That's a great question. The dementia tsunami as you so aptly bill it is a threat to our national and global health, economic prosperity, and security. Let's take a deeper look at the factors:

• Our nation, the populations of other developed nations and, increasingly, the populations of developing nations, are aging, meaning that Alzheimer's - as a disease related to aging - is only going to become ever more prevalent in the coming decades unless we make significant progress in the discovery and development of a means of prevention and treatment. Aging expert and USAgainstAlzheimer's board member Ken Dychtwald tells this story like no one else can. Essentially, thanks to public health innovations and advances in medicine, humanity has helped conquer many of the diseases and other causes of death that for thousands of years kept life expectancy in the 35-45 age range, progress that enabled us to add more than 30 years to the average life expectancy of Americans during the past century. This growth in healthy life spans generated unprecedented economic prosperity, but the aging of populations generally -- coupled with the aging of the baby boom generation specifically -- means our nation and other developed and developing nations will experience tremendous growth in the number of persons age 65 and older, adding to the financial costs of caring for Americans and putting a drag on economic growth. We must make sure our health and social service systems are prepared to ride what Ken Dychtwald has for decades predicted as a historically-unprecedented "age wave".
• What is painfully obvious, yet not always adequately understood, is that no one survives Alzheimer's. Of course other diseases claim lives but many of them, particularly those that are most common - including many forms of cancer, diabetes, heart disease, HIV/AIDS, and more - can be prevented and/or treated. That is not true for Alzheimer's and related dementias. Alzheimer's is currently the sixth leading cause of death in the United States and the only leading cause of death than cannot be prevented or treated with a disease-modifying therapy. Right now, here in the U.S. alone, more than 5 million Americans are suffering this sentence, and about 36 million people globally - more than the current population of people with HIV/AIDS - are dying with dementia. Most of these people are forced by the disease to pull out of the workforce and many will be dependent completely or entirely on family caregivers, which gets us to the next factor:
• Fifteen million family caregivers are taxed with providing uncompensated care to their loved ones. See any family caregiver, particularly one who has provided care for years, and I bet you they will look as though they've gone through hell. They will be tired and worn down; they will be sick with ailments that have gone undiagnosed or unaddressed because they lack the time and/or money to seek medical care; they will be suffering from loneliness and isolation, possibly even depression, brought about by their own loss of a professional and personal life and by experiencing the deterioration of their loved one. Even if still working outside the home, chances are they will have bypassed promotions, have reduced the hours they work, and have been far less productive given these stressors. The reality of tens of millions of people - both patients and their caregivers - forced out of the workforce and out of being productive and contributing members of society - is an economic disaster, with unpaid caregivers contributing more than $210 billion this year in uncompensated care, according to the most recent iteration of Facts & Figures by the Alzheimer's Association.
• Shifting gears slightly, another factor is the lack of a highly focused and goal-oriented Alzheimer's research agenda. When America has strived to solve complex challenges in the past, we have used highly targeted and outcomes-oriented initiatives, like the moonshot in the 1960's, HIV/AIDS treatment efforts in the 1990's and the sequencing of the human genome earlier in this century, to do so. We need a similar goal-oriented and milestone-driven approach to developing means to treat and prevent Alzheimer's and dementia and prevent this tsunami from becoming the national disaster it most assuredly will become without a comprehensive and aggressive response.
• Inadequate levels of public research funding for Alzheimer's and dementia imposes another challenge in addressing the tsunami. We all know well the fiscal and economic challenges our nation faces. Given these budgetary realities, tens of billions of dollars in increased NIH and other funding is highly unlikely for the foreseeable future. But we also know that Alzheimer's is already costing our nation hundreds of billions of dollars annually while our federal research commitment to the disease is less than $500 million. Congress and the NIH must step up and recognize that only by investing appropriate sums of money into targeted Alzheimer's research will we be able to save taxpayers trillions of dollars in the decades ahead, as well as to achieve our national goal of preventing and treating Alzheimer's by 2025. We also must provide the policy environment that will incent the biopharmaceutical industry to retain its commitment to Alzheimer's research.
• Related to the research challenge are the scientific challenges associated with the disease as well as the complexity, length, and cost associated with the drug development process. It now takes fifteen years and more than $1 billion to develop one therapy. That is too long and too expensive - simply unacceptable. While scientific and medical breakthroughs funded by increased public and private investments are absolutely essential, we must also change the current 'business as usual' attitude and work to compress the drug development timeline significantly using a variety of innovations and tools in order to translate scientific breakthroughs into life-enhancing and extending medicines more quickly and efficiently. Qualified biomarkers, data standards and data sharing, and robust patient registries are all examples of tools that would have such an impact.
• The extraordinary length of Alzheimer's disease compared to other diseases is another factor. The average patient lives with the disease for a number of years before being diagnosed and then for an average of 8 years after diagnosis, with some living 20 years or longer. Meryl Comer can speak more to the toll it takes on caregivers. Many of us have experienced loved ones battling cancer or other diseases and know how painful those last few months can be. But Alzheimer's imposes a very long and extremely exhausting experience for the victim, one that exacts a tremendous toll on caregivers and other loved ones.
• Another factor to consider is that our health system is ill-prepared to care for tens of millions of people with Alzheimer's victims over the coming decades. Patients with Alzheimer's and other dementias cost Medicare about 3 times more money than patients without Alzheimer's, nine times for Medicaid. Alzheimer's, particularly as the disease progresses, makes it nearly impossible for patients to self-manage their other conditions, for example, a diabetic forgetting to manage his/her blood glucose levels. And, in the latter stages of the disease, Medicaid-supported institutionalization is common because of a victim's total dependency on others for care. This means comorbidities go unaddressed, causing the patient to become sicker and to require more intensive and expensive interventions. Our health care system must become more dementia-capable and dementia-sensitive with the goal of increasing the quality of care and at the same time reducing costs of care and care giver burden.
• Related to this point is the fact that our nation is sorely lacking an adequate number of appropriately trained dementia caregivers ranging from skilled nursing professionals through geriatricians and related specialties. We absolutely must recruit more competent individuals into these careers and also help improve the competency and knowledge of those already in the field. The National Plan has set some important goals and strategies in this area and they must be pursued aggressively. Most care facilities are simply ill-prepared to provide quality dementia care. Compounding the problem further is that our healthcare financing system is also ill-equipped to compensate for both care planning services, for the costs of long-term nursing facility care and for the living wage required to assure a motivated and capable care workforce.
• Finally, another factor we must address is the stigma associated with Alzheimer's and dementia. Until all of us are as comfortable assessing our brain health as we are our body health, patients and caregivers will remain closeted for far too long, delaying entry into the care and support systems as well as gaining access to the innovations coming from the research enterprise. Given the likelihood that effective interventions will need to be administered far earlier on in the disease process - likely when symptoms are very mild or even non-existent - it is critical for patients and caregivers to overcome their fear, and the stigma and isolation, now associated with the disease. We must bring Alzheimer's out of the shadows, first and foremost, so patients receive the care they need and so our elected officials recognize the scope of the crisis and summon the political will to act accordingly.