Rising Tide: The Impact of Dementia in Canada 2008 to 2038 October 2009

Transcription

1 Rising Tide: The Impact of Dementia in Canada 2008 to 2038 October 2009 North York Corporate Centre 4576 Yonge Street, Suite 400 Toronto, ON M2N 6N4 Tel: (416) Fax: (416)

2 Alzheimer Society of Canada, Canada, 2009 ISBN Suggested citation Smetanin, P., Kobak, P., Briante, C., Stiff, D., Sherman, G., and Ahmad, S. Rising Tide: The Impact of Dementia in Canada 2008 to RiskAnalytica, This report and the analysis it contains was prepared by RiskAnalytica using its Life at Risk simulation platform. Page 2

3 Acknowledgements This report was prepared by RiskAnalytica for the Alzheimer Society of Canada, funded by the Canadian Institute of Health Research (CIHR) and Pfizer. The content and findings of this report are independent and not influenced by the above mentioned. RiskAnalytica would like to acknowledge the contributions, comments, research and input from the following subject matter experts: Dr. Ian McDowell Professor, Faculty of Medicine, Epidemiology and Community Medicine University of Ottawa Dr. Joan Lindsay Epidemiologist Health Surveillance and Epidemiology Division, Public Health Agency of Canada Dr. Mark Oremus Professor, Population and Public Health and Assistant Professor, Department of Clinical Epidemiology and Biostatistics McMaster University Dr. Gary Naglie Clinical Researcher, Geriatric Medicine, Toronto Rehabilitation Institute Clinical Scientist, University Health Network Associate Professor, University of Toronto Dr. B. Lynn Beattie Professor, Division of Geriatric Medicine, Department of Medicine University of British Columbia Dr. Sandra Black Professor of Neurology, Department of Medicine, University of Toronto Neuroscience Program Research Director, Sunnybrook Research Institute Dr. Howard Chertkow Professor, Department of Neurology and Neurosurgery and Medicine McGill University Dr. Carole Cohen Geriatric Psychiatrist and Associate Professor, Department of Psychiatry University of Toronto Dr. Marcus Hollander President, Hollander Analytical Services Ltd. Dr. Walter Wodchis Assistant Professor, HPME, University of Toronto Research Scientist, Toronto Rehabilitation Network Adjunct Scientist, Institute for Clinical Evaluative Sciences Dr. Ken LeClair Professor and Chair, Division of Geriatric Psychiatry, Department of Psychiatry Queen s University David Harvey Director, Transitions and Transformation Management Alzheimer Society of Ontario Dr. Vija Mallia Administrator, Castlevie Wychwood Towers Dr. Anne Martin Matthews Scientific Director of the Institute of Aging Canadian Institute of Health Research Dr. Carrie McAiney Assistant Professor, Psychiatry and Behavioural Neurosciences McMaster University Dr. Raymond Pong Research Director, Centre for Rural and Northern Health Research Laurentian University Page 3

4 Anne Lotz (Former) Client Services Manager, Toronto Central CCAC Dr. Sherry Dupuis Associate Professor, Department of Recreation and Leisure Studies University of Waterloo Dr. Howard Feldman Professor, Neurology University of British Columbia Dr. Serge Gauthier Director of the Alzheimer s Disease Research Unit McGill Centre for Studies in Aging McGill University Susan Thorning Chief Executive Officer Ontario Community Support Association Mary Schulz Director, Information, Support Services and Education Alzheimer Society of Canada Joan Skelton Senior Consultant, Public Policy and Government Relations Alzheimer Society of Ontario Scott Dudgeon Chief Executive Office Alzheimer Society of Canada Patricia Wilkinson Manager, Media and Government Relations Alzheimer Society of Canada Dr. William Reichman President and Chief Executive Officer Baycrest Dr. Ron Keren Clinical Director, University Health Network and Whitby Mental Health Centre Memory Clinics Physician Leader, Psychogeriatric Services, Toronto Rehabilitation Institute Dr. Margaret Macadam Associate Professor, Faculty of Social Work University of Toronto Lyn Krutzfeldt Board of Directors, Alzheimer Society of Canada Frances Morton Coordinator and Knowledge Broker Alzheimer Knowledge Exchange John O Keefe Vice President Alzheimer Society of Canada Margaret Ringland Director of Member Relations and Professional Services Ontario Association of Non Profit Housing and Services for Seniors Fern Teplitsky Community, Long Term Care and Planning Consultant Melusine Klein Director, Brand Development Alzheimer Society of Canada Page 4

5 EXECUTIVE SUMMARY INTRODUCTION AND SCOPE The Problem The aging of the Canadian population has led to an epidemiological shift in disease profile, resulting in age related illnesses such as dementia becoming one of the biggest challenges facing society. Over 480,600 Canadians were estimated to have dementia in 2008, with over 107,610 new cases diagnosed among seniors aged 65 years and older in This has placed a significant burden on health care and social service systems in Canada with over $8.1 billion dollars being spent on direct health care costs alone in The debilitating effects of dementia extend further than the population with the disease to include patient families, formal and informal caregivers, health care providers, the health care system, as well as society as a whole. As a result, the current economic burden of dementia on Canadian society, including direct costs, indirect costs and informal caregiver opportunity costs is over $14.9 billion (according to 2008 estimates). The life and economic consequences of dementia are expected to be further magnified over the next 30 years, when an estimated 1.1 million Canadians will have some form of dementia. The Objective The objective of the current analysis is to estimate the health and economic burden of dementia in Canada over the next 30 years and assess the potential impact of dementia management interventions on reducing this burden. The evaluation of the dementia burden and the impacts of dementia management interventions will help to demonstrate the urgent need for a national dementia strategy in Canada, to quantify, plan and mitigate the effects of this growing illness. Such a national strategy would aid in managing the health, economic and social impacts of this illness through a comprehensive understanding of the epidemiology of the disease and its overall influence on Canadian society. A dementia model was built within RiskAnalytica s Life at Risk platform to estimate the burden of disease over a thirty year time horizon, using historical data inputs. The base model represents a general burden of disease model assuming that the current trends of dementia remain constant. This model allows for measures of health (incidence, prevalence and mortality) and economics (direct and indirect health care costs, taxation revenues lost due to the disease, and caregiver costs) to be compared to what if scenarios staking into account the impacts of various interventions. The Interventions Four intervention scenarios were identified by the Alzheimer Society of Canada and its subject matter experts and used to simulate the potential impacts of dementia prevention and patient and caregiver support programs. The following intervention scenarios evaluated included: 1. Primary Prevention #1 the impact of physical activity programs that aim to increase physical activity by 50% on reducing dementia incidence; 2. Primary Prevention #2 the impact of hypothetical primary prevention programs to delay disease onset by two years; Page 5

6 3. Informal Caregiver Support the impact of hypothetical caregiver support programs on delaying admission to long term care (LTC) and reducing the caregiver burden; and 4. System Navigation the impact of assigning a system navigator to all dementia patients on reducing, costs, delaying admission into LTC and reducing the caregiver burden The differences between the outcomes of the base model and intervention scenarios provide an indication of the value proposition of the proposed interventions. CURRENT AND FUTURE BURDEN OF DEMENTIA IN CANADA Within the next 30 years, approximately 2.8% of the Canadian population is expected to have dementia. These 1.1 million Canadians suffering from dementia in 2038 will place a significant burden on the health care system, adding major challenges to our already scarce resources. Current and Future Dementia Prevalence in Canada, Males and Females, All Age Groups: ,200,000 1,000,000 Dementia in Canada: Prevalence 1,125,184 Prevalence of Dementia Total People with Dementia 800, , , , , ,667 Prevalence of Dementia Females 200,000 Prevalence of Dementia Males The demand for long term care (LTC) beds alone is expected to increase by over 10 times the current demand, leaving dementia patients requiring critical care, to rely on community based services and informal caregivers to meet their complex needs. By 2038, the total number of hours of informal care is expected to increase 3.2 times the current estimate, to approximately 756 million hours per year. An increase in the number of individuals with dementia will also take an extraordinary toll on their caregivers. According to 2009 estimates, informal caregivers are expected to provide over 246 million hours per year of unpaid care to those with dementia. Given that advancing age is a leading risk factor for dementia, as the proportions of adults to seniors in the population changes over time, a decrease in the availability of formal and informal care resources required to tend to the elderly, will further amplify this problem. Over the next 30 years dementia is expected to burden Canadian society with over $872 billion dollars in total direct health costs, unpaid caregiver costs and indirect costs. Page 6

7 Key Findings Incidence According to 2008 estimates, there were over 103,700 newly diagnosed cases of dementia in seniors aged 65 years and older. o Of these approximately 49% were diagnosed with Alzheimer s disease, 21% with vascular dementia with the remaining 30% with other forms of dementia. o Approximately 60% of all newly diagnosed cases of dementia occurred in females. By 2038, the projected number of newly diagnosed cases of dementia for those aged 65 years and older is expected to reach over 257,800 per year (2.5 times the 2008 estimate). o Of these approximately 51% are expected to be diagnosed with Alzheimer s disease, 20% with vascular dementia, with the remaining 29% with other forms of dementia. o Approximately 55% of all newly diagnosed dementias are expected to occur in females. New cases of dementia among Canadians are on the rise. Over the next 30 years the number of newly diagnosed cases is expected to increase 2.5 times the current estimate, reaching over 257,800 new cases. This increase is primarily due to the changing age structure of the Canadian population. Prevalence According to 2008 estimates, over 480,600 Canadians have dementia, which accounts for 1.5% of the total population. o Of these approximately 63% have Alzheimer s disease, 20% have vascular dementia, and the remaining 17% suffer with other forms of dementia. o Approximately 62% of all Canadians with dementia were female. By 2038, there are projected to be over 1.1 million Canadians with dementia, which will account for approximately 2.8% of the total population (2.3 times the 2008 estimate). o Of these approximately 69% will have Alzheimer s disease, 20% vascular dementia, and the remaining 11% will have other forms of dementia. o Approximately 61% of Canadians with dementia will be female. In the next 30 years over 1.1 million Canadians will be living with dementia, accounting for 2.8% of the total population. Mortality Page 7

8 Mortality in the population with dementia was compared to mortality in people of the same age and sex who did not have dementia. In 2008 it was estimated that there were 22,660 deaths in the demented population compared to 6,500 deaths in the population without dementia. By 2038 the number of deaths in the demented population is projected to be 44,360 compared to 16,250 deaths in the population without dementia. Mortality in the population with dementia is over 3 times higher than in the same population assuming they did not have the disease. Across Care Settings According to 2008 estimates, the distribution of Canadians 65 years and over with dementia across each care setting was: o 45.4% residing in LTC. o 33.3% receiving community care services. o 21.3% receiving no formal care. By 2038, the projected prevalence of Canadians 65 years and over with dementia is expected to be distributed across care settings as follows: o o o 37.6% expected to reside in LTC. 42.7% expected to be receiving community care services. 19.7% expected to be receiving no formal care. Over the next 30 years the excess demand for long term care will increase. With a bed shortage more people with dementia will rely on community care services to meet their complex needs. Page 8

9 Economic Burden The total economic burden of dementia was estimated as the sum of the total direct costs, indirect costs, and opportunity costs to informal caregivers that are attributable to dementia. According to 2008 estimates, the total economic burden of dementia was over $14.9 billion dollars (in 2008 present value terms). Within the next 30 years, the total economic burden of dementia is estimated to be over $872 billion dollars (2008 present value terms). Cumulatively, over the next 30 years dementia will cost Canadian society over $872 billion dollars. Page 9

10 INTERVENTION SCENARIOS The impacts of the proposed intervention scenarios were compared to the base model results to derive the expected value of the interventions. Key value propositions for each of the scenarios are reported below: Impact of physical activity on dementia incidence The short term ( ) impacts of increased levels of physical activity are expected to yield the following results: Over 5,970 new cases of dementia would be averted, a 4.3% reduction from the base model. Over 32,450 fewer Canadians would be suffering from dementia, a 5.1% reduction from the base model. There would be 2,120 fewer deaths within the population with dementia, a 7.6% reduction from the base model. Over 13,570 fewer Canadians over the age of 65 with dementia would be residing in LTC, a 7.4% reduction from the base model. Over 11,690 fewer Canadians over the age of 65 with dementia would be receiving community care, a 5.3% reduction from the base model. A savings of over $5.6 billion dollars to Canadian society (in 2008 present value terms), a 2.4% reduction from the base model. The long term ( ) impacts of increased levels of physical activity are expected to yield the following results: Over 10,750 new cases of dementia would be averted, a 4.2% reduction from the base model. Over 96,410 fewer Canadians would be suffering from dementia, an 8.6% reduction from the base model. There would be 5,420 fewer deaths within the population with dementia, a 12.3% reduction from the base model. Over 36,210 fewer Canadians over the age of 65, with dementia would be residing in LTC, an 8.2% reduction from the base model. Over 41,550 fewer Canadians over the age of 65, with dementia would be receiving community care, an 8.3% reduction from the base model. A savings of over $51.8 billion dollars to Canadian society (in 2008 present value terms), a 5.9% reduction from the base model. Increasing physical activity levels among Canadians is expected to significantly reduce the numbers of new and prevalent cases of dementia over the next 30 years, saving Canadian society over $51.8 billion dollars. Page 10

11 Impact of prevention programs to delay disease onset: The short term ( ) impacts of the second primary prevention are expected to yield the following results: Over 25,950 new cases of dementia would be averted, an 18.9% reduction from the base model. Over 137,500 fewer Canadians would be suffering from dementia, a 21.7% reduction from the base model. There would be 9,790 fewer deaths within the population with dementia, a 35.0% reduction from the base model. Over 57,520 fewer Canadians over the age of 65, with dementia would be residing in LTC, a 31.4% reduction from the base model. Over 49,740 fewer Canadians over the age of 65, with dementia would be receiving community care, a 22.4% reduction from the base model. A savings of over $24.2 billion dollars to Canadian society (in 2008 present value terms), a 10.1% reduction from the base model. The long term ( ) impacts of the second primary prevention are expected to yield the following results: Over 48,400 new cases of dementia would be averted, an 18.9% reduction from the base model. Over 409,640 fewer Canadians would be suffering from dementia, a 36.4% reduction from the base model. There would be 24,670 fewer deaths within the population with dementia, a 55.6% reduction from the base model. Over 153,870 fewer Canadians over the age of 65, with dementia would be in LTC, a 34.8% reduction from the base model. Over 175,860 fewer Canadians over the age of 65, with dementia would be in community care, a 34.9% reduction from the base model. A savings of over $218.6 billion dollars to Canadian society (in 2008 present value terms), a 25.1% reduction from the base model. Delaying the onset of dementia by two years will significantly reduce the numbers of people living with dementia and the number of admissions into long term care over the next 30 years, saving Canadian society over $218.6 billion dollars. Page 11

12 Informal Caregiver Support Programs: (a) Impact of caregiver support programs on admission into LTC The short term ( ) impacts of informal caregiver support programs are expected to yield the following results: Over 8,810 fewer Canadians over the age of 65 years, with dementia would be residing in LTC, a 4.8% reduction from the base model. A savings of over $2.4 billion dollars to Canadian society (in 2008 present value terms), a 1.0% reduction from the base model. The long term ( ) impacts of informal caregiver support programs are expected to yield the following results: Over 14,270 fewer Canadians over the age of 65 years with dementia would be residing in LTC, a 3.2% reduction from the base model. A savings of over $12.2 billion dollars to Canadian society (in 2008 present value terms), a 1.4% reduction from the base model Informal caregiver support programs are expected to significantly reduce the numbers of dementia patients residing in long term care facilities over the next 30 years, saving Canadian society over $12.2 billion dollars. (b) Impact of caregiver support programs on the informal caregiver burden The short term ( ) impacts of informal caregiver support programs are expected to provide a savings of over $10.2 billion dollars to Canadian society (in 2008 present value terms), a 4.3% reduction from the base model. The long term ( ) impacts of informal caregiver support programs are expected to provide a savings of over $50.5 billion dollars to Canadian society (in 2008 present value terms), a 5.8% reduction from the base model. Informal caregiver support programs are expected to reduce the burden placed on informal caregivers saving Canadian society over 50.5 billion dollars over the next 30 years. Page 12

13 System Navigation: (a) Impact of system navigation on admission into LTC The short term ( ) impacts of a system navigator are expected to yield the following results: Over 11,690 fewer Canadians over the age of 65 years with dementia would be residing in LTC, a 6.4% reduction from the base model. A savings of over $3.2 billion dollars to Canadian society (in 2008 present value terms), a 1.4% reduction from the base model. The long term ( ) impacts of a system navigator are expected to yield the following results: Over 19,090 fewer Canadians over the age of 65 years with dementia would be residing in LTC, a 4.3% reduction from the base model. A savings of over $16.2 billion dollars to Canadian society (in 2008 present value terms), a 1.9% reduction from the base model. The implementation of a system navigator is expected to reduce the numbers of patients with dementia residing in long term care facilities over the next 30 years, saving Canadian society over $16.2 billion dollars. (b) Impact of system navigation on the informal caregiver burden The short term ( ) impacts of a system navigator are expected to provide a savings of over $19.8 billion dollars to Canadian society (in 2008 present value terms), an 8.3% reduction from the base model. The long term ( ) impacts of a system navigator are expected to provide a savings of over $97.5 billion dollars to Canadian society (in 2008 present value terms), an 11.2% reduction from the base model. System navigators are expected to reduce the burden placed on informal caregivers saving Canadian society over $97.5 billion dollars over the next 30 years. Page 13

14 FUTURE DIRECTIONS The Rising Tide project has estimated the burden of dementia in Canada over the next 30 years by looking at the impacts of dementia prevention as well as patient and caregiver support programs on reducing the health, financial and societal consequences of the illness. An increase in the incidence, prevalence and mortality can be expected over time. This increase is primarily due to the aging of the Canadian population. The results of the analysis reveal the expected demand for LTC beds for dementia patients over the next 30 years to be over 10 times the current demand. This presents an enormous challenge for LTC facilities (currently at capacity), leaving more dementia patients who require LTC to rely on community care services. This in turn, places an additional burden on the availability of community care resources and the demand on informal caregivers. As the Canadian population ages, there may be fewer resources available to meet the care requirements of the dementia population across all care settings, posing an enormous resource capacity issue as well as an extensive economic burden on society as a whole. The scenarios evaluated within the Life at Risk dementia model provide an indication of how dementia management interventions could potentially reduce the estimated burden. Prevention programs that involve increasing levels of physical activity or those that could delay disease onset, result in fewer new cases of the illness consequently reducing the strain on existing health and economic resources. Support programs for patients and their caregivers are also shown to provide significant benefits in reducing the demand placed on LTC and better equipping informal caregivers to cope and manage their needs as care providers. Page 14

15 TABLE OF CONTENTS EXECUTIVE SUMMARY... 5 INTRODUCTION AND SCOPE... 5 CURRENT AND FUTURE BURDEN OF DEMENTIA IN CANADA... 6 INTERVENTION SCENARIOS FUTURE DIRECTIONS TABLE OF EXHIBITS INTRODUCTION SCOPE OF THE ENGAGEMENT STRUCTURE OF THE REPORT OVERVIEW OF DEMENTIA WHY IS DEMENTIA A PROBLEM APPROACH OVERVIEW OF APPROACH TO MODELING DEMENTIA IN CANADA Validation of Approach and Outcomes LIFE AT RISK METHODOLOGY OVERVIEW OF METHODOLOGY: LIFE AT RISK Overview of general model and assumptions The Structure of The Model The Life at Risk dementia Model, Data and ASsumptions THE CURRENT AND FUTURE BUREN OF DEMENTIA IN CANADA HEALTH BURDEN OF DEMENTIA IN CANADA Number of new cases of dementia in canada Number of people living with dementia in canada Mortality DEMENTIA AND HEALTH CARE UTILIZATION Informal care hours ECONOMIC BURDEN OF DEMENTIA IN CANADA Direct health costs Opportunity costs of informal caregivers Economic disability Indirect costs Economic burden conclusions SCENARIO ANALYSIS OF DEMENTIA INTERVENTIONS PROPOSED INTERVENTION SCENARIOS LIFE AND ECONOMIC IMPACTS OF SCENARIOS CONCLUSIONS GENERAL CONCLUSIONS Page 15

16 6.2 BUSINESS CASE IMPLICATIONS LIMITATIONS FUTURE RESEARCH PRIORITY AREAS GLOSSARY OF TERMS APPENDIX A: BIBLIOGRAPHY APPENDIX B: DATA SOURCES APPENDIX C: DEMENTIA CARE MAP APPENDIX D: ALL CAUSE DEMENTIA RESULTS LIFE TERMS Prevalence Incidence Mortality Disability ALL CAUSE DEMENTIA AND HEALTHCARE UTILIZATION ECONOMIC SIMULATION RESULTS: ALL CAUSE DEMENTIA Direct Health Costs For Patients With All Cause Dementia Opportunity costs of Informal Caregiving for Patients with Dementia Indirect Costs Total Economic Burden Of Dementia SCENARIO 1 IMPACT OF PHYSICAL ACTIVITY ON DEMENTIA INCIDENCE: SIMULATION RESUTLS Life Terms Healthcare Utilization Economic Burden SCENARIO 2: IMPACT OF PREVENTION PROGRAMS TO DELAY DISEASE ONSET: SIMULATION RESULTS Life TermS HealthCare Utilization Economic Burden SCENARIO 3A: INFORMAL CAREGIVER SUPPORT PROGRAMS: IMPACT ON ADMISSION INTO LTC: SIMULATION RESULTS HealthCare Utilization Economic Burden SCENARIO 3B: INFORMAL CAREGIVER SUPPORT PROGRAMS: IMPACT ON THE INFORMAL CAREGIVER BURDEN: SIMULATION RESULTS Economic Burden SCENARIO 4A: SYSTEM NAVIGATION: IMPACT ON ADMISSION INTO LTC: SIMULATION RESULTS HealthCare Utilization Economic Burden SCENARIO 4B: SYSTEM NAVIGATION: IMPACT ON INFORMAL CAREGIVER BURDEN: SIMULATION RESULTS Economic Burden APPENDIX E: ALZHEIMER S RESULTS Prevalence: Incidence: Page 16

17 APPENDIX F: VASCULAR DEMENTIA RESULTS Prevalence: Incidence: APPENDIX G: DETAILED LIFE AT RISK METHODOLOGY APPENDIX H: LIFE AT RISK ECONOMIC FRAMEWORK Page 17

18 TABLE OF EXHIBITS EXHIBIT 1 DEMENTIA RISK FACTORS AND PROTECTIVE FACTORS IDENTIFIED BY THE CGC AND PATTERSON ET AL. (2007) 32 EXHIBIT 2 EXPECTED FUTURE TOTAL CANADIAN POPULATION AS A FUNCTION OF AGE (SIMULATED VALUES): 2008 TO EXHIBIT 3 KEY COMPONENTS OF THE LIFE AT RISK MODEL AND ASSUMPTIONS EXHIBIT 4 LIFE AT RISK MODULES: EXHIBIT 5 DEMENTIA, HEALTH SYSTEM DIRECT COSTS, DEMENTIA CLIENTS IN LTC FACILITY EXHIBIT 6 DEMENTIA, HEALTH SYSTEM DIRECT COSTS, DEMENTIA CLIENTS IN COMMUNITY EXHIBIT 7 DEMENTIA, INFORMAL CAREGIVER HOURS, DEMENTIA CLIENTS IN LTC FACILITY DUE TO DEMENTIA 58 EXHIBIT 8 DEMENTIA, INFORMAL CAREGIVER HOURS, DEMENTIA CLIENTS IN LTC FACILITY DUE TO A COMORBID CONDITION EXHIBIT 9 DEMENTIA, INFORMAL CAREGIVER HOURS, DEMENTIA CLIENTS IN COMMUNITY DUE TO DEMENTIA 58 EXHIBIT 10 DEMENTIA, INFORMAL CAREGIVER HOURS, DEMENTIA CLIENTS IN COMMUNITY DUE TO A COMORBID CONDITION EXHIBIT 11 DEMENTIA, INFORMAL CAREGIVER HOURS, DEMENTIA CLIENTS NOT IN FORMAL CARE DUE TO DEMENTIA 59 EXHIBIT 12 DEMENTIA, INFORMAL CAREGIVER HOURS, DEMENTIA CLIENTS NOT IN FORMAL CARE DUE TO A COMORBID CONDITION EXHIBIT 13 CURRENT AND FUTURE DEMENTIA INCIDENCE IN CANADA, SELECTED YEARS, AGES 65+ BY SEX: EXHIBIT 14 CURRENT & FUTURE DEMENTIA INCIDENCE IN CANADA, AGES 65+ BY SEX: EXHIBIT 15 CURRENT & FUTURE DEMENTIA INCIDENCE IN CANADA, BY YEAR & AGE STRUCTURE FOR THOSE 65+: EXHIBIT 16 CURRENT & FUTURE DEMENTIA PREVALENCE IN CANADA, SELECTED YEARS, TOTAL POPULATION BY SEX: EXHIBIT 17 CURRENT & FUTURE DEMENTIA PREVALENCE IN CANADA, TOTAL POPULATION: EXHIBIT 18 CURRENT & FUTURE DEMENTIA PREVALENCE IN CANADA, TOTAL POPULATION BY SEX: EXHIBIT 19 CURRENT & FUTURE DEMENTIA PREVALENCE IN CANADA, TOTAL POPULATION BY YEAR & AGE STRUCTURE: EXHIBIT 20 MORTALITY OF THE POPULATION WITH DEMENTIA AGAINST THE SAME POPULATION ASSUMING THEY DO NOT HAVE THE DISEASE, AGES 65+, BY SEX: Page 18

19 EXHIBIT 21 MORTALITY OF THE POPULATION WITH DEMENTIA AGAINST THE SAME POPULATION ASSUMING THEY DO NOT HAVE THE DISEASE, AGES 65+: EXHIBIT 22 MORTALITY OF THE POPULATION WITH DEMENTIA AGAINST THE SAME POPULATION ASSUMING THEY DO NOT HAVE THE DISEASE, AGES 65+, BY SEX: EXHIBIT 23 MORTALITY OF THE POPULATION WITH DEMENTIA AGAINST THE SAME POPULATION ASSUMING THEY DO NOT HAVE THE DISEASE, AGES 85+ BY SEX: EXHIBIT 24 MORTALITY OF THE POPULATION WITH DEMENTIA AGAINST THE SAME POPULATION ASSUMING THEY DO NOT HAVE THE DISEASE, AGES 65+, BY YEAR AND AGE STRUCTURE: EXHIBIT 25 DEMENTIA PREVALENCE BY CARE SETTING, AGES 65+: EXHIBIT 26 PREVALENCE OF DEMENTIA BY CARE SETTING, AGES 65+: EXHIBIT 27 DIVISION OF DEMENTIA PREVALENCE INTO CARE SETTINGS, AGES 65+: EXHIBIT 28 SUPPLY OF LONG TERM CARE BEDS AND NUMBER OF BEDS OCCUPIED BY DEMENTIA PATIENTS, AGES 65+: EXHIBIT 29 HOURS OF INFORMAL CARE PER YEAR, LONG TERM CARE (LTC), COMMUNITY CARE (CC), NO FORMAL CARE: EXHIBIT 30 DEMENTIA, TOTAL AND INCREMENTAL DIRECT HEALTH COSTS, LONG TERM CARE (LTC), COMMUNITY CARE (CC), NO FORMAL CARE, AND INFORMAL CARE, FUTURE VALUES: EXHIBIT 31 DEMENTIA, CUMULATIVE TOTAL AND INCREMENTAL DIRECT HEALTH COSTS, LONG TERM CARE (LTC), COMMUNITY CARE (CC), NO FORMAL CARE, AND INFORMAL CARE, 2008 CANADIAN PRESENT VALUES: EXHIBIT 32 DEMENTIA, TOTAL AND INCREMENTAL INFORMAL CARE OPPORTUNITY COSTS AT AVERAGE WAGES, LONG TERM CARE (LTC), COMMUNITY CARE (CC), AND NO FORMAL CARE, FUTURE VALUES: EXHIBIT 33 DEMENTIA, CUMULATIVE TOTAL AND INCREMENTAL INFORMAL CARE OPPORTUNITY COSTS AT AVERAGE WAGES, LONG TERM CARE (LTC), COMMUNITY CARE (CC), AND NO FORMAL CARE, 2008 PRESENT VALUES: EXHIBIT 34 PERCENTAGE OF DEMENTIA PATIENTS DISABLED, BY SEVERITY LEVEL AND MODE OF CARE, AGES EXHIBIT 35 ILLUSTRATES THE TREND IN THE TOTAL NUMBER OF PEOPLE WITH SEVERE DEMENTIA AND THE SUM OF THOSE WITH MILD, MODERATE AND NO DISABILITY. THE SIMULATION RESULTS SHOW THE PREVALENCE OF THOSE WITH SEVERE DEMENTIA CONTINUES TO REPRESENT THE MAJORITY OF TOTAL PREVALENCE OF DEMENTIA OVER THE THIRTY YEAR SIMULATED PERIOD EXHIBIT 35 PREVALENCE OF DEMENTIA BY DISABILITY LEVEL, AGES 65+: EXHIBIT 36 PERCENTAGE OF INFORMAL CAREGIVERS DISABLED, BY SEVERITY LEVEL ACROSS CARE MODES FOR PATIENTS AGES 65+ IN LTC, CC AND NO FORMAL CARE EXHIBIT 37 LOST PRODUCTION (GDP) ATTRIBUTED TO PEOPLE WITH DEMENTIA AND INFORMAL CAREGIVERS, FUTURE VALUES: Page 19

20 EXHIBIT 38 ANNUAL LOST PRODUCTION ATTRIBUTED TO THE DISABILITY DUE TO DEMENTIA AND INFORMAL CARE, FUTURE VALUES: EXHIBIT 39 CUMULATIVE LOST PRODUCTION ATTRIBUTED TO THE DISABILITY DUE TO DEMENTIA AND INFORMAL CARE, 2008 PRESENT VALUES: EXHIBIT 40 ANNUAL WAGE IMPACT OF DISABILITY DUE TO DEMENTIA AND INFORMAL CARE: FUTURE VALUES: EXHIBIT 41 CUMULATIVE WAGE IMPACT OF DISABILITY DUE TO GENERAL DEMENTIA AND INFORMAL CARE: 2008 PRESENT VALUES: EXHIBIT 42 CORP. PROFIT IMPACT OF DISABILITY DUE TO DEMENTIA AND INFORMAL CARE, FUTURE VALUES: EXHIBIT 43 CUMULATIVE CORP. PROFIT IMPACT OF DISABILITY DUE TO DEMENTIA & INFORMAL CARE, 2008 PRESENT VALUES: EXHIBIT 44 ANNUAL REDUCTION IN DOMESTIC DEMAND ASSOCIATED WITH THE DISABILITY DUE TO DEMENTIA AND INFORMAL CARE, FUTURE VALUES: EXHIBIT 45 CUMULATIVE REDUCTION IN DOMESTIC DEMAND ASSOCIATED WITH THE DISABILITY DUE TO DEMENTIA AND INFORMAL CARE, 2008 PRESENT VALUES: EXHIBIT 46 TOTAL PROVINCIAL AND FEDERAL TAXATION REVENUE IMPACT ATTRIBUTED TO DEMENTIA AND INFORMAL CARE, FUTURE VALUES: EXHIBIT 47 CUMULATIVE TOTAL PROVINCIAL AND FEDERAL TAXATION REVENUE IMPACT ATTRIBUTED TO DEMENTIA AND INFORMAL CARE, 2008 PRESENT VALUES: EXHIBIT 48 TOTAL ECONOMIC BURDEN ATTRIBUTED TO DEMENTIA AND INFORMAL CARE, FUTURE VALUES: EXHIBIT 49 TOTAL ECONOMIC BURDEN ATTRIBUTED TO DEMENTIA AND INFORMAL CARE, FUTURE VALUES: EXHIBIT 50 CUMULATIVE TOTAL ECONOMIC BURDEN ATTRIBUTED TO DEMENTIA AND INFORMAL CARE, 2008 PRESENT VALUES: EXHIBIT 51 CHALLIS ET AL. (2002) 24 MONTH DESTINATION OUTCOMES FOR THE INTENSIVE CARE MANAGEMENT SERVICES GROUP (CASES) VS. THE USUAL CARE GROUP (CONTROLS) EXHIBIT 52 SCENARIO 1: PRIMARY PREVENTION #1, IMPACT OF PHYSICAL ACTIVITY ON GENERAL DEMENTIA INCIDENCE: EXHIBIT 53 SCENARIO 2: PRIMARY PREVENTION #2, IMPACT OF DELAYING DISEASE ONSET: EXHIBIT 54 SCENARIO 3 (A): INFORMAL CAREGIVER SUPPORT, IMPACT OF CAREGIVER SUPPORT PROGRAMS ON ADMISSION INTO LONG TERM CARE: EXHIBIT 55 SCENARIO 3 (B): INFORMAL CAREGIVER SUPPORT, IMPACT OF CAREGIVER SUPPORT PROGRAMS ON THE INFORMAL CAREGIVER BURDEN: EXHIBIT 56 SCENARIO 4 (A): SYSTEM NAVIGATOR, IMPACT OF IMPLEMENTING A SYSTEM NAVIGATOR ON ADMISSION INTO LONG TERM CARE: Page 20

21 EXHIBIT 57 SCENARIO 4 (B): SYSTEM NAVIGATOR, IMPACT OF IMPLEMENTING A SYSTEM NAVIGATOR ON INFORMAL CAREGIVER BURDEN EXHIBIT 58 ALL CAUSE DEMENTIA PREVALENCE: EXPECTED VALUE (MALES & FEMALES, BY AGE GROUP: ) 138 EXHIBIT 59 ALL CAUSE DEMENTIA PREVALENCE: 95% LOWER BOUND (MALES & FEMALES BY AGE GROUP: ) 139 EXHIBIT 60 ALL CAUSE DEMENTIA PREVALENCE: 95% UPPER BOUND (MALES & FEMALES BY AGE GROUP: ) 140 EXHIBIT 61 ALL CAUSE DEMENTIA PREVALENCE: EXPECTED VALUE ( MALES, BY AGE GROUP: ) EXHIBIT 62 ALL CAUSE DEMENTIA PREVALENCE: 95% LOWER BOUND ( MALES, BY AGE GROUP: ) 142 EXHIBIT 63 ALL CAUSE DEMENTIA PREVALENCE: 95% UPPER BOUND (MALES, BY AGE GROUP: ). 143 EXHIBIT 64 ALL CAUSE DEMENTIA PREVALENCE: EXPECTED VALUE (FEMALES, BY AGE GROUP: ). 144 EXHIBIT 65 ALL CAUSE DEMENTIA PREVALENCE: 95% LOWER BOUND (FEMALES, BY AGE GROUP: ) 145 EXHIBIT 66 ALL CAUSE DEMENTIA PREVALENCE: 95% UPPER BOUND (FEMALES, BY AGE GROUP: ) 146 EXHIBIT 67 ALL CAUSE DEMENTIA INCIDENCE: EXPECTED VALUE (MALES & FEMALES, BY AGE GROUP: ) 147 EXHIBIT 68 ALL CAUSE DEMENTIA INCIDENCE: 95% LOWER BOUND (MALES & FEMALES, BY AGE GROUP: ) 148 EXHIBIT 69 ALL CAUSE DEMENTIA INCIDENCE: 95% UPPER BOUND (MALES & FEMALES, BY AGE GROUP: ) 149 EXHIBIT 70 ALL CAUSE DEMENTIA INCIDENCE: EXPECTED VALUE (MALES, BY AGE GROUP: ) EXHIBIT 71 ALL CAUSE DEMENTIA INCIDENCE: 95% LOWER BOUND (MALES, BY AGE GROUP: ) EXHIBIT 72 ALL CAUSE DEMENTIA INCIDENCE: 95% UPPER BOUND (MALES, BY AGE GROUP: ) EXHIBIT 73 ALL CAUSE DEMENTIA INCIDENCE : EXPECTED VALUE (FEMALES, BY AGE GROUP: ) EXHIBIT 74 ALL CAUSE DEMENTIA INCIDENCE: 95% LOWER BOUND (FEMALES, BY AGE GROUP ) 154 EXHIBIT 75 ALL CAUSE DEMENTIA INCIDENCE: 95% UPPER BOUND (FEMALES, BY AGE GROUP: ) 155 EXHIBIT 76 ALL CAUSE DEMENTIA MORTALITY: EXPECTED VALUE (MALES & FEMALES, BY AGE GROUP: ) 156 EXHIBIT 77 ALL CAUSE DEMENTIA MORTALITY : 95% LOWER BOUND (MALES & FEMALES, BY AGE GROUP: ) 157 EXHIBIT 78 ALL CAUSE DEMENTIA MORTALITY: 95% UPPER BOUND (MALES & FEMALES, BY AGE GROUP: ) 158 EXHIBIT 79 ALL CAUSE DEMENTIA MORTALITY: EXPECTED VALUE ( MALES, BY AGE GROUP: ) Page 21

22 EXHIBIT 80 ALL CAUSE DEMENTIA MORTALITY: 95% LOWER BOUND (MALES, BY AGE GROUP: ). 160 EXHIBIT 81 ALL CAUSE DEMENTIA MORTALITY: 95% UPPER BOUND (MALES, BY AGE GROUP: ) EXHIBIT 82 ALL CAUSE DEMENTIA MORTALITY: EXPECTED VALUE (FEMALES, BY AGE GROUP: ) EXHIBIT 83 ALL CAUSE DEMENTIA MORTALITY:95% LOWER BOUND (FEMALES, BY AGE GROUP: ) 163 EXHIBIT 84 ALL CAUSE DEMENTIA MORTALITY: 95% UPPER BOUND (FEMALES, BY AGE GROUP: ) 164 EXHIBIT 85 ALL CAUSE DEMENTIA MORTALITY IN POPULATION WITH DEMENTIA REMOVING EXCESS RISK OF DEATH DUE TO DEMENTIA: EXPECTED VALUE ( MALES & FEMALES, BY AGE GROUP: ) EXHIBIT 86 ALL CAUSE DEMENTIA, MORTALITY IN POPULATION WITH DEMENTIA REMOVING EXCESS RISK OF DEATH DUE TO DEMENTIA: 95% LOWER BOUND (MALES & FEMALES, BY AGE GROUP: ) EXHIBIT 87 ALL CAUSE DEMENTIA MORTALITY IN POPULATION WITH DEMENTIA REMOVING EXCESS RISK OF DEATH DUE TO DEMENTIA: 95% UPPER BOUND (MALES & FEMALES, BY AGE GROUP: ) EXHIBIT 88 ALL CAUSE DEMENTIA MORTALITY IN POPULATION WITH DEMENTIA REMOVING EXCESS RISK OF DEATH DUE TO DEMENTIA: EXPECTED VALUE (MALES, BY AGE GROUP: ) EXHIBIT 89 ALL CAUSE DEMENTIA MORTALITY IN POP. WITH DEMENTIA REMOVING EXCESS RISK OF DEATH DUE TO DEMENTIA: 95% LOWER BOUND (MALES, BY AGE GROUP: ) EXHIBIT 90 ALL CAUSE DEMENTIA MORTALITY IN POP. WITH DEMENTIA REMOVING EXCESS RISK OF DEATH DUE TO DEMENTIA: 95% UPPER BOUND (MALES, BY AGE GROUP: ) EXHIBIT 91 ALL CAUSE DEMENTIA MORTALITY IN POP. WITH DEMENTIA REMOVING EXCESS RISK OF DEATH DUE TO DEMENTIA: EXPECTED VALUE (FEMALES, BY AGE GROUP: ) EXHIBIT 92 ALL CAUSE DEMENTIA MORTALITY IN POP. WITH DEMENTIA REMOVING EXCESS RISK OF DEATH DUE TO DEMENTIA: 95% LOWER BOUND (FEMALES, BY AGE GROUP: ) EXHIBIT 93 ALL CAUSE DEMENTIA MORTALITY IN POP. WITH DEMENTIA REMOVING EXCESS RISK OF DEATH DUE TO DEMENTIA: 95% UPPER BOUND (FEMALES, BY AGE GROUP: ) EXHIBIT 94 ALL CAUSE DEMENTIA DISABILITY BY SEVERITY LEVEL (MALES & FEMALES, ALL AGE GROUPS: ) 174 EXHIBIT 95 ALL CAUSE DEMENTIA PREVALENCE OF GOOD FUNCTIONING BY TYPE OF CARE (MALES & FEMALES, ALL AGE GROUPS: ) EXHIBIT 96 ALL CAUSE DEMENTIA PREVALENCE OF MILD DISABILITY, BY TYPE OF CARE ( MALES & FEMALES, ALL AGE GROUPS: EXHIBIT 97 ALL CAUSE DEMENTIA PREVALENCE OF MODERATE DISABILITY: MODE OF CARE (MALES & FEMALES, ALL AGE GROUPS: ) EXHIBIT 98 ALL CAUSE DEMENTIA, PREVALENCE OF SEVERE DISABILITY: MODE OF CARE ( MALES & FEMALES, ALL AGE GROUPS: ) EXHIBIT 99 ALL CAUSE DEMENTIA PREVALENCE: MODE OF CARE (MALES AND FEMALES, ALL AGE GROUPS: ) 179 Page 22

23 EXHIBIT 100 SUPPLY OF LONG TERM CARE BEDS AND NUMBER OF BEDS OCCUPIED BY ALL CAUSE DEMENTIA PATIENTS: EXHIBIT 101 ALL CAUSE DEMENTIA, TOTAL & INCREMENTAL DIRECT HEALTH COSTS, LONG TERM CARE (LTC), COMMUNITY CARE (CC), NO CARE, AND CAREGIVERS, FUTURE VALUES: EXHIBIT 102 ALL CAUSE DEMENTIA, TOTAL & INCREMENTAL DIRECT HEALTH COSTS, LONG TERM CARE (LTC), COMMUNITY CARE (CC), NO CARE, AND CAREGIVERS, 2008 PRESENT VALUES: EXHIBIT 103 ALL CAUSE DEMENTIA, DIRECT HEALTH COSTS, PATIENTS RESIDING IN LONG TERM CARE FACILITIES DUE TO DEMENTIA, BY COST COMPONENT, FUTURE VALUES: EXHIBIT 104 ALL CAUSE DEMENTIA, DIRECT HEALTH COST, PATIENTS RESIDING IN LONG TERM CARE FACILITIES DUE TO DEMENTIA, BY COST COMPONENT, 2008 PRESENT VALUES: EXHIBIT 105 ALL CAUSE DEMENTIA, INCREMENTAL DIRECT HEALTH COST, COMORBIDITY ADJUSTED PATIENTS RESIDING IN LONG TERM CARE FACILITIES, BY COST COMPONENT, FUTURE VALUES: EXHIBIT 106 ALL CAUSE DEMENTIA, INCREMENTAL DIRECT HEALTH COSTS, COMORBIDITY ADJUSTED PATIENTS RESIDING IN LONG TERM CARE FACILITIES, BY COST COMPONENT, 2008 PRESENT VALUES: EXHIBIT 107 ALL CAUSE DEMENTIA, DIRECT HEALTH CARE COST, PATIENTS IN COMMUNITY CARE DUE TO DEMENTIA, BY COST COMPONENT, FUTURE VALUES: EXHIBIT 108 ALL CAUSE DEMENTIA, DIRECT HEALTH COSTS PATIENTS IN COMMUNITY CARE DUE TO DEMENTIA, BY COST COMPONENT, 2008 PRESENT VALUES: EXHIBIT 109 ALL CAUSE DEMENTIA, INCREMENTAL DIRECT HEALTH COSTS, COMORBIDITY ADJUSTED PATIENTS IN COMMUNITY CARE, BY COST COMPONENT, FUTURE VALUES: EXHIBIT 110 ALL CAUSE DEMENTIA, INCREMENTAL DIRECT HEALTH COSTS, COMORBIDITY ADJUSTED PATIENTS IN COMMUNITY CARE, BY COST COMPONENT, 2008 PRESENT VALUES: EXHIBIT 111 ALL CAUSE DEMENTIA, DIRECT HEALTH COST, INDIVIDUALS NOT RECEIVING CARE, BY COST COMPONENT, FUTURE VALUES: EXHIBIT 112 ALL CAUSE DEMENTIA, DIRECT HEALTH COSTS, INDIVIDUALS NOT RECEIVING CARE, 2008 PRESENT VALUES: EXHIBIT 113 ALL CAUSE DEMENTIA, INCREMENTAL DIRECT HEALTH COST, COMORBIDITY ADJUSTED INDIVIDUALS NOT RECEIVING CARE, BY COST COMPONENT, FUTURE VALUES: EXHIBIT 114 ALL CAUSE DEMENTIA, INCREMENTAL DIRECT HEALTH CARE COSTS, COMORBIDITY ADJUSTED INDIVIDUALS NOT RECEIVING CARE, BY COST COMPONENT, 2008 PRESENT VALUES: EXHIBIT 115 ALL CAUSE DEMENTIA, INFORMAL CAREGIVER OPPORTUNITY COSTS AT AVERAGE WAGES, LONG TERM CARE (LTC), COMMUNITY CARE (CC), AND NO CARE, FUTURE VALUES: EXHIBIT 116 ALL CAUSE DEMENTIA, INFORMAL CAREGIVER OPPORTUNITY COSTS AT AVERAGE WAGES, LONG TERM CARE (LTC), COMMUNITY CARE (CC), AND NO CARE, 2008 PRESENT VALUES: EXHIBIT 117 ALL CAUSE DEMENTIA, INFORMAL CAREGIVER OPPORTUNITY COSTS AT MINIMUM WAGES, LONG TERM CARE (LTC), COMMUNITY CARE (CC), AND NO CARE, FUTURE VALUES: Page 23

24 EXHIBIT 118 ALL CAUSE DEMENTIA, INFORMAL CAREGIVER OPPORTUNITY COSTS AT MINIMUM WAGES, LONG TERM CARE (LTC), COMMUNITY CARE (CC), AND NO CARE, 2008 PRESENT VALUES: EXHIBIT 119 LOST PRODUCTION DUE TO DISABILITY ATTRIBUTED TO ALL CAUSE DEMENTIA AND LABOUR FORCE EFFECTS OF INFORMAL CARE, DIFFERENCE BETWEEN THE ABSENCE OF CASE AND THE BASE CASE, FUTURE AND 2008 PRESENT VALUES: EXHIBIT 120 WAGE IMPACT DUE TO DISABILITY ATTRIBUTED TO ALL CAUSE DEMENTIA AND LABOUR FORCE EFFECTS OF INFORMAL CARE, DIFFERENCE BETWEEN THE ABSENCE OF CASE AND THE BASE CASE, FUTURE AND 2008 PRESENT VALUES: EXHIBIT 121 CORPORATE PROFITS IMPACT DUE TO DISABILITY ATTRIBUTED TO ALL CAUSE DEMENTIA AND LABOUR FORCE EFFECTS OF INFORMAL CARE, DIFFERENCE BETWEEN THE ABSENCE OF CASE AND THE BASE CASE, FUTURE AND 2008 PRESENT VALUES: EXHIBIT 122 DOMESTIC DEMAND IMPACT DUE TO DISABILITY ATTRIBUTED TO DEMENTIA AND LABOUR FORCE EFFECTS OF INFORMAL CARE, DIFFERENCE BETWEEN THE ABSENCE OF CASE AND THE BASE CASE, FUTURE AND 2008 PRESENT VALUES: EXHIBIT 123 TOTAL TAXATION REVENUE (PROVINCIAL + FEDERAL) IMPACT ATTRIBUTED ALL CAUSE DEMENTIA AND INFORMAL CARE, DIFFERENCE BETWEEN THE ABSENCE OF CASE AND THE BASE CASE, FUTURE VALUES: EXHIBIT 124 TOTAL TAXATION REVENUE (PROVINCIAL + FEDERAL) IMPACT ATTRIBUTED ALL CAUSE DEMENTIA AND INFORMAL CARE, DIFFERENCE BETWEEN THE ABSENCE OF CASE AND THE BASE CASE, 2008 PRESENT VALUES: EXHIBIT 125 PROVINCIAL TAXATION REVENUE IMPACT ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE, DIFFERENCE BETWEEN THE ABSENCE OF CASE AND THE BASE CASE, FUTURE VALUES: EXHIBIT 126 PROVINCIAL TAXATION REVENUE IMPACT ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE, DIFFERENCE BETWEEN THE ABSENCE OF CASE AND THE BASE CASE, 2008 PRESENT VALUES: EXHIBIT 127 FEDERAL TAXATION REVENUE IMPACT ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE, DIFFERENCE BETWEEN THE ABSENCE OF CASE AND THE BASE CASE, FUTURE VALUES: EXHIBIT 128 FEDERAL TAXATION REVENUE IMPACT ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE, DIFFERENCE BETWEEN THE ABSENCE OF CASE AND THE BASE CASE, 2008 PRESENT VALUES: EXHIBIT 129 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE, FUTURE VALUES: EXHIBIT 130 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE, 2008 PRESENT VALUES: EXHIBIT 131 ALL CAUSE DEMENTIA, INCIDENCE, PREVALENCE, MORTALITY: INTERVENTION SCENARIO VS. BASE CASE (MALES & FEMALES, 65+) EXHIBIT 132 ALL CAUSE DEMENTIA, PREVALENCE ACCORDING TO CARE TYPES: INTERVENTION SCENARIO VS. BASE CASE (MALES & FEMALES, AGES 65+) Page 24

25 EXHIBIT 133 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE (MALES & FEMALES, AGES 65+, FUTURE VALUES) EXHIBIT 134 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE (MALES & FEMALES, AGES 65+, 2008 PRESENT VALUES) EXHIBIT 135 ALL CAUSE DEMENTIA, INCIDENCE, PREVALENCE, MORTALITY: INTERVENTION SCENARIO VS. BASE CASE (MALES & FEMALES, AGES 65+) EXHIBIT 136 ALL CAUSE DEMENTIA, PREVALENCE ACCORDING TO CARE TYPES: INTERVENTION SCENARIO VS. BASE CASE (MALES & FEMALES, AGES 65+) EXHIBIT 137 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE (MALES& FEMALES, AGES 65+, FUTURE VALUES) EXHIBIT 138 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE ( MALES & FEMALES, AGES 65+, 2008 PRESENT VALUES) EXHIBIT 139 ALL CAUSE DEMENTIA, PREVALENCE ACCORDING TO CARE TYPES: INTERVENTION SCENARIO VS. BASE CASE ( MALES & FEMALES, AGES 65+) EXHIBIT 140 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE (MALES & FEMALES, AGES 65+, FUTURE VALUES) EXHIBIT 141 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE (MALES & FEMALES, AGES 65+, 2008 PRESENT VALUES) EXHIBIT 142 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE ( MALES & FEMALES, AGES 65+, FUTURE VALUES) EXHIBIT 143 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE ( MALES & FEMALES, AGES 65+, 2008 PRESENT VALUES) EXHIBIT 144 ALL CAUSE DEMENTIA, PREVALENCE ACCORDING TO CARE TYPES: INTERVENTION SCENARIO VS. BASE CASE (MALES & FEMALES, AGES 65+) EXHIBIT 145 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE ( MALES & FEMALES, AGES 65+, FUTURE VALUES) EXHIBIT 146 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA AND INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE ( MALES & FEMALES, AGES 65+, 2008 PRESENT VALUES) EXHIBIT 147 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA & INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE ( MALES & FEMALES, AGES 65+, FUTURE VALUES: ) EXHIBIT 148 TOTAL ECONOMIC BURDEN ATTRIBUTED TO ALL CAUSE DEMENTIA & INFORMAL CARE: INTERVENTION SCENARIO VS. BASE CASE (MALES & FEMALES, AGES 65+, 2008 PRESENT VALUES) EXHIBIT 149 ALZHEIMER S, PREVALENCE, MALES AND FEMALES, EXPECTED VALUE, BY AGE GROUPS: EXHIBIT 150 ALZHEIMER S, PREVALENCE, MALES AND FEMALES, 95% LOWER BOUND, BY AGE GROUPS: Page 25

26 EXHIBIT 151 ALZHEIMER S, PREVALENCE, MALES AND FEMALES, 95% UPPER BOUND, BY AGE GROUPS: EXHIBIT 152 ALZHEIMER S, PREVALENCE, MALES, EXPECTED VALUE, BY AGE GROUPS: EXHIBIT 153 ALZHEIMER S, PREVALENCE, MALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 154 ALZHEIMER S, PREVALENCE, MALES, 95% UPPER BOUND, BY AGE GROUPS: EXHIBIT 155 ALZHEIMER S, PREVALENCE, FEMALES, BY AGE GROUPS: EXHIBIT 156 ALZHEIMER S, PREVALENCE, FEMALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 157 ALZHEIMER S, PREVALENCE, FEMALES, 95% UPPER BOUND, BY AGE GROUPS: EXHIBIT 158 ALZHEIMER S, INCIDENCE, MALES AND FEMALES, EXPECTED VALUE, BY AGE GROUP: EXHIBIT 159 ALZHEIMER S, INCIDENCE, MALES AND FEMALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 160 ALZHEIMER S, INCIDENCE, MALES AND FEMALES, 95% UPPER BOUND, BY AGE GROUPS: EXHIBIT 161 ALZHEIMER S, INCIDENCE, MALES, EXPECTED VALUE, BY AGE GROUP: EXHIBIT 162 ALZHEIMER S, INCIDENCE, MALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 163 ALZHEIMER S, INCIDENCE, MALES, 95% UPPER BOUND, BY AGE GROUPS: EXHIBIT 164 ALZHEIMER S, INCIDENCE, FEMALES, EXPECTED VALUE, BY AGE GROUPS: EXHIBIT 165 ALZHEIMER S, INCIDENCE, FEMALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 166 VASCULAR DEMENTIA, PREVALENCE, MALES AND FEMALES, BY AGE GROUPS: EXHIBIT 167 VASCULAR DEMENTIA, PREVALENCE, MALES AND FEMALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 168 VASCULAR DEMENTIA, PREVALENCE, MALES AND FEMALES, 95% UPPER BOUND, BY AGE GROUPS: EXHIBIT 169 VASCULAR DEMENTIA, PREVALENCE, MALES, EXPECTED VALUE, BY AGE GROUPS: EXHIBIT 170 VASCULAR DEMENTIA, PREVALENCE, MALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 171 VASCULAR DEMENTIA, PREVALENCE, MALES, 95% UPPER BOUND, BY AGE GROUPS: EXHIBIT 172 VASCULAR DEMENTIA, PREVALENCE, FEMALES, EXPECTED VALUE, BY AGE GROUPS: EXHIBIT 173 VASCULAR DEMENTIA, PREVALENCE, FEMALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 174 VASCULAR DEMENTIA, PREVALENCE, FEMALES, 95% UPPER BOUND, BY AGE GROUPS: Page 26

27 EXHIBIT 175 VASCULAR DEMENTIA, INCIDENCE, MALES AND FEMALES, EXPECTED VALUE, BY AGE GROUP: EXHIBIT 176 VASCULAR DEMENTIA, INCIDENCE, MALES AND FEMALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 177 VASCULAR DEMENTIA, INCIDENCE, MALES AND FEMALES, 95% UPPER BOUND, BY AGE GROUPS: EXHIBIT 178 VASCULAR DEMENTIA, INCIDENCE, MALES, EXPECTED VALUES, BY AGE GROUP: EXHIBIT 179 VASCULAR DEMENTIA, INCIDENCE, MALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 180 VASCULAR DEMENTIA, INCIDENCE, MALES, 95% UPPER BOUND, BY AGE GROUPS: EXHIBIT 181 VASCULAR DEMENTIA, INCIDENCE, FEMALES, EXPECTED VALUE, BY AGE GROUPS: EXHIBIT 182 VASCULAR DEMENTIA, INCIDENCE, FEMALES, 95% LOWER BOUND, BY AGE GROUPS: EXHIBIT 183 VASCULAR DEMENTIA, INCIDENCE, FEMALES, 95% UPPER BOUND, BY AGE GROUPS: Page 27