Witnesses appearing before the Senate Subcommittee on Labor-HHS-Education Appropriations
Richard J. Hodes, M.D.
National Institute on Aging
March 9, 2005
William Beldon, Deputy Assistant Secretary, Budget
INTRODUCTION
ALZHEIMER’S DISEASE AND THE NEUROSCIENCE OF AGING
OTHER AGING-RELATED RESEARCH
HEALTH COMMUNICATIONS AND PROMOTION
DEMOGRAPHY
INTRODUCTION
Mr. Chairman and Members of the Committee:
The NIA is requesting an FY 2006 budget of $1,057,203,000, an increase of $5,213, 000, or 0.5 percent over the comparable FY 2005 appropriation.
Thank you for this opportunity to participate in today’s hearing. I am Dr. Richard Hodes, Director of the National Institute on Aging, and I am pleased to be here today to tell you about our progress making and communicating scientific discoveries that will improve the health and well-being of older Americans.
There are today approximately 35 million Americans ages 65 and over, according to the U.S. Bureau of the Census, and this number is expected to rise dramatically in the coming decades. The mission of the National Institute on Aging (NIA) is to improve the health and well-being of these older Americans through research. In support of its mission, the Institute conducts and supports an extensive program of research on all aspects of aging, from the basic cellular and molecular changes that occur as we age, to the prevention and treatment of common age-related conditions, to the behavioral and social aspects of growing older, including the demographic and economic implications of an aging society. In addition, the NIA is the lead federal agency for research related to the all-important effort to prevent and treat Alzheimer’s disease (AD). Finally, our education and outreach programs provide vital information to older people across the Nation on a wide variety of topics, including living with chronic conditions, maintaining optimal health, and caregiving.
ALZHEIMER’S DISEASE AND THE NEUROSCIENCE OF AGING
AD is a devastating condition with a profound impact on individuals, families, the health care system, and society as a whole. Approximately 4.5 million Americans are currently battling AD, with annual costs for the disease estimated to exceed $100 billion.1 Moreover, the rapid aging of the American population threatens to increase this burden significantly in the coming decades: By the year 2050, the number of Americans with AD could rise to some 13.2 million, an almost three-fold increase.2
These statistics lend an urgency to the NIA’s efforts to better understand, prevent, and treat AD, and in the past year, we have made several important steps forward. For example, a priority for the NIA is to identify risk factors for AD, as interventions that impact the effect of a risk or preventative factor could potentially delay the onset of the disease or prevent it altogether. Results from several recent studies have associated diabetes, which affects about one in five persons over age 60 years,3 with increased risk of cognitive impairment, including AD, raising the possibility that prevention strategies for diabetes may also have major consequences for preventing or delaying AD.
Evidence is also mounting that lifestyle choices may affect risk of AD. In one recent study, older dogs on a regimen of regular physical exercise and mental stimulation and a diet fortified with plenty of fruits, vegetables, and vitamins performed better on cognitive tests and were better able to learn new tasks than dogs in a “control group.” Although the results of this study need to be replicated in humans, they do provide evidence that diet and mental exercise may protect against late-life cognitive decline, and that they may work more effectively in combination than by themselves.
An area of some controversy has been the effects of hormonal influences on cognitive aging in women, with some studies demonstrating a decreased risk for AD among users of hormone therapy and others, notably the Women’s Health Initiative Memory Study (WHIMS), showing that post-menopausal women on certain regimens were actually at higher risk for cognitive decline. The risks and benefits of hormone therapy remain under study. One new avenue of inquiry is the use of selective estrogen receptor modulators (SERMs) to prevent cognitive decline. SERMs mimic estrogen’s actions in some tissues but block the action of the body’s naturally occurring estrogen in others, offering the benefits of traditional hormone therapy with fewer potential health risks. In a recent study, the SERM raloxifene (Evista®), frequently prescribed for the prevention and treatment of osteoporosis, appeared to reduce the risk of cognitive impairment in postmenopausal women. More research is needed, but this is a promising area of research.
The first NIH AD prevention trial, comparing the effects of vitamin E and donepezil (Aricept®) in preventing AD in people diagnosed with mild cognitive impairment (MCI), often a precursor condition to AD, recently concluded. Preliminary data indicate that people with MCI taking donepezil were at reduced risk of progressing to AD for the first 18 months of the 3-year study when compared with their counterparts on placebo. The reduced risk of progressing from MCI to a diagnosis of AD disappeared after 18 months, and by the end of the study, the probability of progressing to AD was the same in the two groups.
NIA is currently supporting over 20 additional AD clinical trials, including large-scale prevention trials, which are testing agents such as anti-inflammatory drugs, statins, homocysteine-lowering vitamins, and anti-oxidants for their effects on slowing progress of the disease, delaying AD’s onset, or preventing the disease altogether. Trials are also assessing interventions for the behavioral symptoms (agitation, aggression, and sleep disorders) of people with AD. The Institute also supports the development of new agents for AD prevention and treatment, including chemical compounds to validate new drug targets, an activity with relevance to the “Molecular Libraries” area of the NIH Roadmap.
This year, we have moved forward with two major AD initiatives. The Alzheimer’s Disease Neuroimaging Initiative, a longitudinal, prospective, natural history study of normal aging, mild cognitive impairment, and early AD to evaluate neuroimaging techniques such as magnetic resonance imaging (MRI) and positron emission tomography (PET), was funded at its full level September 2004, with funding also identified for several ancillary studies. This ambitious initiative is being implemented jointly with several other NIH Institutes, academic institutions, and industry partners, and exemplifies the potential for scientific discovery that is the goal of the NIH Roadmap component on Public-Private Partnerships.
The NIA is accelerating the pace of Alzheimer=s disease genetics research with its AD Genetics Initiative, a major new program to speed the creation of a large repository of DNA and cell lines from families with multiple AD cases. The goal of this initiative is to develop the resources necessary for identifying the remaining late-onset AD (LOAD) risk factor genes, associated environmental factors, and the interactions of genes and the environment. To aid recruiting efforts, the NIA Alzheimer’s Disease Education and Referral Center worked closely with the Alzheimer’s Association as well as several academic partners to publicize the initiative.
In addition to AD, the NIA supports research on other neurological diseases, including Parkinson’s disease, frontotemporal dementia, and prion diseases. For example, NIA investigators, along with researchers from the National Institute of Neurological Disorders and Stroke, were part of an international research team that identified a mutation that is believed to be the most common genetic cause of Parkinson's disease identified to date. This discovery could lead to the development of a test to detect the mutation in individuals at risk.
OTHER AGING-RELATED RESEARCH
Diseases of aging continue to affect many older men and women, seriously compromising their quality of life. Diseases and conditions currently under study at the NIA include:
Anemia. Recently, NIA investigators found an overall prevalence of anemia of 11 percent in men and 10.2 percent in women ages 65 years and older, with prevalence increasing dramatically over age 85. The American Society of Hematology (ASH) has worked closely with several NIH institutes to establish a research agenda on anemia in the elderly. An ASH workshop, “Clinical Implications of Anemia in the Elderly,” was held in March 2004 to establish a research agenda on anemia in the elderly; a report of this workshop will be published in the journal Blood in spring 2005. Program staff from NIA and several other NIH Institutes participated in the ASH workshop and will work collaboratively to identify research priorities. In addition, the NIA is developing an initiative to stimulate a broad range of research on anemia in the elderly that will inform efforts to decrease the associated functional impairment, morbidity and decreased survival.
Obesity. According to the National Health and Nutrition Examination Survey, some 64 percent of U.S. adults are either overweight or obese. Overweight and obesity are linked with an array of conditions, including diabetes, osteoarthritis, and cardiovascular disease. As we age, we tend to gain fat, which may interfere with the work of tissues in which it accumulates. For example, marrow in most bones becomes partially or wholly replaced by adipose (fat) cells, and fat accumulates around and infiltrates the bundles of muscle fibers in muscles of the limbs and trunk. The accumulation of fat in the muscle appears to be doubly dangerous, interfering with both mechanical function of the muscles and insulin sensitivity. The NIA is planning an initiative to stimulate research exploring adipogenesis in aging – i.e., the origin of the increased propensity to form fat cells, and its impact on tissues and systems. This area of research has the potential to broadly impact our understanding of both the decline in function of individual tissues in the musculoskeletal system, and the frequently seen changes in glucose metabolism and insulin sensitivity with age.
Elder Abuse and Mistreatment. Many older Americans are vulnerable to mistreatment, including physical and psychological abuse, neglect, and financial exploitation. However, the scope of the problem remains unknown. The National Research Council (NRC), at the request of the NIA, established a Panel to review risk and prevalence of elder abuse and neglect. The Panel’s 2003 report, Elder Mistreatment. Abuse, Neglect, and Exploitation in an Aging America, outlines a number of key priorities, including the development of operational definitions of elder mistreatment and the development of reliable and valid measures of prevalence. To that end, the NIA is planning a pilot program to develop the tools to accurately assess the prevalence of elder abuse, a necessary first step in developing interventions.
HEALTH COMMUNICATIONS AND PROMOTION
Last year, the NIH launched NIHSeniorHealth.gov, a unique web site developed by NIA and the National Library of Medicine and geared toward the health needs of older adults. In its first year, the site was extremely successful, attracting some 380,000 unique visitors and garnering over three million page views. It was the only web site to receive an “Industry Innovators Award” from the International Council on Active Aging. A Spanish-language version of the site is currently under development.
Meals on Wheels Initiative. During a 2002 Congressional hearing, it was recommended that NIA and the Administration on Aging (AoA) work together to disseminate research-based consumer education materials to the thousands of seniors who participate in the Meals-on-Wheels (MOW) program. In participation with AoA, NIA conducted focus groups with the MOW Association of America to identify the types of information of greatest interest to MOW’s clients and the best ways to deliver such information. Now, a new booklet entitled “Take Your Medicines the Right Way – Everyday!”is being made available to MOW providers for their clients free of charge. The booklet is in easy-to-read language and covers important steps to help ensure safe and effective medication use.
DEMOGRAPHY
As the percentage of Americans over age 65 increases, profound societal changes will likely occur. NIA-supported researchers are exploring the changing demographic, social, and economic characteristics of the older population. The results of this research often have important implications for public policy. A major source of demographic data on aging is the Health and Retirement Study, a biennial survey of more than 22,000 Americans over age 50, which provides data for researchers, policy analysts, and program planners who are making major policy decisions that affect retirement, health insurance, saving and economic well-being. In 2004, the NIA added a cohort of “Early Baby Boomers” to this study; this will provide crucial information on the savings, retirement, and health behaviors of tens of millions of Americans now approaching retirement age.
Thank you for the opportunity to testify before this Subcommittee. I would be happy to answer any questions you may have.
- Data from the Alzheimer’s Association. See also Ernst, RL; Hay, JW. “The U.S. Economic and Social Costs of Alzheimer’s Disease Revisited.” American Journal of Public Health 1994; 84(8): 1261 – 1264. This study cites figures based on 1991 data, which were updated in the journal’s press release to 1994 figures. (Back to text.)
- Hebert, LE et al. “Alzheimer Disease in the U.S. Population: Prevalence Estimates Using the 2000 Census.” Archives of Neurology August 2003; 60 (8): 1119 – 1122. (Back to text.)
- See http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm. Statistics are taken from the 1999-2001 National Health Interview Survey and 1999-2000 National Health and Nutrition Examination Survey (estimates projected to year 2002). (Back to text.)
