107th Congress

Report: Alzheimer's Disease (AD)—Hearing Before the Senate Appropriations Subcommittee on Labor, HHS, Education—April 30, 2002

Members Present

Senators Tom Harkin (D-IA), Chairman, and Arlen Specter (R-PA), Ranking Member.

Witnesses

Panel One: Richard Hodes, Director of the National Institute on Aging (NIA), National Institutes of Health (NIH)

Panel Two: Orien Reid, Chair, Board of Directors, Alzheimer's Association; Marilyn Albert, Chair, Medical and Scientific Advisory Council, Alzheimer's Association; Carol and Gene Gratz, East Central Iowa Chapter, Alzheimer's Association; and David Hyde Pierce, Actor.

Purpose of Hearing: The purpose of the hearing was to 1) celebrate Alzheimer's disease (AD) Capitol Hill Day, 2) to hear an update on the state of the science in AD research, 3) to provide a forum for representatives of AD associations across the Nation to express their support for additional funding for AD research, and 4) to highlight the condition of those who suffer from the disease and those who care for them.

Summary: Both Senators Specter and Harkin stated their support for research on this disease, and they acknowledged that the AD Association would like to see NIH spend $1 billion for AD research. Senator Specter mentioned the upcoming press conference on the Human Cloning Prohibition Act of 2002. This legislation would prohibit reproductive cloning, provide specific permission for therapeutic cloning (referred to as "nuclear transfer" by Senator Harkin), require therapeutic cloning protocols to comply with the Common Rule, and impose civil and criminal penalties for violations of the prohibition. Senators Specter and Harkin agreed on the need to keep open this research option, especially for AD research, and, in particular, suggested that the many AD Association representatives raise this issue with the Senate and House Members they visit-especially the Senator from Tennessee, Bill Frist. Senator Harkin emphasized the need to put a human face on this disease for the Congress.

Opening Statements

Dr. Hodes noted that, until very recently, preventing or curing AD was considered, at best, a distant possibility. Now, the picture is considerably brighter. Through laboratory and population-based scientific studies, we have identified a number of risk factors for AD, including both genetic and possible lifestyle factors. NIA is currently supporting 18 AD clinical trials, seven of which are large-scale prevention trials. These trials are testing agents such as estrogen, anti-inflammatory drugs, and anti-oxidants for their effects on slowing progress of the disease, delaying AD's onset, or preventing it altogether. Recent studies indicate that elevated blood levels of the amino acid homocysteine, already considered a risk factor for cardiovascular disease, are associated with an increased risk of developing AD. Other studies have indicated that other factors already implicated in heart disease, such as elevated cholesterol levels and high blood pressure, may also contribute to the risk for AD. The use of statins, the most common type of cholesterol-lowering drugs, may lower the risk of developing AD. Other research has identified three genes which cause early onset AD. Recent genetic studies suggest that as many as four additional and as yet unidentified genes may also be risk factors. Finding new risk factor genes will help identify pathways affecting the development or progression of AD and may eventually lead to better predictors of the disease even before it is diagnosed. It also appears that exercise can be a preventive factor for the development of AD.

Ms. Reid discussed her own family history. She noted that the AD Association is asking Congress to increase the funding to AD research this year by $200 million, but they hope to see a $1 billion figure one day soon as well. Carol and Gene Gratz discussed their personal history with the disease, both as patient and care-giver. Dr. Albert discussed her personal research and noted that it has shown that there are mechanisms to detect brain changes that can indicate years in advance that individuals may be at risk, though the speed of an individual's progression to debilitating disease is not predictable. She emphasized that it is important to intervene before substantial damage is already done to the brain. Mr. Pierce, representing the AD Association, spoke to the promise of research to find a breakthrough for this disease. He urged the Senators to maintain their commitment to medical research funding for AD and to increase funding to $1 billion a year "as soon as possible."

Questions

Senator Harkin

• To Dr. Hodes: There is an immunization study on mice aimed toward the development of a possible vaccine that was halted because there was an outbreak of meningitis in the subjects in the study. Can you comment on this? Is there still ongoing research on immunization possibilities? Since the initial studies appeared that the research was safe, how did this happen?
• To Dr. Albert: I understand you are working on a book about AD? Dr. Albert responded that the book (entitled, "Keep Your Brain Young,") is out; and it emphasizes the need to stay physically and mentally active.
• To Drs. Hodes and Albert: Are you specific about certain things that people can do like take certain vitamins, or the effect of stress as a risk factor? What can you tell us about certain substances like ginko biloba and other dietary supplements? Are there studies underway about these dietary supplements? Senator Harkin then asked the audience to raise their hands if they take any of these on a daily basis. Virtually the entire audience raised their hands. Senator Harkin reiterated that, "we need to get going on this [dietary supplement] research, but that is for NCCAM to move ahead on."
• Is it true that AD can only be accurately diagnosed at autopsy?
• To Dr. Hodes: You said there are 18 clinical trials underway. Which ones look most promising?
  
  Senator Specter
  
  
• To Dr. Hodes: I would be interested, to the extent you can be consistent with your scientific methodology, give us some estimate as when there might be a cure for Alzheimer's Disease? With regard to prevention, the prospects are good that the scientific research has a realistic possibility of preventing AD?
• To Dr. Hodes: When we talk about raising the funding this year by approximately $50 million, from $600 million to $650 million, what ammunition can you give Senator Harkin and myself to use with our colleagues in the Senate as to why that increase ought to be given? What can you tell us which we can pass on to the other Members of the Senate? What can you accomplish with $1 billion that you can't accomplish with $650 million? Dr. Hodes, I'd like you to see if you can quantify this more specifically.
• To Mr. Pierce: With your family background, what do you think of NIH research to prevent AD?
• Do you think it would be desirable to randomly test for the AD gene? Mr. Pierce's response was that for an individual with a significant family history (parents and siblings, several relatives in the same generation), perhaps those individuals might be tested. Because disease progression varies widely, random testing is not advisable.
• Senator Sepcter urged the witnesses and audience to support nuclear transplantation and speak to Congressional Members. (This was echoed by Senator Harkin.)

Prepared by Anne Houser/OD/OLPA, May 1, 2002