PHILADELPHIA —How will we, as individuals, and a society, live with brains at risk for Alzheimer's disease dementia? As part of Health Affairs’ April issue, a theme issue focusing on Alzheimer’s, a neurodegenerative disease ethicist and clinician with the Perelman School of Medicine at the University of Pennsylvania offers keen observations to help navigate ethically-charged points on the course of the disease progression.
"The new concept of Alzheimer's disease, as a spectrum of diseases ranging from people with pathological biomarkers but no symptoms, to those with advanced dementia, raises many ethical and policy-related questions for individuals and society as to how we will live with Alzheimer's disease" notes Jason Karlawish, MD, professor of Medicine, Medical Ethics and Health Policy and associate director of the Penn Memory Center. "Unlike other diseases of aging, where people learn they are at a higher risk or in the process of developing symptoms that could precipitate an acute and obvious event, such as a stroke, heart attack or hip fracture, society has not prepared or adjusted for someone to be labeled as 'likely to have Alzheimer's disease dementia' at some time in the future."
One in three seniors dies with Alzheimer's or another dementia and more than 15 million family and friends serve as caregivers to those with the disease, making Alzheimer's the most expensive condition in the United States. It affects an individual's ability to make decisions and perform daily tasks, such as taking medications safely. The progressive, untreatable illness affects not only patients, but caregivers as well. Progress in diagnostics and studies to develop prevention treatments may, in the coming years, expand the diagnosis to include persons who are asymptomatic but at risk of developing dementia caused by Alzheimer’s disease.
Dr. Karlawish offers suggestions for society and individuals to adapt and prepare:
"Whether as patients or as caregivers, we all have Alzheimer's disease," says Karlawish. "The question we must engage with is, How should we live with it?"
Dr. Karlawish’s work is supported by a Robert Wood Johnson Foundation Investigator Award in Health Policy Research and the Marian S. Ware Alzheimer’s Disease Program.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year.
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