management personnel. Proposals are reviewed by the pertinent Administrative 147 TUESDAY, APRIL 16, 1991. NATIONAL INSTITUTE ON AGING WITNESSES DR. T. FRANKLIN WILLIAMS, DIRECTOR, NATIONAL INSTITUTE ON AGING DR. WILLIAM F. RAUB, DEPUTY DIRECTOR, NATIONAL INSTITUTES OF HEALTH DR. GENE COHEN, DEPUTY DIRECTOR, NATIONAL INSTITUTE ON AGING DAVID L. CHICCHIRICHI, EXECUTIVE OFFICER, NATIONAL INSTITUTE ON AGING KARYN S. ROSS, BUDGET OFFICER, NATIONAL INSTITUTE ON AGING DENNIS P. WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET, OFFICE OF THE SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES Mr. NATCHER. We take up next the National Institute on Aging. We have Dr. Williams. Mr. NATCHER. Dr. Williams, it is a pleasure to have you back before the committee again. Before you give us your statement, tell us who you have with you at the table. INTRODUCTION OF WITNESSES Dr. WILLIAMS. On my right, I have Dr. Cohen, Deputy Director. On my left, Ms. Karyn Ross, Budget Officer, and David Chicchirichi, Executive Officer. And, of course, Dr. Raub and Mr. Williams. Mr. NATCHER. Go right ahead. OPENING STATEMENT Dr. WILLIAMS. Mr. Chairman, it is really a pleasure to present some of our accomplishments in research on aging and outline future directions and plans. The research funded by the NIA is crucial for keeping suffering, disability and medical expenditures for older Americans and their families from increasing in magnitude with the graying of America. We know from research findings, as well as from experience, that people can age and remain healthy. This gives us the challenge to identify and reduce risks leading to disease, disability and costly long-term care. Our primary goal is to assure or restore independence and a high quality of life throughout the life span. ALZHEIMER'S DISEASE Alzheimer's disease is our highest priority. NIA conducts and supports the major portion of research on Alzheimer's disease and coordinates the efforts of other Institutes and the Department of Health and Human Services Council on Alzheimer's Disease and the Centers, as well as the Congressionally-mandated Advisory Panel on Alzheimer's Disease. 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 $90 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. My goal, which I truly think is possible, is to do just that before the year 2000. We are making rapid and significant progress in understanding the disease, particularly its biochemical defects and the possibilities for treatment. At the basic biochemical level, there is, first, new evidence about the role of genetic abnormalities. A recent study reports that in two affected families, a mutation or change in the gene specific for the amyloid protein which is associated with damage and death of nerve cells in Alzheimer's disease. We have also learned more about how this amyloid protein may cause such damage: A fragment of this protein which may have growth-promoting effects on nerve cells in small amounts, when released in larger amounts, appears to be very toxic to cells. One treatment possibility would be to find a drug or compound which would inhibit the excessive release of this fragment. There is a report in today's New York Times, a very thorough article on the aging brain, which includes a comment on newer evidence on the direct effects of this amyloid protein in animal studies in interfering with animal memory. It will of course need confirmation, but this is a major step forward. One of the directions for therapy would clearly be to find a drug or compound which would inhibit the excessive amounts of this protein and its effect. We are moving ahead to support the development of other drugs and compounds like nerve growth factors which we think will have even more potential value, and are establishing a network of sites for conducting more clinical trials. We have the real prospect of identifying medications which will delay the progress of this disease, if not halt it entirely. If we could delay its onset or progress by five years, we could cut in half the burdens and costs of this dis ease. PHYSICAL FRAILTY Another area that is highly important is that of the burdens of physical frailty in older persons, with disabilities causing loss of independence, including falls, hip fractures, osteoporosis, urinary incontinence, and visual and hearing impairments. Physical frailty is estimated to cost between $50 billion and $80 billion a year. It is increasingly evident that one is never too old for prevention or reduction of such frailty. Our research support for clinical trials to reduce frailty includes such emphasis on exercise and other efforts to improve strength, balance and gait, including minimizing or modifying the use of medications. In one of the studies supported by our Institute, which received wide notice this year, a group of frail 90-year-old residents of a nursing home showed remarkable improvements in muscle mass and function and ability to walk, through muscle-strengthening exercises. In this area, among others, we are giving particular attention to research related to women, who have a longer life span and suffer disproportionately from some of these chronic, disabling conditions. We have also started a special initiative on frailty in older minority populations. BASIC RESEARCH ON AGING We are expanding our attention to changes in the vascular system with aging, which may underlie changes in other organ systems including the brain. At the basic level, there is very promising research showing that there are non-proliferative genes which act in a balanced way with genes which promote cell growth and proliferation. At least some of these non-proliferative genes become more active in aging cells, and can counteract the effects of oncogenes, that is, cancer-promoting genes. What we are learning about these interactions may help us intervene to stop the development of cancers. We are supporting research on problems of sleep and are coordinating the work of the Congressionally-mandated Sleep Commission. With the participation of other Federal agencies, we are providing funds and managing a new health and retirement survey, as approved by the last Congress. We continue to have a major concern about research training and career development in the fields of aging and geriatrics. The new initiative for the Claude D. Pepper Older Americans Independence Centers is a major step forward in this aspect; we expect to fund the first four such centers this fiscal year. Mr. Chairman, the fiscal year 1992 budget request for the National Institute on Aging is $348,558,000. I will be happy to answer any questions. [The statement of Dr. Williams follows:] |