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NATIONAL INSTITUTE ON AGING

STATEMENT OF DR. T. FRANKLIN WILLIAMS, DIRECTOR

BUDGET REQUEST Senator HARKIN. Dr. Williams, back to you now.

Your funding request of $348.5 million is 7.7 percent more than 1991. The Aging Institute enjoyed the largest percentage increase in 1991 compared to 1990 of any institute, due largely to the increases for Alzheimer's research initiated by this committee.

So, Dr. Williams, we are delighted to have you with us again today and look forward to hearing your statement. Please proceed.

Dr. WILLIAMS. Thank you very much, Senator Harkin. It is really a pleasure to present some of our recent accomplishments and outline our future directions and plans, including our use of the funds that Congress has given us.

The research funded by the National Institute on Aging is crucial for keeping suffering, disability, and medical expenditures for older Americans from increasing in magnitude with the

graying of America. Older people can age and remain healthy. This gives us the challenge to identify and reduce risks leading to disease and cost of long-term care. Our ultimate goal is to assure independence and a high quality of life throughout the lifespan.

ALZHEIMER'S DISEASE Alzheimer's disease is certainly our highest priority, and we coordinate research efforts with other institutes, including the National Institute of Neurological Disorders and Stroke, and several others. This disease, as you well know, is currently responsible for disability and misery in up to 4 million older Americans and their families costing them and society an estimated $80 billion annually. A high percentage of those of us alive today will be at risk for this disease in the next century unless we can stop this terrible condition.

We are making rapid and significant progress in understanding the disease, particularly its biochemical defects and possibilities for treatment. In terms of understanding the basic biochemical defects, we learn more all the time about genetic roles. For example, a recent publication identified a specific mutation in the amyloid protein gene which is associated with the damage in Alzheimer's disease. In terms of the makeup of both the amyloid protein that causes the damage at the cellular level and the neurofibrillary tangles, which are the other major pathological finding, we are learning more almost every week about the nature of these proteins. This gives us insights into understanding how we might intervene in the production of these proteins and prevent their progress.

In terms of treatment, we have just concluded a very thorough clinical trial of the drug tetrahydroaminoacridine, or THA, and the results will be published very shortly and available to the scientific medical community. I, myself, do not have the results yet, but will have them very shortly.

We are moving ahead to encourage and develop clinical trials on other potential intervention agents for Alzheimer's disease. Work with nerve growth factors has now progressed from animal research to clinical trials, and we are working with other metabolic intervening agents and agents that affect brain vascular function.

We have a real prospect of identifying medications that will delay the progress of this disease, if not halt it entirely. I agree with Dr. Goldstein's comments earlier when he was speaking of Parkinson's disease and Alzheimer's disease, that our first major goal is really to delay the progress of this disease. For example, if we could simply delay the progress of Alzheimer's disease by 5 or 6 years, we could cut in one-half the numbers and costs of this dis

ease.

BURDEN OF PHYSICAL FRAILTY

Another area that is equally important is that of the burden of physical frailty in older people where the costs are estimated to be between $50 and $80 billion a year. These disabilities include hip fractures, the problems of osteoporosis, and other causes of disability causing loss of independence, including visual and hearing impairments.

It is increasingly evident that one is never too old for prevention or reduction of frailty. In one study supported by our Institute, which received wide notice this past year, 90-year-old nursing home residents showed a remarkable improvement in muscular function and ability to walk through muscle-strengthening exercises, including a documented marked increase in muscle mass. One of our emphases in physical frailty is to intervene to strengthen muscles, improve balance, and modify use of medications. In this area among others, we are giving particular attention to research related to women because of their longer lifespan and because they suffer disproportionately from disorders such osteoporosis and incontinence.

We are also expanding our attention to changes in the vascular system associated with aging which may underlie changes found in other organ systems including the brain. There is, in addition, very promising basic research showing that there are nonproliferative genes which act in a balanced way with genes which promote proliferation in cells. These nonproliferative genes, at least some of them, can counteract the effects of oncogenes, or in other words, cancer promoting genes, under certain circumstances. What we are seeing at the cellular level is a balance of proliferative and nonproliferating influences which may allow us to intervene with cancer. This is a very exciting finding at the cellular and molecular biological level relating to aging.

Just a couple of other brief comments. With the participation of other Federal agencies, we are providing funds for the new health and retirement survey, which was approved by the last Congress.

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We continue to have a major interest in training and career development, as do many of the other NIH components. The Pepper Centers for Research and Training are a major support in this aspect.

Senator HARKIN. How many are established now?
Dr. WILLIAMS. Three have been established.
Senator HARKIN. Three.

Dr. WILLIAMS. We have funded three Geriatric Research and Training Centers which we call Pepper Centers. The last Congress authorized Pepper Centers for Independence in Older Americans, and we expect to fund four of those this year.

Senator HARKIN. Four out of the five.

PREPARED STATEMENT

Dr. WILLIAMS. We expect to fund at least four.

I might just add that we have initiated a dissertation support program for minority students working toward Ph.D.'s and this has received considerable interest.

As you stated, our budget request is $348,558,000, and I am very eager to proceed to questions.

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I am pleased to be able to present to you accomplishments recently

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achieved by the research programs of the National Institute on Aging (NIA), as

well as outline current plans and the directions charted for future research.

We work to coalesce scientific opportunities in order to address major

challenges in aging and the critical national needs to alleviate suffering,

disability, and medical expenditures.

But more importantly, our research is

crucial for keeping these problems from increasing in magnitude with the

"graying" of America.

Demographically, America is predicted to experience

marked growth in the older age groups because of the maturation of the baby

boom generation, and also potentially because of beneficial changes in the

personal lifestyle of Americans, including a more healthy diet, increased

exercise, and a reduction in smoking.

The demonstrated fact that older adults

can age and remain healthy highlights the challenging need to identify and

reduce health risks leading to disease, disability and resulting long-term

care requirements. NIA-supported studies on aging have evolved to a higher

level of intensity; now more than ever we are presented with the opportunity

to promote Independence and reduce disability in later life.

Statistics on the growth of the older population tell a compelling story:

currently, more than 30 million persons are over 65 years of age; about 3

million are over 85 years of age.

This over-85 group, whom we often call the

"oldest old," is the fastest growing segment of the American population:

in

1987 medical expenses for this oldest old group averaged $9,178 per person

with Medicare contributing over a third of that cost, compared to $3,728 per

person in the age 65 to 69 group.

Unless we can develop, through research and

its benefits, means to prevent and effectively treat the major causes of

disability in old age, the total cost of care for just those aged 85 and more

are projected to rise in real dollars from the $9.2 billion spent in 1987 to

over $50 billion in the year 2040.

NIA's ultimate goals of research are to

assure independence and a high quality of life throughout the life span.

As one of the highest priorities for the NIA, research on Alzheimer's

disease will be supported at a level of $155 million in FY 1992.

This disease

is currently responsible for disability and misery in up to four million

Americans and their families, costing them and society as a whole well over

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$80 billion in direct health care and other costs annually. The prevalence of

dementia, the most common form of which is Alzheimer's disease, increases with

age; some recent estimates indicate that up to 47% of those over age 85 are

afflicted.

The marked growth over the next 50 years of the older population

may result in up to a five-fold increase in dementia patients along with

associated health-care costs.

• We have made significant progress in understanding this disease.

Researchers investigate and learn more about the biochemical defects

responsible for the diagnostic hallmarks of Alzheimer's disease--the amyloid

plaques and the neurofibrillary tangles within the brain.

A recent finding

shows that a fragment of the amyloid protein molecule, which may support the

growth of nerve cells at low concentrations, has at higher concentration a

major toxic effect upon nerve cells.

Also, genetic studies will continue to

develop information on the association between two subtypes of Alzheimer's

disease and genes located on chromosomes 19 and 21.

Regarding progress in treatment, we recently completed the patient

accrual/data gathering phase of an important clinical trial, conducted within

our Alzheimer's Disease Research Centers and at other sites, of the drug known

as THA.

It is expected that results will soon be published and available to

the scientific and medical community. This well designed and executed study

has already begun to serve as a model for future trials of new promising

agents.

We also concentrate efforts on more accurately diagnosing and

assessing the progress of Alzheimer's. Special effort is being made to find

positive markers of the disease, using innovative techniques from molecular

biology to search for abnormalities in non-neural tissue.

Researchers are

also utilizing sophisticated imaging techniques to improve the diagnostic

utility of MRI, PET, and CT scanning. This will allow for differentiation

between early stage Alzheimer's and other neurological and psychiatric

illnesses and better ensure correct treatment of the patient's condition.

The burden of care for the Alzheimer patient is tremendous - financially,

emotionally, and physically.

Our substantial research in long term care

demonstrates that such burdens often make the caregivers "hidden patients,"

often needing outside assistance and support to maintain their own health and

functioning.

We have just released a new request for grant applications to

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