer Association, 2020). Other HP2020 goals and objectives for dementia include reducing the number of elderly adults with moderate to severe functional disabilities and improving the number of elderly adults participating in light to vigorous activities.

Guidelines and a Screening Method for Dementias

Dementia can be screened based on the cognitive assessment toolkit provided by the Alzheimer’s Association, The Medicare Annual Wellness Visit Algorithm for Assessment of Cognition toolkit. The main practical approaches focus on the clinical recognition of the progressive decline in a patient based on their history, a notable decline in the ability to conduct their daily activities, patterns of mental issues, personality, and behavioral changes over time.

Validity of Screening Tool Method for Dementias

The Medicare Annual Wellness Visit Algorithm for Assessment of Cognition has been validated using the General Practitioner Assessment of Cognition (GPCOG), the Memory Impairment Screen (MIS), the Mini-Cog^TM, the Short Form of the Informant Questionnaire on Cognitive Decline in the Elderly (Short IQCODE), and the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8). These assessment tools incorporate patient history, concerns of the patient’s caregivers, and the observations of the health professional during an assessment.

The Medicare Annual Wellness Visit Algorithm for Assessment of Cognition has also been validated by research; however, researchers note the need to improve the tool kit. For instance, The tool was found to have a high confidence interval, resulting in increased accuracy when detecting dementia. However, its accuracy has reduced in identifying dementia in high-risk patients with chronic conditions. In addition, the tool has low sensitivity but high specificity; still, outcomes vary across participant characteristics such as race and age (McCarthy et al., 2022).

Population Level Planning Interventions

Nationally, the Alzheimer’s Association, in conjunction with the Centers for Disease Control and Prevention (CDC), established the Healthy Brain Initiative State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map (HBI Road Map). The HBI Road Map provides a framework for partnerships between state and federal agencies to improve focus on cognitive health as a critical component of public health (Alzheimer Association, 2020).

At the state level, The Florida legislature passed HB 473, which established the Purple Ribbon Task Force (PRTF) within the Department of Elder Affairs. This led to the development of the Alzheimer’s disease state plan. The state’s Department of Health has recognized Alzheimer’s and related dementias as areas of priority focus within the State Health Improvement Plan. Florida’s governance has also pushed for funding and establishment of memory disorder clinics across the state and has promoted awareness of dementia.

The HBI Road Map suggests the implementation of the “Behavioral Risk Factor Surveillance System (BRFSS) optional module for Cognitive Decline in 2019 or 2020 and the BRFSS optional module for Caregiving in 2021 or 2022. M-2 Support national data collection on dementia and caregiving” (Alzheimer Association, 2020).

Conclusion

This paper has reviewed dementia based on the HP2020 initiative. Dementia affects an individual’s daily activities, leading to dependency and adverse social, psychological, and economic outcomes. Applying the Healthy People 2020 goals, objectives, and guidelines for dementia and related validated assessment tools can support the planning of population-level interventions and improve the dementia population outcomes.

References

Alzheimer Association. (2020). Healthy People 2020. https://act.alz.org/site/DocServer/2015_Healthy_People_Fact_Sheet.pdf?docID=47503#:~:text=Healthy%20People%202020%20sets%20a%20goal%20of%20decreasing,Alzheimer%E2%80%99s%20disease%20and%20other%20dementias%20by%2010%20percent

Gamble, L. D., Matthews, F. E., Jones, I. R., Hillman, A. E., Woods, B., Macleod, C. A., Martyr, A., Collins, R., Pentecost, C., Rusted, J. M., & Clare, L. (2022). Characteristics of people living with undiagnosed dementia: findings from the CFAS Wales study. BMC Geriatrics, 22(1), 1–12. https://doi.org/10.1186/S12877-022-03086-4/TABLES/2

HealthyPeople.gov. (n.d.). Dementias, Including Alzheimer’s Disease | Healthy People 2020. Retrieved September 9, 2022, from https://www.healthypeople.gov/2020/topics-objectives/topic/dementias-including-alzheimers-disease

Henskens, M., Nauta, I. M., Drost, K. T., Milders, M. v., & Scherder, E. J. A. (2019). Predictors of care dependency in nursing home residents with moderate to severe dementia: A cross-sectional study. International Journal of Nursing Studies, 92, 47–54. https://doi.org/10.1016/J.IJNURSTU.2018.12.005

Heuer, H. W., Wang, P., Rascovsky, K., Wolf, A., Appleby, B., Bove, J., Bordelon, Y., Brannelly, P., Brushaber, D. E., Caso, C., Coppola, G., Dickerson, B., Dickinson, S., Domoto-Reilly, K., Faber, K., Ferrall, J., Fields, J., Fishman, A., Fong, J., … Boxer, A. L. (2020). Comparison of sporadic and familial behavioral variant frontotemporal dementia (FTD) in a North American cohort. Alzheimer’s & Dementia, 16(1), 60–70. https://doi.org/10.1002/ALZ.12046

Institute of Medicine (U.S.) Committee on Leading Health Indicators for Healthy People 2020. (2011). Leading Health Indicators for Healthy People 2020: Letter Report. Leading Health Indicators for Healthy People 2020. https://doi.org/10.17226/13088

McCarthy, E. P., Chang, C. H., Tilton, N., Kabeto, M. U., Langa, K. M., & Bynum, J. P. W. (2022). Validation of Claims Algorithms to Identify Alzheimer’s Disease and Related Dementias. The Journals of Gerontology: Series A, 77(6), 1261–1271. https://doi.org/10.1093/GERONA/GLAB373

Möller, H. J. (2018). Possibilities and limitations of DSM-5 in improving the classification and diagnosis of mental disorders. Psychiatria Polska, 52(4), 611–628. https://doi.org/10.12740/PP/91040

Stokes, A. C., Weiss, J., Lundberg, D. J., Xie, W., Kim, J. K., Preston, S. H., & Crimmins, E. M. (2020). Estimates of the Association of Dementia with U.S. Mortality Levels Using Linked Survey and Mortality Records. JAMA Neurology, 77(12), 1543–1550. https://doi.org/10.1001/JAMANEUROL.2020.2831 

World Health Organization (WHO). (2021, September 2). Dementia. https://www.who.int/news-room/fact-sheets/detail/dementia

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HP2020 Paper: Topics & Objectives 2030

• Arthritis
• Osteoporosis
• Dementias

1. Research Topic: Your course faculty will provide you with topic/s for this assignment. Please check the NR503 Course Announcements.

2. Identify your target population (for instance, age or other demographic, aggregate population); this must be in your city or state.
3. Discuss population-based health education interventions for your target population that are aimed at reducing morbidity and mortality for the problem. Be sure to review the research literature and HP2020 for interventions.
4. Identify how and what data for interventions is being tracked.
5. In a four (4) page paper, address the following. Refer to the rubric for expanded details related to grading expectations.
Identify the problem in the introduction section.
Provide an overview of the problem in your state/nation.
Review of descriptive epidemiological and demographic data on mortality/morbidity and risk.
HP2020: Present the goal, overview, and objectives of Healthy People 2020 for the paper topic.
Population-level prevention and health promotion review. Describe population and primary health care-focused interventions. Use of scholarly literature and HP2020 is required. There should be a direct correlation to evidence for all strategies.