Alzheimer’s, known mostly for the memory loss and confusion it causes, may be the nation’s third-most deadly killer, according to a study that suggests many more Americans die from the disease than is known.

As many as a half-million people in the U.S. are killed by Alzheimer’s each year, or about five times more than the 83,494 now cited on death certificates, the research found. Many people fail to understand the destruction from Alzheimer’s disease, which is fatal when it impairs parts of the brain that control basic functions like breathing and swallowing.

Heart disease and cancer remain the top U.S. killers. Alzheimer’s, though, would replace respiratory disease as No. 3 based on the study results, up from No. 6. The findings should increase urgency to spend more on research on an illness that’s becoming more common as the population ages, Bryan James, the lead author and an epidemiologist at Rush University Medical Center in Chicago. It already costs more than $200 billion a year to care for patients with the disease, he said.

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