Letter to Hon. Xavier Becerra, Secretary of the U.S. Department of Health & Human Services - Cortez Masto Urges Biden Administration to Establish National Strategy to Prevent Alzheimer's Dementia-Related Diseases

Letter

Dear Secretary Becerra:

As Members of Congress who deeply care about the health of our constituents and the economic
health of our country, we write today to urge you to establish an ambitious national goal to
prevent Alzheimer's disease and related dementias (ADRD) and to develop a plan to achieve this
goal. We believe that reducing the prevalence of dementia should be a priority for the
Department of Health and Human Services (HHS).

The proportion of the U.S. population over 55 years old is increasing at rate 20 times larger than
the growth rate of the collective population younger than 55. Our nation's health care system is
not adequately investing in keeping people healthy into their highest ages.

Alzheimer's disease is a public health crisis that is expanding, with a projected increase to nearly
14 million people in the U.S. with the disease by 2050. In 2021, Alzheimer's and other
dementias will cost the nation $355 billion, including $239 billion in Medicare and Medicaid
payments combined. Unless we prevent, slow or adequately treat this disease, in 2050,
Alzheimer's is projected to cost more than $1.1 trillion (in 2021 dollars) -- a three-fold increase
both in government spending under Medicare and Medicaid and in out-of-pocket spending.

Communities of color and women bear a disproportionate burden. Black Americans are two to
three times more likely, and Latinos are 1.5 times more likely, to have Alzheimer's disease than
non-Hispanic whites. By 2030, nearly 40% of Americans diagnosed with Alzheimer's are
projected to be Black or Latino. Two-thirds of people living with Alzheimer's and other
dementias are women.

A significant percentage of dementia could be delayed - and in some cases prevented - by early
intervention. In fact, studies indicate that more approximately 40 percent of dementia cases are
potentially preventable by addressing risk factors including hypertension, diabetes, depression,
physical inactivity, poor nutrition, smoking, hearing loss, traumatic brain injury, sleep, air
pollution and social isolation and loneliness. Many of these factors are also demonstrated risk
factors for COVID‐19.

A recent survey of healthcare providers found agreement that a healthy lifestyle benefits brain
health and adults in the general population are likely to engage in brain-healthy behaviors if they
know it may help maintain their mental functioning. Further, 81% of people over the age of 40
would be motivated to have a healthier lifestyle to potentially slow the progression of the disease
if they found out they had dementia at an early stage.

Unfortunately, our current healthcare system falls woefully short:
 Only 16 percent of Medicare beneficiaries report having received a cognitive
assessment.
 Fewer than half of primary care physicians include screening for memory and thinking in
their standard protocol.
 Primary care practitioners do not routinely promote dementia risk reduction.
 Less than half of beneficiaries with a dementia diagnosis in their medical record are even
informed of their diagnosis by their doctor.

The Centers for Medicare and Medicaid Services (CMS) and other HHS agencies have
significant opportunity to encourage providers, payers to proactively address brain health among
non-symptomatic, healthy adults and to strengthen early detection and risk-reducing
interventions that delay disease progression. These levers include payment reforms, quality
incentives, and beneficiary and provider education. Importantly, overcoming barriers to access
and improving the quality of cognitive assessments would be an important first step that already
can be taken within the existing authorities.

Public health plays a critical role. The Centers for Disease Control and Prevention's
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), and
specifically its Alzheimer's and Healthy Aging Program are working to bolster infrastructure,
health promotion, and coordination of healthy-aging efforts across CDC and provide a more
proactive focus on addressing the social determinants of health and health disparities.

And more must be done to prioritize health equity. We urge HHS to ensure that health systems,
researchers, and advocates have access to accurate and representative data on Alzheimer's and
related dementias and the social determinants of health that shape Alzheimer's risk. Further,
HHS should make targeted investments -- through the National Institutes of Health (NIH) and the
Health Resources and Services Administration (HRSA) -- in research and treatment infrastructure
in communities with a high burden of Alzheimer's and related dementias, including a strong
focus on community health centers which are underequipped to provide dementia related health
services.

Early intervention to prevent, diagnose, treat or slow the progression of Alzheimer's disease and
related dementia would result in substantial savings to the U.S. health care system and to
families. One estimate projected that delaying the onset of Alzheimer's by five years would
reduce Medicare and Medicaid spending by $121 billion over the first five years. In 2030 alone,
the savings would total $47 billion. In the first 10 years, Medicare would save a cumulative $345
billion, and Medicaid would spend $189 billion less.

This call for a national prevention strategy is widely supported. More than 190 national
organizations and top experts are calling for a national dementia prevention goal and an
accountable plan to reach that goal that addresses health equity gaps. Supporters of this national
goal include UsAgainstAlzheimer's, Volunteers of America, the American Federation of
Teachers, American Heart Association, National Urban League, YMCA of the USA,
AARP, UnidosUS, the National Kidney Foundation, the Southern Christian Leadership
Conference, HADASSAH, and the Milken Institute.

On July 19, the National Alzheimer's Project Act (NAPA) Advisory Council took an important
first step. The Council formally recommended that a fifth goal be added to the National Plan to
reduce the burden of risk factors for Alzheimer's and related dementias and recommended
commensurate strategies and tactics. An aggressive 15 percent reduction in risk factors could
result in as many as 1.2 million fewer people living with ADRD in 2050. We urge you accept
this recommendation, add this goal to the National Plan Update, and prioritize its implementation
within HHS.
The Administration and the scientific community have identified Alzheimer's disease as a
priority area -- with good reason. Dementia ranks at the top of fears of aging Americans and is on
track to triple by 2060. It is the only top-10 cause of death in the U.S. with no known cure. It is
also one of the most urgent health inequities of our time.

We are confident that a clear goal and strategic investments in health equity will benefit families,
society, our economy, and the nation. Any success in preventing or delaying dementia will
reduce financial pressure on Medicare and Medicaid; decrease the cognitive, physical,
psychological, and economic burden of those living with symptoms and their caregivers;
improve the quality of life of patients and caregivers; and increase the likelihood that adults can
thrive and remain independent into their later years.

Thank you for your commitment to ensuring our nation's health. We urge you to redouble that
commitment by setting a national goal to prevent Alzheimer's disease. We look forward and
stand ready to work with you to support this effort and appreciate your attention to this important
matter.

Sincerely.

Shelley Moore Capito
United States Senator

Debbie Stabenow
United States Senator

Edward J. Makey
United States Senator

Marco Rubio
United States Senator

Sherrod Brown
United States Senator

Kevin Cramer
United States Senator

Robert Menendez
United States Senator

James Lankford
United States Senator

Jacky Rosen
United States Senator

James M. Inhofe
United States Senator

Tina Smith
United States Senator

Roger F. Wicker
United States Senator

Richard Blumenthal
United States Senator

Catherine Cortez Masto
United States Senator

Amy Klobuchar
United States Senator

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