Dementia is not new. Ancient Greeks and Romans wrote about it, and it even makes an appearance in Shakespeare. But it wasn’t until 1906 that Alois Alzheimer, a German scientist who pioneered investigations into various psychiatric disorders and brain diseases, first presented a case study of a 51-year old German woman, Auguste D., who had been admitted to the hospital in 1903 with symptoms that included reduced comprehension and memory, an inability to speak or understand speech, disorientation, unpredictable behavior, and other behavioral and psychiatric problems. When Dr. Alzheimer conducted an autopsy of his patient, he had the benefit of the latest scientific technology—new techniques for staining brain tissues and greatly improved microscopes. These innovations allowed him to identify many globs of sticky proteins between neurons and tangled bundles of fibrils within cells throughout the cortex, or outer layer of neurons in her brain. Of course, these plaques and tangles are two characteristic features of the disease that now bears his name.
We’ve come quite a long way since then. But, as this report shows, some things remain the same. Scientists are still pushing the bounds of technology to develop new methods and tools that can enhance their ability to learn about AD and other neurodegenerative diseases. Investigators are still combining dogged persistence with imagination and insight to improve their understanding of AD.
With that increased knowledge, however, comes heightened sense of urgency. As our population ages and the number of people age 65 and older steadily climbs, the prevalence of AD and other neuro-degenerative diseases, and the costs to families and society, will continue to rise. Our growing appreciation for the decades-long developmental process of the disease and its complex nature means that we must devise multifaceted preventive and treatment strategies that begin early and continue throughout life.
As we said in the Introduction, good travelers plan for how they will meet future challenges as their journey unfolds. NIH has developed a number of resources that will help it meet these challenges in AD. For example, several NIH Roadmap (http://nihroadmap.nih.gov) initiatives provide innovative infrastructure critical to discovery of the underlying causes and basic biological pathways associated with AD as well as numerous other diseases and conditions:
- The Molecular Libraries and Imaging Initiative offers biomedical researchers access to small molecules that can be used as chemical probes to explore the functions of genes, cells, and biochemical pathways in healthy aging and disease.
- The Building Blocks, Biological Pathways, and Networks Initiative supports exploration of the array of intricate and interconnected pathways that facilitate communication among genes, molecules, and cells; how these pathways are integrated in humans and other complex organisms; how disturbances in these pathways may lead to disease; and what might be done to restore disturbed pathways to their normal functions.
- The Interdisciplinary Research Initiative is helping to address the complex challenges of AD research by encouraging and facilitating interaction among disciplines that is so critical to the study of a complex disease like AD and the development of research and therapeutic technologies. New reward systems and incentives are being developed to promote the work of multidisciplinary teams that bring together the expertise of neuroscientists, psychologists, social scientists, epidemiologists, geneticists, biologists, imaging specialists, biomedical engineers, and others to build synergy to find solutions for AD.
- The Re-Engineering the Clinical Research Enterprise Initiative is supporting work to find the best ways to foster broad community-based participation in clinical studies, including clinical trials. This emphasis is a critical shift for addressing the problems of illnesses like AD, which often require care within the home and in community settings.
- NIA also participates in the activities of the multi-Institute NIH Blueprint for Neurosciences Research. This effort provides a framework to enhance and fund cooperative activities and resources among 15 NIH Institutes and Centers to reduce the burden of nervous system disorders, including AD (Baughman RW et al., 2006). These NIH Institutes and Centers are working to make collaboration a day-to-day part of how NIH does neuroscience. By pooling resources and expertise, NIH can take advantage of economies of scale, confront challenges too large for any single Institute, and develop research tools and infrastructure that will serve the entire neuroscience community.
Participants have built on existing programs to develop an inventory of neuroscience tools funded by NIH and other government agencies, enhance training in the neurobiology of disease for basic neuroscientists, and expand ongoing gene expression database efforts. Advances in the neurosciences and the emergence of powerful new technologies will continue to provide new opportunities for Blueprint activities that will enhance the effectiveness and efficiency of AD and other research across NIH. Systematic development of genetically engineered mouse strains through the Blueprint will be of critical importance to AD research as will training in critical cross cutting areas such as neuroimaging and computational biology.
NIA is also continuing to partner with NIMH, NINDS, and NINR in the AD Prevention Initiative, which is designed to invigorate discovery and testing of new treatments, identify risk and protective factors, enhance early detection methods, and advance basic AD research. This initiative also is aimed at improving patient care strategies and developing approaches to lessen caregiver burdens.
Bringing the best scientific minds together to talk also helps NIA and other NIH Institutes and Centers chart a course for their future efforts in AD research. In October 2006, NIA, NINDS, NIMH, NIBIB, and NINR co-sponsored a conference called “AD: Setting the Research Agenda a Century after Auguste D.” Organizers chose this important centennial anniversary of Dr. Alzheimer’s first presentation on the disease to ask leading AD scientists to provide an overview of the status of current research from their particular perspective and to articulate the critical questions and issues that need to be addressed for continued progress in AD research. Recommendations from the presentations and the discussion sessions will help guide AD research plans and priorities over the next few years.
Another important way AD research moves forward into the future is through collaboration between investigators from public and private sectors to maximize the quality and impact of research. As Part 3 of the Progress Report showed, there is a growing emphasis on developing standardized data collection systems and sharing data and biological samples with other qualified investigators in a timely fashion. As a result, NIH supports much of the basic research and development that is the foundation for new directions and clinical applications sponsored by the industry.
The multi-faceted, collaborative AD research effort described here combines an accelerated search for causes, a vigorous assault on the effects of the disease, and an intensive effort to find ways to interrupt progression or delay onset. This effort sustains the fight against AD and brings us closer to the day when we will be able to successfully manage or even prevent this terrible disease, which robs our older relatives and friends of their most precious possession—their minds.
<< Back | Next >>
