Early diagnosis can lower cost of Alzheimer's

Although occurrence of dementia-causing diseases such as Alzheimer's grows along with the population, local and even regional insurers typically do not cover testing needed to properly diagnose or evaluate how well someone responds to treatment.

Medicare does, but people with symptoms of dementia younger than 65 fall into a giant hole, says Dr. Norman L. Foster, professor of neurology at the University of Utah and director of the Center for Alzheimer's Care, Imaging and Research, the only academic research clinic in the Intermountain West. That early diagnosis and treatment can alter the course of a disease like Alzheimer's both financially and in terms of quality of life, he says.

Research and evaluation efforts have lagged in the region because of the financial issues, says Foster, who is also a senior investigator for the Brain Institute.

Because of large families and healthy lifestyles that boost longevity, Utah is expected to see more increase of Alzheimer's than any other state in the next 20 years. Those over 85 have the highest risk of the disease, while 70-75 are the most common ages for onset. The number of Alzheimer's cases that strike early are estimated at fewer than 10 percent. That's still a lot of people, Foster says.

Younger patients may be able to get coverage under Social Security Disability, but that process typically takes a year or more and the coverage for imaging and neurological testing doesn't kick in for another two years after that. Meanwhile, the disease progresses. The problem creates a lot of work for patient-appeals advocates who routinely battle for coverage, on a test-by-test, case-by-case basis, he says. Sometimes they win.

Those same early-onset patients fall into other holes, as well. They're too young to get some services afforded older people who have dementia, such as Meals on Wheels, adult day care or respite care funded through local governments.

"Those who have symptoms at a much earlier age than traditional seem to have very unique issues that need to be addressed," says Scott Snow, director of the Alzheimer's Association's Utah chapter.

It starts with the difficulty of getting the right diagnosis, since it's not one that pops to mind in younger patients, he says. And it progresses through myriad other issues: careers cut short, available resources lost and more. "It seems like they often have additional health costs. And the longer it takes to get a diagnosis, there are additional costs or stressors attached to wondering what is happening to me or to a loved one."