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HEOR Articles

Global Burden, Emerging Breakthroughs: The Dual Stories of Alzheimer’s Disease

 

Valerie Henson, MPH; Katie Hayes; Michelle DiNicolas, PhD; Lalitha Priya Chandrashekhar, PFG MedComm, LLC., Somerset, NJ, USA

 

With an aging global population and increased awareness driving projected rises in Alzheimer’s disease incidence, the societal and economic burdens of the disease are mounting. At the same time, funding uncertainties threaten to stall research progress—underscoring the urgency to seize opportunities for breakthroughs powered by cutting-edge technology and innovation in healthcare.

 

Introduction

Alzheimer’s disease (AD) affects 55 million people worldwide,2 with its reach extending far beyond those diagnosed to include loved ones and caregivers. With no definitive cure, the number of individuals impacted by AD is projected to soar to over 152 million by 2050.3 As one of the most feared conditions associated with aging,4 the consequences of the disease are felt across multiple layers of society—public health, economics, and individual lives. As the global impact of AD continues to grow, understanding its broader implications is critical. This piece explores the burden of AD, examining its public health and economic impact, providing an overview of the disease state, reviewing current and emerging treatments, and highlighting critical gaps in the care ecosystem.

 

Alzheimer’s Disease Overview

AD is the most common cause of dementia—the umbrella term for conditions impacting memory, thinking, and social cognition.5 Approximately 6 million Americans over the age of 65 are affected, and AD accounts for 60-70% of dementia cases worldwide.2,6 The typical symptoms can include weakening or loss of memory, reasoning skills, language, and spatial understanding, and behavioral/personality changes.7 As the condition progresses, complications such as a decline in physical health, infections, and loss of control over bodily functions may also happen.7 While the cause of AD is not known, it likely stems from a combination of genetics, environmental factors, and age.8 Diagnosing AD requires a complex combination of physical exams, diagnostic procedures, and discussions with the patient and family. Typical medical tests, such as urine or blood analysis, may be utilized to assess other potential medical problems.9 AD is often diagnosed by a neurologist after a series of examinations of the patient’s reflexes, coordination, eye movement, speech, and sensation levels.10 Symptoms of depression, such as apathy, loss of interest in activities, social withdrawal/isolation, and impaired thinking/concentration, can often overlap with AD and can be difficult to differentiate.11 Brain imaging with MRI is another standard test used in AD diagnosis to rule out other potential conditions with similar symptoms.10

 

Public Health Impacts, Disparities, and Unmet Needs

The burden of AD and related dementia is increasing, due to the aging global population and persistent health disparities. Although advancing age is the strongest risk factor, newer research suggests the risk of developing dementia may be even higher than previous estimates.12 But AD does not affect all communities equally. Studies show significant racial disparities, with some minority groups facing a disproportionately higher risk. As demographic shifts continue, these higher-risk populations are expected to make up more than half of the United States population by 2045, raising concerns about the growing impact of the disease.12 Socioeconomic factors further compound these disparities. Limited access to education and nutrition may contribute to early differences in cognitive reserve, while inequities in healthcare and a greater burden of vascular risk factors in midlife drive higher rates of AD in marginalized communities.12

"As demographic shifts continue, these higher-risk populations are expected to make up more than half of the United States population by 2045, raising concerns about the growing impact of the disease."

Despite the growing demand for dementia care, the healthcare system in the United States remains unprepared for the rising AD cases—20 states have been classified as “dementia neurology deserts” due to the severe shortage of geriatric specialists and critical limitations in access to diagnostic and treatment services.13 Compounding the challenge, the complexity of AD requires a holistic approach addressing physical, mental, and social well-being. Yet, the siloed nature of the healthcare system makes it difficult to provide streamlined, coordinated care, leaving many patients and caregivers without the support they need.14 These gaps in workforce capacity and care coordination not only strain the healthcare system but also limit patients’ access to timely diagnoses and comprehensive support. As the prevalence of AD rises, so does the urgency for effective treatments and interventions. While recent advancements in research have brought new therapies to the forefront, questions remain about their accessibility, efficacy, and long-term impact on disease progression.

Safety is a major concern for patients with AD and their caregivers, highlighting an unmet need for support and frameworks to address these issues.15 Caregivers report uncertainty in dealing with emergencies, managing medications, fall/wander prevention, and avoiding exploitation/fraud.15 Addressing neuropsychiatric comorbidities associated with AD is a significant unmet need for patients and caregivers. Apathy, agitation, sleep disturbances, aggression, and depression are common neuropsychiatric symptoms accompanying AD.16 There is a gap in research specific to these symptoms in patients with AD, although the impact is significant. Neuropsychiatric symptoms contribute to increased healthcare expenditure as well as increased burden on healthcare providers and caregivers.16

 

Treatment Landscape

The classes of medications used for AD include cholinesterase inhibitors, NMDA receptor agonists, and monoclonal antibodies.5 While none of these medications are curative, they can slow disease progression, prolonging quality of life and allowing patients to retain certain levels of independence17:

  • Cholinesterase inhibitors (donepezil, galantamine, rivastigmine, and others): these drugs prevent the breakdown of acetylcholine, which can help memory and cognition17
  • NMDA receptor antagonists (memantine): slow the neurotoxicity associated with AD by blocking the NMDAR subtype of glutamate receptors18
  • Monoclonal antibodies (lecanemab and donanemab): target amyloid-β (Aβ) peptide, tau protein, and neuroinflammation19

Additionally, antipsychotics may be used in an off-label capacity to treat behavioral changes associated with the condition.20

"Addressing neuropsychiatric comorbidities associated with Alzheimer's disease is a significant unmet need for patients and caregivers."

 

Caregiver Insights

Caregiving for a loved one with AD and related dementia often extends far beyond a full-time job; it can drastically reshape personal lives. For many caregivers, the emotional and social toll is significant. In fact, nearly half of caregivers reported avoiding social gatherings, fearing how their loved one might be treated by others.21 Additionally, 41% of caregivers said they refrain from taking vacations, concerned that their loved one would face mistreatment in their absence.21

The total annual indirect societal cost of AD increases with severity, ranging from $36,934 for mild cognitive impairment due to AD to $145,250 for severe disease per patient (2024 USD).22 When factoring in both patient productivity losses and spillover effects to unpaid caregivers, the total annual indirect cost of AD is estimated at a staggering $832 billion.22 This economic strain underscores the growing impact on caregivers, who often bear much of the financial and emotional weight of the disease.

Amid these challenges, the day-to-day management of AD symptoms presents a substantial barrier, particularly for family caregivers who are often unpaid and lack professional support. However, emerging technological interventions show promise in easing the caregiver burden, offering tools to improve both patient care and caregiver well-being.23

 

Emerging Technologies

Monoclonal antibodies can potentially slow the progression of AD by targeting and clearing amyloid deposits.24 The most recent FDA approval for an AD drug was for donanemab, a monoclonal antibody treatment.25 Rather than just addressing symptoms of AD, monoclonal antibodies may slow the cognitive decline associated with the disease.24 Currently, lecanemab and donanemab are the only FDA-approved monoclonal antibodies on the market for AD.

This evolving approach aligns with a broader shift in AD care toward precision medicine. During a plenary session at the American Academy of Neurology (AAN) Annual Meeting in April 2025, Dr. Reisa Sperling emphasized the importance of tailoring treatments to an individual’s genetic and molecular profile. She highlighted how emerging therapies are increasingly designed to target specific pathophysiological pathways, enabling earlier and more personalized interventions.26 One example of this precision-driven shift is the development of novel diagnostic tools. Research from the University of Cambridge has shown that virtual reality (VR) technology could be used for early AD detection.27 In a recent study, participants navigated a virtual environment to assess spatial awareness—a cognitive function that can decline years before more noticeable symptoms of AD appear.27 The use of VR in this context highlights the growing role of technology and personalized assessment tools in identifying AD earlier and more accurately.27

 

A Global Perspective

AD is accelerating into a global health crisis with a projection to reach 82 million patients by 2030.3 The economic toll is staggering; currently exceeding US $1.3 trillion annually, it is expected to approach $3 trillion by 2030.28 Informal caregiving alone accounts for around 40% of this cost, highlighting the profound societal burden of AD.29

This burden is not equally shared. In low-income countries, up to 90% of dementia cases go undiagnosed and untreated,28 reflecting deep disparities in awareness, diagnostic capacity, and access to care. These gaps leave millions without support while reinforcing global health inequities.

By contrast, high-income countries have adopted innovative models to manage the crisis. Japan leads with dementia-friendly communities and early detection initiatives.30 Sweden’s national strategy emphasizes personalized care and strong caregiver support. The Netherlands excels in integrated, person-centered care coordinated across providers. Luxembourg launched its national dementia plan in 2013 and followed with a prevention program targeting modifiable risk factors.31

Still, even the most advanced systems face growing demands. Global progress depends on closing diagnostic gaps, expanding access to community-based care and sharing best practices. Without coordinated, inclusive action, AD will continue to strain health systems, families, and economies at an unsustainable scale.

"Without coordinated, inclusive action, Alzheimer's disease will continue to strain health systems, families, and economies at an unsustainable scale."

The Road Ahead

Alzheimer’s disease research is facing a major setback as freezes on federal medical research grants prompt sweeping budget cuts and widespread layoffs across key agencies, including the Food and Drug Administration, National Institutes of Health (NIH), Health and Human Services, and Centers for Disease Control and Prevention.31 This funding halt risks stalling critical progress in treatment development at a pivotal moment. The NIH projects a need for $445 million to meet the 2026 goals of the National Plan to Address Alzheimer’s Disease but is currently facing a $113 million shortfall for new research in the upcoming fiscal year.32

Compounding the issue, proposed cuts to diversity, equity, and inclusion (DEI) research funding could halt vital studies on women’s health.33 This is particularly significant in the AD space, where women represent nearly two-thirds of all AD and dementia cases.34 Without continued support for DEI research, efforts to understand how sex and gender differences influence risk factors, disease mechanisms, and progression may be significantly hindered.35,36 As these challenges mount, the future of AD research and the pursuit of critical breakthroughs remain at a crossroads, with the potential for lasting consequences on treatment development and public health.

 

References

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