normal aging. But, much of what we have already learned tells us that many sleep disturbances are caused by conditions sometimes as easy to reverse as a simple adjustment of medication. A continuing priority for NIA is training for research and academic leadership in aging and geriatric medicine, including particular emphasis on bringing more persons from minority backgrounds into these fields. A new initiative we will continue into 1992 is support for minority Ph.D. candidates for dissertation studies. We need to provide more encouragement and support for developing scientists at every level of education. All programs fostered by the National Institute on Aging have the longrange goal of ensuring that we Americans can look forward to a healthier and more productive life into our older years, and in the process, alleviate the tremendous health care costs that threaten to burden the older individual and society as a whole. Mr. Chairman, the FY 1992 budget request for the National Institute on Aging is $348,558,000. I will be happy to answer any questions. BIOGRAPHICAL SKETCH OF DR. T. FRANKLIN WILLIAMS Birthdate: November 26, 1921 Belmont, North Carolina Education: B.S., University of North Carolina, 1942; M.A., Columbia University, 1943; M.D., (Cum Laude) Harvard Medical School, 1950 Professional History: 1983 to present, Director, National Institute on Military Service: 1983 to present, Assistant Surgeon General, U.S. Societies and Associations: American Association for the Advancement County Medical Societies; Gerontological Society of America; New York Honors and Awards: Phi Beta Kappa; Alpha Omega; Sigma Xi; Member, Publications: Author of over 131 publications in journals and books. QUESTIONS SUBMITTED BY THE SUBCOMMITTEE Senator HARKIN. Dr. Williams, we will submit some questions to you in writing. I had some on life expectancy and a science article last fall that I wanted to talk to you about. I have a vote, and I only have about 5 minutes left to go make it. So, we will just dismiss this panel, and the next panel can come forward. I will be back in about 10 minutes or so, something like that. [A brief recess was taken.] [The following questions were not asked at the hearing, but were submitted to the Department for response subsequent to the hearing:] QUESTIONS SUBMITTED BY THE SUBCOMMITTEE ALZHEIMER'S Question. Last year the Committee provided a significant increase for Alzheimer's with funding for all of the several Institutes at NIH approaching $200 million total and almost $156 million at the National Institute on Aging. This is up from the $78 million the Institute spent on Alzheimer's in FY 1989 and the $91 million the Institute spent on Alzheimer's in FY 1990. In spite of these increases, I understand that the professional judgement of the Alzheimer's community is that the NIA budget for Alzheimer's should be set at $290 million in FY 1992. Tell the Committee what we are learning about the causes and the possible cures for Alzheimer's. Do there continue to be scientific opportunities in the Alzheimer's field that should be pursued beyond the 1992 funding levels? Answer. Research beyond that planned for FY 1992 could be pursued in many aspects of Alzheimer's disease research--basic biological studies into its etiology, means to improve upon early diagnosis, and the development of treatment approaches. There are basically two approaches to the treatment of Alzheimer's disease. The first involves slowing, stopping, or reversing the biological processes that lead to the decreased functioning of nerve cells by compounds, such as nerve growth factor, that target the neurodegenerative process itself. Only very recently has information become available which indicates that we may be close to understanding some of the processes leading to cell death in Alzheimer's disease. Thus, it may take some time to develop compounds which are directed to these processes. The other approach attempts to increase the functioning of Alzheimer's disease patients and ameliorate both the cognitive and non-cognitive behavioral symptoms. This may be through drugs or other compounds which facilitate the neural functioning of remaining neurons or which bypass the compromised systems, or by behavioral methods which help the patient use his or her available faculties to the fullest. NIA is encouraging and supporting the discovery, development, and testing of new pharmacological treatments and behavioral procedures directed toward relieving the symptoms of the disease and increasing the functioning of the patient. One area in Alzheimer's disease treatment research to receive immediate emphasis would be preclinical drug studies. Once a potential drug is developed, it must be carefully tested under laboratory conditions, often using animal systems, to determine its efficacy before moving the drug to clinical trial studies in patients. Determination of toxicity after the biological activity of the compound has been assessed is also necessary. Toxicological tests must determine that there are not likely to be immediate or major deleterious effects on organ systems before the compound can be given to humans. The development of these resources would facilitate screening compounds in animal models and would ensure that the development of new compounds for treating Alzheimer's disease would proceed to clinical testing as rapidly as possible. Regarding research into the causes of Alzheimer' disease, it is characterized by neuropathological features known as amyloid plaques and neurofibrillary tangles: these are abnormal proteins and are the central lesions in the brains of Alzheimer's disease victims. A long-standing question has been whether the amyloid plaques and tangles represent causes or only parallel symptoms of some undetected disease process. We are now approaching the answer to this question. Detailed studies of two families in which Alzheimer's disease is inherited has revealed a defect in the gene for the precursor of the amyloid protein. The significance of this result is that it is the first time any case of Alzheimer's disease has been traced to a cause. Although this exact defect probably does not cause the majority of Alzheimer's disease, the significance of these recent findings is that the amyloid plaques of Alzheimer's disease could represent the central causative event of the disease. Another unanswered question in Alzheimer's disease is the cause of dysfunction and eventual death of neurons. This may be the most important issue, since it represents irreversible damage to the brain. Recently, amyloid beta protein was shown to have both growth-promoting and toxic effects on neurons in cell culture, depending on the developmental stage of the cells and the concentration of the protein. With respect to the early diagnosis of Alzheimer's disease, the objective is to develop reliable multi-dimensional diagnostic procedures and instruments for identification. Advances would improve the correlation between clinical signs and the neuropathology discussed above and would allow patients, families, and physicians to know what they are dealing with and how to better plan for the future. Research has been funded on the use of non-invasive imaging techniques for diagnosis and is part of an overall effort to support the development and improvement of biological markers for diagnosis of Alzheimer's disease. HEALTH AND RETIREMENT SURVEY Question. Last year the Committee provided some additional funding and urged the NIA to continue planning for the Health and Retirement Survey. I understand that the planning phase of this survey is underway and that a cohort of Americans between the ages of 57 and 61 will be selected and tracked until their deaths to learn of changing trends in the older population. What important findings does the Institute expect to learn from this survey? Answer. An award for a cooperative agreement was made in September 1990 to the University of Michigan to support the Health and Retirement Survey. The first year of the study includes an intensive planning phase, and the study is now five months into that phase. The first meeting of the monitoring committee was held March 5. The survey will likely focus on individuals who are initially between the ages of 51 (or 53) and 61. About 8,000 households will be included in the survey, yielding a sample of about 14,000 persons. The first interviews for this study are planned for April 1992. This study will provide policy-makers and researchers with important and timely information concerning the role of key factors affecting the causes and consequences of retirement. Included in the study will be questions regarding health condition and disability status, work history, economic situation, pension policies, employer retirement incentives, family structure and family responsibilities. Researchers will be able to model the retirement decision-making process with data from this study. Much needed information focusing on the causes and consequences of retirement for women and minority groups will be collected as part of this study. As findings emerge they will provide the necessary information base for federal and private sector retirement policies. They will assist in evaluating current policies aimed at allowing those who wish to continue working to have the maximum opportunity to do so. Retirement decisions can affect activities and financial resources for up to three decades beyond the date of retirement. The study will provide data on how people are making these decisions today in light of increased longevity and risk for long term disability. Question. Could this same survey or study be conducted just as appropriately by the Agency for Health Care Policy and Research? Answer. The focus of this study includes the role that health care plays on the decision to retire and the consequences of retirement for an individual and his or her family; however, the scope of this study encompasses numerous economic components in addition to health care. It is broader and different than the usual research supported by the Agency for Health Care Policy and Research, although any comments from the agency regarding the planning or implementation of the study would be welcomed. study requires special expertise in areas such as retirement, public and private pensions, labor market behavior of older workers, savings for retirement, migration, housing, work-related disability, aging, and psychosocial characteristics of respondents. This The initial plans for the survey were fully discussed with other federal agencies and a special meeting of the Federal Forum on Aging-Related Statistics was held to discuss the survey; it was decided that NIA should conduct the study. Other federal agencies directly involved with planning the study and represented on the Health and Retirement Survey Monitoring Committee include the Social Security Administration, the National Center for Health Statistics, and the Office of Assistant Secretary for Planning and Evaluation, DHHS. Agencies providing technical assistance include the Health Care Finance Administration, the Pension and Welfare Agency and the National Institute for Occupational Safety and Health. |