The federal perspective

Dementia and especially Alzheimer's disease have a huge adverse effect on quality of life of the patients and their caregivers, especially families. The counting of all the persons affected would total in the millions of old, young and working-age Americans. Dementia is a worsening public health problem, and both states and the federal agencies have been involved in measures to respond.

Federal funding for research inevitably has a political side to the allocation of funds among competing applicants for the money. Breast cancer, heart disease and other visible campaigns are more likely to draw the attention of the media and the members of the appropriations committee of the House and Senate, inducing an allocation of taxpayer funds for the most “popular disease” causes. So research dollars from the annual budgets of the National Institutes of Health have tended to be spent upon more “hot-button diseases” with much more active constituency and advocacy groups, like breast cancer. The slow manifestation of problems inside the brain is a challenge in many respects; studies of the brain degeneration that is the hallmark of dementia are quite costly. Research funds for dementia have not matched up with all of the needs and opportunities for further exploration of genetics and neurological treatment modalities among the medical research community.

Federal involvement in the fight against Alzheimer's disease was formalized in early 2011, with the enactment of the National Alzheimer's Project Act (NAPA). Pursuant to this legislation, the US Department of Health and Human Services (HHS) published the first National Plan to Address Alzheimer's Disease (AD) in mid-2012. There is slow progress, but there is still a great need for additional funding from voluntary, academic and nonprofit entities to augment the slice of federal funds. Dementia as a political “cause” or “brand” to be “promoted” to the public and to the political audience among key legislators still trails behind cancer and many other disease research efforts.

The role of Medicare Part A on responses to dementia

The 1965 implementation of a tax and health benefits system for the elderly, “Medicare” was a historic breakthrough.