What’s the Latest on VA’s Coverage of New Alzheimer’s Drug?

The VA has announced that it will cover Leqembi, a monoclonal antibody therapy made by pharmaceutical companies Eisai and Biogen, for veterans in the disease’s early stages. This makes the VA the first and largest health program in the country to endorse the treatment, reports’ military.com in its recent article entitled, “VA to Cover New Drug for Early Stage Alzheimer’s Disease.”

In January, the FDA granted accelerated approval for Leqembi, also known as lecanemab, when research showed that the medication slowed the physical and mental decline in some patients with early Alzheimer’s by as much as 27%. Although research is ongoing on the treatment’s effectiveness, the drug is among the first to show that it reduces beta amyloid — the toxic protein that contributes to the development of Alzheimer’s — in the brain.

“This treatment option is the latest therapy to target and affect the underlying disease process of Alzheimer’s instead of only treating the symptoms of the disease,” said Dr. Billy Dunn, director of the Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research, during the accelerated approval announcement.

The VA treats about 168,000 veterans with Alzheimer’s, some of whom are in the early stages. Leqembi has an estimated cost of $26,500 a year, and a two-milliliter dose at the VA will cost the department $194.63. A five-milliliter dose will cost $486.57, according to the department’s National Acquisition Center Contract Catalog.

According to VA Press Secretary Terrence Hayes, the drug will be available only at the request of a provider to vets who “most closely align with” patients who meet the selection criteria for clinical trials. This means that the VA patients must meet the same demographic and health history standards as those studied by the manufacturers.

“Each dose of the medication administered for each patient will be tracked and monitored for safety and appropriateness of use, in real-time, by VA’s Center for Medication Safety,” Hayes said in an email to Military.com. “VA will continue to monitor the clinical evidence and safety data for this agent and adjust the criteria for use as appropriate. VA also has capabilities and safeguards in place that are very different from the private sector, such as the ability to conduct real-time medication-use evaluations that will allow for continued safe use of the medication.”

Leqembi is approved for use only in patients with early Alzheimer’s with a “confirmed presence,” via a brain scan, of beta amyloid.

Reference: military.com (March 14, 2023) “VA to Cover New Drug for Early Stage Alzheimer’s Disease”

Use Estate Planning to Prepare for Cognitive Decline

Since 2000, the national median age in the U.S. has increased by 3.4 years, with the largest single year gain of 0.3 years in 2021, when the median age reached 38.8 years. This may seem young compared to the life expectancies of older Americans. However, the median age in 1960 was significantly lower, at 29.5 years, according to the article “Don’t Let Cognitive Decline Derail Well-Laid Financial Plans” from Think Advisor.

An aging population brings many challenges to estate planning attorneys, who are mindful of the challenges of aging, both mental, physical and financial. Experienced estate planning attorneys are in the best position to help clients prepare for these challenges by taking concrete steps to protect themselves.

Individuals with cognitive decline become more vulnerable to potentially negative influences at the same time their network of trusted friends and family members begins to shrink. As people become older, they are often more isolated, making them increasingly susceptible to scams. The current scam-rich environment is yet another reason to use estate planning.

When a person is diagnosed with Alzheimer’s or any other form of dementia, an estate plan must be put into place as soon as possible, as long as the person is still able express their wishes. A diagnosis can lead to profound distress. However, there is no time to delay.

While typically, the person may state they wish their spouse to be entrusted with everything, this has to be properly documented and is only part of the solution. This is especially the case if the couple is close in age. A secondary and even tertiary agent needs to be made part of the plan for incapacity.

The documents needed to protect the individual and the family are a will, financial power of attorney, durable power of attorney and health care documentation. In addition, for families with more sophisticated finances and legacy goals, trusts and other estate and tax planning strategies are needed.

A common challenge occurs when parents cannot entrust their children to be named as their primary or secondary agents. For example, suppose no immediate family members can be trusted to manage their affairs. In that case, it may be necessary to appoint a family friend or the child of a family friend known to be responsible and trustworthy.

The creation of power of attorney documents by an estate planning attorney is critical. This is because if no one is named, the court will need to step in and name a professional guardian. This person won’t know the person or their family dynamics and may not put their ward’s best interests first, even though they are legally bound to do so. There have been many reports of financial and emotional abuse by court-appointed guardians, so this is something to avoid if possible.

Reference: Think Advisor (April 21, 2023) “Don’t Let Cognitive Decline Derail Well-Laid Financial Plans”

Is Low Bone Mineral Density Linked to Dementia?

In a study of community-dwelling older adults, every standard deviation lower BMD at the femoral neck was linked with a 12% higher risk for developing all-cause dementia, says Mohammad Arfan Ikram, MD, PhD, of Erasmus University Medical Center in Rotterdam, The Netherlands, and colleagues.

MedPage Today’s recent article entitled, “Osteoporosis: Another Dementia Predictor?” says that each standard deviation lower for femoral neck BMD was also linked with a 14% higher risk for Alzheimer’s disease during the 11-year follow-up, the group wrote in Neurology.

When the researchers looked at only the first decade of follow-up, older adults falling into the lowest group of BMD in the femoral neck had a twofold higher risk for dementia than those in the highest tertile. In the first 10 years, those in the lowest tertile for trabecular bone score and total body BMD also saw a significantly higher risk for developing all-cause dementia. However, when expanding to the entire follow-up period, only low femoral neck BMD was still significantly connected with dementia onset.

“Low bone density and dementia are two conditions that commonly affect older people simultaneously, especially as bone loss often increases due to physical inactivity and poor nutrition during dementia,” noted Ikram. “However, little is known about bone loss that occurs in the period leading up to dementia. Our study found that bone loss indeed already occurs before dementia and thus is linked to a higher risk of dementia.”

“Previous research has found factors like diet and exercise may impact bones differently as well as the risk of dementia,” Ikram added. “Our research has found a link between bone loss and dementia, but further studies are needed to better understand this connection between bone density and memory loss.”

“It’s possible that bone loss may occur already in the earliest phases of dementia, years before any clinical symptoms manifest themselves,” he explained. “If that were the case, bone loss could be an indicator of risk for dementia and people with bone loss could be targeted for screening and improved care.”

The researchers also noted that prior data suggested a link between low femoral neck BMD with structural brain changes, which may be a major driver of elevated dementia risk. These changes include declined white matter volume, increased white matter hyperintensity volume, the occurrence of silent brain infarction and progression of parenchymal atrophy.

In addition, it’s possible that these individuals experienced some loss of cognition that subsequently lead to poorer dietary nutrition and lifestyle habits.

Reference: MedPage Today (March 22, 2023) “Osteoporosis: Another Dementia Predictor?”

Does Government Have Financial Assistance for Alzheimer’s?

Social Security Disability Insurance (SSDI) provides financial support to those who’ve worked and paid into the Social Security system and are now unable to work due to a disability, including dementia. To be eligible for SSDI, a person must have enough work history and their condition must meet the SSA’s definition of a disability.

Help! Dementia recent article entitled, “Financial Costs and Planning for Dementia and Alzheimer’s,” explains that Supplemental Security Income (SSI) provides financial support to those who have a limited income and assets and are aged, blind, or disabled. People with dementia may be eligible for SSI, if they satisfy the income and asset limits set by the Social Security Administration.

The Area Agency on Aging has information and resources on financial assistance for those suffering from dementia. However, financial assistance can vary depending on the location and the services offered by the agency. Some services that the aging agency may provide include:

Information on government benefits, such as Medicaid, may be available to individuals with dementia and their families to help cover the costs of care.
Assistance with long-term care planning, like resources on long-term care options, including assisted living facilities and in-home care. They can help individuals with dementia and their families plan for their future care needs.
Information on financial assistance programs, such as grants and loans, may be available to individuals with dementia and their families to help cover the costs of care.
Life resource planners and elder law lawyers can be helpful to those with dementia and their families who need assistance with financial and legal planning.

Life resource planners are professionals who specialize in helping individuals and families plan for their future, including financial and legal planning. They can provide guidance on government benefits, caregiving and long-term care planning.

Elder law lawyers specialize in legal issues affecting older adults, including government benefits and long-term care planning.

Reference: Help! Dementia (Feb. 12, 2023) “Financial Costs and Planning for Dementia and Alzheimer’s”

Can a Dementia Patient Sign Legal Documents?

Once a diagnosis of dementia has been received, families need to immediately begin advance care planning, as explained in a recent article titled “Can Someone With Dementia Sign Legal Documents” from Health News. Depending on their medical condition, some patients with dementia, particularly in early stages, may be capable of making their own decisions regarding legal decisions. However, discussions must begin early, so the person can be involved and understand the planning process.

When family members don’t know the wishes of their loved ones, they are more likely to experience distress and difficulties in making decisions. Families report feelings of guilt, self-doubt and stress while making advance care decisions with no input from their loved ones.

Laws concerning advance care vary from state to state. An elder law attorney can help older adults interpret state laws, plan how their wishes will be carried out and understand financial options.

Advance care planning focuses on both long-term care and planning for funeral arrangements. These documents typically include a durable power of attorney for healthcare, a living will and Do-Not Resuscitate orders, often called a DNR. Depending on state law, there may also be a MOLST document, short for Medical Orders for Life-Sustaining Treatment.

The durable power of attorney for healthcare names another person who can serve as a proxy for the person with dementia, if and when the person is not able to make informed healthcare decisions for themselves.

A living will states a person’s wishes for end-of-life treatment. This documents their views about specific medical procedures including but not limited to dialysis, tube feeding or blood transfusions. If the person should become unconscious, then families may make treatment decisions based on what their loved one wanted.

A Do-Not-Resuscitate order is placed in a patient’s medical chart if the person does not want to receive CPR (cardiopulmonary resuscitation) if their heart stops or breathing ceases. This must be signed by a doctor before it is placed in the chart.

Planning for a funeral is a difficult task. However, it will alleviate stress and possible guilt in the future. People with dementia can tell their loved ones in advance what they want regarding a funeral or memorial service, burial, or cremation. If any arrangements are already in place, such as the purchase of a burial plot, providing details to family members will make it easier to manage.

Advance care planning can be a sensitive topic but seeking legal advice early on is useful so the family can focus on making sure their loved one has the care they want. Involving the person with dementia in the process is respectful. An elder lawyer attorney will be able to guide the family to ensure planning is done properly.

Reference: Health News (Jan. 11, 2023) “Can Someone With Dementia Sign Legal Documents”

What Games are Best for Brain Health?

Researchers at Columbia University in New York City and Duke University in Durham, North Carolina, recently found that older participants — with an average age of 71 — who were trained to complete computerized crossword puzzles showed more of a cognitive improvement compared with those who were trained to use web-based cognitive video games, reports Money Talks News’ recent article entitled, “Crossword Puzzles or Video Games: Which Better Protects Your Brain?”

In a summary of the study’s findings, Dr. D.P. Devanand, professor of psychiatry and neurology at Columbia, remarked:

“This is the first study to document both short-term and longer-term benefits for home-based crossword puzzles training compared to another intervention. The results are important in light of difficulty in showing improvement with interventions in mild cognitive impairment.”

The researchers explain that mild cognitive impairment is a stage between the cognitive decline that is normal with aging and full-blown dementia. Those with mild cognitive impairment may struggle with memory, language, thinking or judgment.

The researchers went on to note that those with mild cognitive impairment are at a significant risk for dementia, including Alzheimer’s disease.

As part of the study, 107 participants with mild cognitive impairment were trained for 12 weeks in either crossword puzzles or cognitive games.

Follow-up “booster sessions” were then held for up to 78 weeks.

While both forms of training were equally effective early in the course of disease, crossword puzzles were better in the later stages. Those who used crossword puzzles showed less brain shrinkage at 78 weeks.

Dr. Devanand says the study results show that further research on developing a home-based digital therapeutic for delaying Alzheimer’s disease “should be a priority for the field.”

Reference: Money Talks News (Nov. 5, 2022) “Crossword Puzzles or Video Games: Which Better Protects Your Brain?”

How Many Americans Suffer from Dementia?

In a nationally representative cross-sectional study of about 3,500 older adults, 10% (95% CI 9-11) were classified as having dementia and 22% (95% CI 20-24) as having mild cognitive impairment, according to Jennifer Manly, PhD, of Columbia University Irving Medical Center in New York City, and colleagues.

MedPage Today’s recent article entitled “Dementia Strikes One in Ten Americans Over 65” notes that dementia prevalence rates were similar by sex but varied by age, education, and race, and ethnicity, they reported in JAMA Neurology.

The findings are from the first representative study of cognitive impairment in more than 20 years and are based on participants in the Harmonized Cognitive Assessment Protocol (HCAP) project of the ongoing, longitudinal Health and Retirement Study (HRS). HCAP is a cross-sectional random sample of HRS participants who were ages 65 or older in 2016.

“Because the HCAP study is part of the nationally representative and long-running Health and Retirement Study, these data not only show the burden of dementia now, but will be used in the future to track the trends in dementia burden in the decades ahead,” co-author Kenneth Langa, MD, PhD, of the University of Michigan in Ann Arbor, said in a statement.

“Following those trends will be especially important given the likely impact of COVID and other recent population health changes on the risk for dementia in the coming decades,” Langa added.

Of the nearly 10,000 age-eligible HRS participants, roughly 3,500 were selected for HCAP and completed a comprehensive neuropsychological test battery and an in-person interview between June 2016 and October 2017.

Compared with White participants, dementia was more common among Black participants, and mild cognitive impairment was more prevalent among Hispanic participants. The rates rose dramatically with age: 3% of people between ages 65-69 had dementia versus 35% of people ages 90 and older. Every 5-year increase in age led to higher risks of dementia and mild cognitive impairment.

Each additional year of school was also linked with a drop in risks of dementia and mild cognitive impairment. The findings were similar to other recent estimates of dementia prevalence in the U.S.

“With increasing longevity and the aging of the Baby Boom generation, cognitive impairment is projected to increase significantly over the next few decades, affecting individuals, families, and programs that provide care and services for people with dementia,” Manly said in a statement.

The study provides a snapshot in time and cannot assess cognitive impairment incidence or rates of progression among people with mild cognitive impairment, the researchers said.

The HCAP study’s cross-sectional design “does not allow for examination of survival bias, which could inflate prevalence if some groups are living longer with dementia or decrease estimates in groups with higher mortality,” Manly and colleagues added.

Reference: MedPage Today (Oct. 24, 2022) “Dementia Strikes One in Ten Americans Over 65”

Why Does Government Deny Social Security Disability Benefits

Kiplinger’s recent article entitled “3 Main Reasons Why the Government Denies Social Security Disability Benefits” says three main issues are the primary contributors to the high denial rates and prolonged appeals process:

Applicants fail to satisfy work history requirements. Anyone who pays FICA payroll taxes long enough, is typically insured for SSDI. However, that doesn’t mean they’re eligible for benefits. To meet the SSA definition of disability, one must have physical or mental impairments that prevent them from being unable to perform any substantial gainful activity (SGA) for at least 12 months or have a terminal diagnosis. SGA encompasses work performed for pay or profit, and for 2022, the monthly benefit one would receive after qualification is set at $1,350 a month, or $2,260 if you are blind.
Applicants provide incomplete documentation. Detailed medical evidence is required to document a disability and its impact on the person’s ability to perform SGA—it’s a crucial part of the SSDI application. This should include diagnoses, medical tests and results, treatment history, prescription drugs, surgeries, ER and doctor visits and other relevant medical details to show not just that you have a problem, but also that you’ve been receiving regular medical treatment for your issue. This, along with details about how a disability influences your activities of daily living, is especially significant if you have an invisible disability, such as mental disorders, neurological conditions or cognitive dysfunctions caused by injury or disease. Regular monthly treatments and drug therapies with specialists and mental health professionals are an important part of your claim.
Applicants not knowing they have the right to an SSDI representative. The SSA doesn’t tell initial applicants they have the right to retain a representative to assist them. As a result, most people try to navigate the complicated program on their own. You need an advocate to tell the story of your disability and its impact on you and your family. Less than 30% of applicants have an SSDI representative to help them apply. Those individuals are 23% more likely to get their application approved. It also means getting benefits in six months compared with a year or two!

Representatives are taking on more SSDI cases resulting from long COVID symptoms that have exacerbated physical and mental impairments. Long COVID may affect up to 30% of COVID patients, or an estimated 25 million people in the United States, especially those with respiratory disease, diabetes and cognitive issues.

Reference: Kiplinger (July 16, 2022) “3 Main Reasons Why the Government Denies Social Security Disability Benefits”

Can Traveling Help Seniors’ Mental Health?

A study to be published in the October 2022 edition of Tourism Management presents the thoughts of a cross-disciplinary team of experts in both dementia and tourism. Medical News Today’s recent article entitled “’Travel therapy’ may offer treatment for dementia and benefit mental health” reports that the research hasn’t yet been peer-reviewed, but experts think there may be significant benefits of travel for people with dementia, particularly in the areas of mental health and well-being.

Dementia currently has no cure, but some medications and treatments may help control symptoms.

Care is often supportive, including helping those with dementia do as much as they can on their own and helping them have a better quality of life.

Researchers are still working on how to best help those with dementia. One area of interest is how traveling may benefit people with dementia.

The researchers say that the potential benefits of tourism in treating people with dementia are called “travel therapy.” One definition of tourism the researchers used was “visiting places outside one’s everyday environment for no longer than a full year.” They note that the experience of tourism has four main components to it:

Affective Experience: how it impacts feelings, emotions and mood
Cognitive Experience: how it affects thoughts and memories
Conative Experience: how it impacts behavior; and
Sensorial Experience: how it impacts the senses.

The authors concluded that tourism may have a potentially positive impact on well-being and quality of life through a variety of components. However, the literature supporting this in the treatment of dementia is limited.

The study authors also noted that focusing on components of positive psychology, such as what people can do, positive experiences, and well-being may also benefit people with dementia.

They proposed a few options to implement components of tourism to help people with dementia, such as group travel that promotes social interactions or traveling to locations that stimulate the senses.

Reference: Medical News Today (June 30, 2022) “’Travel therapy’ may offer treatment for dementia and benefit mental health”

Can My Pet Help Me in Old Age?

Seniors who own a pet may slow their rate of cognitive decline, according to a preliminary study recently presented at the American Academy of Neurology’s 74th Annual Meeting.

Money Talks News’ recent article entitled “Sharp Mind in Old Age? Thank Your Pet” reports that the positive effect appears to be particularly pronounced for those who own a pet for at least five years.

The study looked at data from 1,369 older adults with an average age of 65.

All had normal cognitive skills at the outset of the study. Of the adults in the study, 53% owned pets, with 32% having had their pet for five years or longer.

After examining cognitive test data, the researchers found that after six years, long-term pet owners had a cognitive composite score that was 1.2 points higher compared than those who did not own pets.

In a press release, study author Dr. Tiffany Braley of the University of Michigan Medical Center in Ann Arbor remarked that the positive impact of pets may stem in part from the animals’ ability to reduce our levels of stress:

“As stress can negatively affect cognitive function, the potential stress-buffering effects of pet ownership could provide a plausible reason for our findings. A companion animal can also increase physical activity, which could benefit cognitive health.”

However, Braley — who also is a member of the American Academy of Neurology — said more research is needed to both confirm the results and identify underlying mechanisms that may be responsible for the link.

Earlier studies have found that the presence of pets can help reduce their owners’ levels of stress and even lower their blood pressure.

Reference: : Money Talks News (May 5, 2022) “Sharp Mind in Old Age? Thank Your Pet”

Estate Planning Blog Articles

Estate & Business Planning Law Firm Serving the Providence & Cranston, RI Areas

What’s the Latest on VA’s Coverage of New Alzheimer’s Drug?

Use Estate Planning to Prepare for Cognitive Decline

Is Low Bone Mineral Density Linked to Dementia?

Does Government Have Financial Assistance for Alzheimer’s?