COVID-19 vaccination in the United States, and based on preliminary data the percentage of deaths from COVID-19 that occurred among older adults decreased 15% from 2020 to 2021.374 The impact of COVID-19 can also be seen when examining the number of deaths from COVID-19 for which death certificates also listed Alzheimer’s or another dementia as a cause of death (referred to as a “multiple cause of death”). In 2020 and 2021, 1 in every 10 death certificates listing COVID-19 as the primary cause of death also listed Alzheimer’s disease or another dementia as a multiple cause of death. Among people age 85 or older who died of COVID-19, Alzheimer’s disease or another dementia was listed as a multiple cause of death on 24% of death certificates.374 COVID-19 has clearly had a dramatic effect on mortality from Alzheimer’s and other dementias. What remains unclear is whether and how this will affect the longer-term trend in deaths from Alzheimer’s once the COVID-19 pandemic has subsided. *Data for 2021 are as of February 7, 2022. Created from data from the National Center for Health Statistics.373 2015-2019 Average 2020 2021 Deaths Due to Alzheimer’s and Other Dementias in the United States in 2020 and 2021 Compared with Previous Years* figure 6 Deaths 8,000 6,000 4,000 2,000 0 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 32 Alzheimer’s Association. 2022 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2022;18. 1.1% Created from data from the National Center for Health Statistics.360,375 Percentage 160 140 120 100 80 60 40 20 0 -20 -40 -60 -80 Breast cancer Cause of death Prostate cancer Heart disease Stroke HIV Alzheimer’s disease 145.2% -65.2% -10.5% -7.3% 1.8% Percentage Changes in Selected Causes of Death (All Ages) Between 2000 and 2019 figure 7 age 65 to 74 were not available), meaning that those deaths would not be expected to occur in that year if the individuals did not have Alzheimer’s dementia.364 A more recent study using data from the nationally representative Health and Retirement Study estimated that about 14% of deaths among Americans age 70 and older from 2000- 2009 were attributable to dementia, while only 5% of death certificates listed dementia as the underlying cause of death for this age group in that time period, indicating underreporting on death certificates.369 According to 2014 Medicare claims data, about one-third of all Medicare beneficiaries who die in a given year have been diagnosed with Alzheimer’s or another dementia.370 Based on data from the Chicago Health and Aging Project (CHAP) study, in 2020 an estimated 700,000 people age 65 and older in the United States had Alzheimer’s dementia at death.371 Although some undoubtedly died from causes other than Alzheimer’s, it is likely that many died from Alzheimer’s disease itself or from conditions in which Alzheimer’s was a contributing cause, such as pneumonia. Thus, taken together, the specific number of deaths caused by Alzheimer’s is unknown. To add further complexity, the vast majority of death certificates listing Alzheimer’s disease as an underlying cause of death are not verified by autopsy, and research has shown that 15% to 30% of those diagnosed with Alzheimer’s dementia during life do not have the brain changes of Alzheimer's disease but instead have the brain changes of another cause of dementia (see Table 1, page 6).21,69,229-231 Therefore, an underlying cause of death listed as Alzheimer’s disease may not be accurate. Irrespective of the cause of death, among people age 70, 61% of those with Alzheimer’s dementia are expected to die before age 80 compared with 30% of people without Alzheimer’s dementia.372 Mortality and Morbidity 33 State Number of Deaths Mortality Rate 56.0 Tennessee 3,252 47.6 Texas 10,101 34.8 Utah 980 30.6 Vermont 315 50.5 Virginia 2,631 30.8 Washington 3,585 47.1 West Virginia 832 46.4 Wisconsin 2,390 41.0 Wyoming 238 41.1 U.S. Total 121,499 37.0 Created from data from the National Center for Health Statistics.A7,360 Number of Deaths and Annual Mortality Rate (per 100,000 People) Due to Alzheimer’s Disease by State, 2019 table 5 34 Alzheimer’s Association. 2022 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2022;18. Public Health Impact of Deaths from Alzheimer’s Disease In the two decades prior to the COVID-19 pandemic, although deaths from other major causes have decreased significantly or remained approximately the same, official records indicate that deaths from Alzheimer’s disease increased significantly. Between 2000 and 2019, the number of deaths from Alzheimer’s disease as recorded on death certificates more than doubled, increasing 145.2%, while deaths from the number one cause of death (heart disease) decreased 7.3% (Figure 7).360,375 The increase in the number of death certificates listing Alzheimer’s as the underlying cause of death probably reflects both a real increase in the actual number of deaths from Alzheimer’s due in large part to Alzheimer’s becoming a more common cause of death as the population ages, as well as increased reporting of Alzheimer’s deaths on death certificates over time by physicians, coroners and others who assign causes of death.376 State-by-State Deaths from Alzheimer’s Table 5 provides information on the number of deaths due to Alzheimer’s by