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Alzheimers mention

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by Hoosier_RN Hoosier_RN, MSN (Platinum*) Platinum*

Hoosier_RN has 20 years experience as a MSN and specializes in LTC, home health, hospice, ICU, ER, dialysis.

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MunoRN has 10 years experience.

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37 minutes ago, Orion81RN said:

It seems many scientists and researchers disagree. I may have misinterpreted, but it seemed that bc the patent will be running out, that they basically didn't want to put all the money into research that would not benefit them so much as other companies who make it after the patent is up. Basically doing the work for other companies. 

I haven't seen that any scientists or researchers disagree on a scientific basis, researchers in the research department of Pfizer have lobbied for research funding on the basis of securing more funding for their department, but they have made no scientific argument for the potential of Enbrel to treat Alzheimer's.  

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Hoosier_RN has 20 years experience as a MSN and specializes in LTC, home health, hospice, ICU, ER, dialysis.

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2 hours ago, MunoRN said:

A review of insurance claims found that those who take Enbrel are less likely to be diagnosed with Alzheimer's later in life, but it's not a result of taking Enbrel, it's that those who are of the socioeconomic status that can obtain Enbrel coverage are also of the socioeconomic status that we already know as a decreased likelihood of Alzheimer's.  Having insurance that covers Enbrel, or the ability to pay out-of-pocket for it, reflects a socioeconomic status associated with lower Alzheimer's risk, it's not the drug itself.

 

I didn't realize that Alzheimers, or any dementia category, had a socioeconomic factor for determining incidence.  I worked at a private pay dementia facility a few years ago.  Those folks could easily afford the best.  It didn't keep them from getting a dementia dx.

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MunoRN has 10 years experience.

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18 minutes ago, Hoosier_RN said:

I didn't realize that Alzheimers, or any dementia category, had a socioeconomic factor for determining incidence.  I worked at a private pay dementia facility a few years ago.  Those folks could easily afford the best.  It didn't keep them from getting a dementia dx.

The reasons for disparities in Alzheimer's incidence based on socioeconomic factors isn't completely understood, but the differences are pretty clear.  It appears at least partly due to differences in insurance coverage and the resulting access to healthcare, but it's not all due to insurance inequality since the difference can also be found in places with relatively equal access to healthcare.

https://www.alzheimersanddementia.com/article/S1552-5260(17)32972-2/fulltext

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11 hours ago, MunoRN said:

The reasons for disparities in Alzheimer's incidence based on socioeconomic factors isn't completely understood, but the differences are pretty clear.  It appears at least partly due to differences in insurance coverage and the resulting access to healthcare, but it's not all due to insurance inequality since the difference can also be found in places with relatively equal access to healthcare.

https://www.alzheimersanddementia.com/article/S1552-5260(17)32972-2/fulltext

Directly from the article you posted: Differences in dementia risk between socioeconomic groups can be partly attributed to differences in treatable health- and lifestyle related factors. Future public health campaigns for dementia risk reduction should try hard to reach out to this vulnerable group.

The aim of this article: Therefore, the aim of this study was to investigate whether differences in socioeconomic status are associated with incident dementia and whether this association is explained by health- and lifestyle-related factors.

It wasn't based on insurance coverage as you're basing your claim. Just saying it's not the best article to support your theory.

 

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MunoRN has 10 years experience.

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9 hours ago, NurseBlaq said:

Directly from the article you posted: Differences in dementia risk between socioeconomic groups can be partly attributed to differences in treatable health- and lifestyle related factors. Future public health campaigns for dementia risk reduction should try hard to reach out to this vulnerable group.

The aim of this article: Therefore, the aim of this study was to investigate whether differences in socioeconomic status are associated with incident dementia and whether this association is explained by health- and lifestyle-related factors.

It wasn't based on insurance coverage as you're basing your claim. Just saying it's not the best article to support your theory.

 

I referenced that article as an example of where insurance coverage inequality didn't explain the socioeconomic variation in Alzheimer's incidence (the study was in the UK).  

While access to healthcare based on coverage may play some direct role, it's likely also a concomitant factor; the socioeconomic factors that predict risk for Alzheimer's are the same factors that predict your likelihood of having insurance or being able to pay out-of-pocket for an expensive medication.  It's the same premise as if you were to find that the more likely someone is to own a car that costs more than $100,000, the less likely they are to develop Alzheimer's.  It's not the $100,000 can that's preventing the Alzheimer's, it's that the ability to own an expensive car goes along with the same factors that make you less likely to develop Alzheimer's.  In this case, the medication Enbrel is the $100,000 car.  

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1 hour ago, MunoRN said:

I referenced that article as an example of where insurance coverage inequality didn't explain the socioeconomic variation in Alzheimer's incidence (the study was in the UK).  

While access to healthcare based on coverage may play some direct role, it's likely also a concomitant factor; the socioeconomic factors that predict risk for Alzheimer's are the same factors that predict your likelihood of having insurance or being able to pay out-of-pocket for an expensive medication.  It's the same premise as if you were to find that the more likely someone is to own a car that costs more than $100,000, the less likely they are to develop Alzheimer's.  It's not the $100,000 can that's preventing the Alzheimer's, it's that the ability to own an expensive car goes along with the same factors that make you less likely to develop Alzheimer's.  In this case, the medication Enbrel is the $100,000 car.  

I see where you're going with this but that's not what I'm getting from it. Socioeconomic status only helps in symptom control and prolonging of effects of Alzheimer's, not prevention. No amount of money can prevent Alzheimer's. Better treat the symptoms and/or control yes, but prevention, no.

In your example, the car only represents the ability to stave off symptoms longer, not prevent Alzheimer's altogether. But again, as the article points out, people with insurance and access to adequate healthcare may still have different outcomes based upon other factors, not strictly socioeconomic ones either. I think that's where the disconnect is coming from.

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myoglobin has 11 years experience as a ASN, BSN and specializes in ICU, trauma, neuro.

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There is some evidence that NSAID's may reduce risk of AD up to 20% (excluding aspirin and acetaminophen which do not seem to confer this protective effect) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882872/ . Thus is is not surprising that Embrel which has immune modulating properties might display similar protective traits. This meta-analysis indicates that exercise may improve cognition in those suffering from dementia including A/D https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6130261/ .  There is also some evidence that a diet which combines the best of the DASH diet and Mediterranean diet (or so called MIND) diet may https://www.alzheimers.net/4-8-15-mind-diet-alzheimers-prevention/ offer further protection against dementia.  AD should be seen as a "modifiable risk factor" rather than a fate even for those at high risk.  

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1 hour ago, NurseBlaq said:

I see where you're going with this but that's not what I'm getting from it. Socioeconomic status only helps in symptom control and prolonging of effects of Alzheimer's, not prevention. No amount of money can prevent Alzheimer's. Better treat the symptoms and/or control yes, but prevention, no.

In your example, the car only represents the ability to stave off symptoms longer, not prevent Alzheimer's altogether. But again, as the article points out, people with insurance and access to adequate healthcare may still have different outcomes based upon other factors, not strictly socioeconomic ones either. I think that's where the disconnect is coming from.

Socioeconomic status (SES) is associated with how likely you are to be diagnosed with Alzheimer's, not just the severity of symptoms.  If the lower incidence of Alzheimer's diagnosis was found in the lower SES group then that could be attributed to under surveillance, but the lower rate of Alzheimer's exists in those more likely to be assessed for Alzheimer's. 

One could argue that the prevalence of Alzheimer's is the same in all SES groups, it's just that symptoms of those in higher SES groups are below the diagnostic threshold for Alzheimer's, but using diagnosis as the measure of prevalence, individuals in higher SES groups are less likely to have Alzheimer's, not just less likely to have more severe symptoms.  

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myoglobin has 11 years experience as a ASN, BSN and specializes in ICU, trauma, neuro.

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I would argue that reasons for SES variations include:

a. Differences in habits (and time and money) to exercise and eat a better diet.

b. Differences in stress levels which have been implicated in risk profile.

c. Differences in medical comorbidites such as depression and diabetes that have also been implicated in AD. 

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3 hours ago, MunoRN said:

Socioeconomic status (SES) is associated with how likely you are to be diagnosed with Alzheimer's, not just the severity of symptoms.  If the lower incidence of Alzheimer's diagnosis was found in the lower SES group then that could be attributed to under surveillance, but the lower rate of Alzheimer's exists in those more likely to be assessed for Alzheimer's. 

One could argue that the prevalence of Alzheimer's is the same in all SES groups, it's just that symptoms of those in higher SES groups are below the diagnostic threshold for Alzheimer's, but using diagnosis as the measure of prevalence, individuals in higher SES groups are less likely to have Alzheimer's, not just less likely to have more severe symptoms.  

If this is the case it's not the socioeconomic status but a piss poor provider with a known/unknown bias towards the poor. Again, the article you quoted says this is a trend among those who have adequate access to healthcare and insurance. If that's the case, it's not socioeconomic but a disparity in the care provided because of other issues.

I AM arguing that the prevalence of Alzheimer's is the same in all SES groups. That's what I've been saying all along. Full stop. If they're "below the diagnostic threshold" it becomes a provider issue, not the patient's. The patient is the only one who suffers from late diagnosis. This is similar to what the topic is in that other thread is about racial bias in healthcare. Race may or may not be a factor in this case but this isn't that thread, just used it as an example of a provider problem, not socioeconomic or patient related issue.

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1 hour ago, myoglobin said:

I would argue that reasons for SES variations include:

a. Differences in habits (and time and money) to exercise and eat a better diet.

b. Differences in stress levels which have been implicated in risk profile.

c. Differences in medical comorbidites such as depression and diabetes that have also been implicated in AD. 

The article covered that under "can be partly attributed to differences in treatable health- and lifestyle related factors". It just didn't specify what those were on a microlevel.

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myoglobin has 11 years experience as a ASN, BSN and specializes in ICU, trauma, neuro.

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2 hours ago, NurseBlaq said:

If this is the case it's not the socioeconomic status but a piss poor provider with a known/unknown bias towards the poor. Again, the article you quoted says this is a trend among those who have adequate access to healthcare and insurance. If that's the case, it's not socioeconomic but a disparity in the care provided because of other issues.

I AM arguing that the prevalence of Alzheimer's is the same in all SES groups. That's what I've been saying all along. Full stop. If they're "below the diagnostic threshold" it becomes a provider issue, not the patient's. The patient is the only one who suffers from late diagnosis. This is similar to what the topic is in that other thread is about racial bias in healthcare. Race may or may not be a factor in this case but this isn't that thread, just used it as an example of a provider problem, not socioeconomic or patient related issue.

I don't believe that AD prevalence is the same in all SES groups.  That is because AD involves the interplay of both genetic an lifestyle factors. While the genetic factors may be more or less evenly distributed, lifestyle factors are not. We know for example that obesity and DMII are heavily distributed towards lower SES. Thus, it should follow that AD distribution skews towards lower socioeconomic status.  

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