Hours. Subcommittee will come to order. I apologize for the dee lay we have a series of votes and very one later too. I do want to get right to it. I want to thank you for being here. We open todays hearings there are 47 Million People in the world living with alzheimers. And other forms of de meng men shah. More than the entire population of spain according to a report by the alzheimers disease international. The number of victims who have alzheimers is projected to or likely to double every 20 years so we are in a race like few other diseases because it is proliferating so fast throughout the globe. And according to dr. Marie menard, who we will hear from, the number is estimated to grow to 115 million by 2050 as populations around the world age, although there is early onset as l but predominantly it is one of the byproducts of all of us ages and there seems to be a higher proclivity the older one gets. Its been estimated that once someone reaches 85, the chance of some form of dementia is one out of two. Its a very serious problem. The total cost of addressing this is 818 billion. But as early as next year it is estimated that this cost will rise to at least 1 trillion. Thats per year. It will go up from there. As we all know, alzheimers is a cruel disease robbing its victims of their memories and their identities. Robbing their family and friends of the person they know and love. It is excruciatingly painful for someone who lose themselves gradually. I have spoken myself to many individuals, especially those who are early onset who have young families and are dealing with the agony that they know it is progressing. There is no cure. There are drugs, five of them so far and others that are in the pipeline that treat symptoms, but theres no actual cure. And so it is very tough. It takes a very heroic person to cope and manage with that. We also know that the families have to deal with a very painful ordeal as well. The caregivers, the loved ones, the family and the friends. In 1999 along with congressman now senator marquis i cofounded the Correctional Task force on alzheimers which i still cochair today to bring this disease to the forefront of the congressional agenda. To advance support for federal research and to increase awareness. The task force worked in partnership with the Alzheimers Association to unanimously pass the national alzheimers project act which established a variety of experts to work with the secretary of hhs to assess and address Alzheimers Research, institutional services, and home and Community Based care with the goal to identify a cure or disease modifying therapy for dementia by 2025. Today there are over 170 members of the house and senate in the task force. This year we work very hard in a bipartisan way to get an increase of some 414 million to the Alzheimers Research funding at nih. Under hhs appropriations chairman extraordinary leadership the fiscal year 2018 was enacted and passed in september of this year including the 400 million increase for Alzheimers Disease Research at the National Institutes of health. This would bring total funding to 1. 8 billion, currently funded at 1 poipt 4 billion,. And nih spending is almost tripled since fiscal year 2015 when 589 million was allocated for such research. Shockingly the majority of people with alzheimers or other forms of dementia have not received a diagnose diagnose diagnosis. Never up able to access the care and treatment of symptoms that they so desperately need. This is true in the developed world, but its even truer in the developing world. Michael points out in his testimony today that detection and diagnosis are a stubborn problem everywhere. Research shows that most people currently living with dementia have not received a formal diagnosis he will testify, and high Income Countries, 20 to 50 of dementia cases are recognized and documented in primary care. This treatment gap is great ner low and middle Income Countries without a diagnosis there cant be treatment, care, or organized support or the opportunity to volunteer for clinical research. Even when alzheimers or other forms of dementia are diagnosed, care is too often fragmented, uncoordinated and unresponsive to the needs of People Living with this. Condition. The response introduced the Health Outcome planning education or hope for alzheimers act of 2015 to provide Medicare Coverage for Care Planning session for patients newly diagnosed with alzheimers disease. For family caregivers or legal representatives. In recognition of this the legislation garnered 310 bipartisan cosponsors. Ultimately medicare adopted an amended version of the hope of actually an improvement for final rule for calendar year 2017s physician fee scheduled. It robs the victims not only of their memories, but also their awareness, but also their lives. In the american journal of Public Health, Research Survey years of life lost between the number of deaths between 1995 and 2015, annual deaths due to alzheimers complications in the u. S. Rose from 20,607 in 1995 to 110,568 in 2015. During that period alzheimers rose from the 14th leading cause of death among ailments in this country in 1995 to number six in 2015. For the record, this is my fourth hearing ive chaired on alzheimers disease. On june 23rd in 2011 we held a hearing on the global strategy to combat the Devastating Health and Economic Impacts of alzheimers. On november 21st we held a hearing on the g 8 dementia summit and beyond. In 2014 on the actual summit report from the g 8 and now in todays hearing of course. Todays hearing is intended to examine the existing potential options for prevention and treatment of this often this always devastating disease. And the statistic cited earlier likely will be more worse in developing countries if they have accurate records of victims and of deaths. As our hearing testimony will demonstrate, there is hope for alzheimers patients, their families and friends. There is a surge for research. For example, Research Team from columbia universitys Medical Center in 2013 said they had traced alzheimers to the early developmental stages. A discovery that they believe could lead to more effective treatments. In science translational medicine two years ago, australian researchers planed a none invasive Ultrasound Technology that clears the brain of neuro toxic plaques, structures that are responsible for cognitive function. By 2016 scientists at the university of zurich said they were amazed to find that their patients treated with the highest dose of april antibiotic drug witness today will tell us more about these and other advances that again the United States is walking point in the world. In this and we had two tremendous witnesses and experts who are doing their best and their staffs to make sure that we get their sooner rather than later. I would also point out for the record this congress ive joined my colleagues in introducing the bold act which would establish centers of excellence and it is designed to really take this to the next to have congressional support for this effort in a robust way. Ive also reintroduced a law passed last year in the house t. Deals with the wandering issue. We know that when alzheimers or autism individuals have the bracelet, theyre found usually within 30 minutes. When they dont and they go wandering, it can be catastrophic if not a cause of death from drowning and a whole host of other reasons if they are not rescued from that wandering. Next week i will reintroduce the global rain health act to increase research on prevention and treatment of autism. And alzheimers and other forms of dementia. This legislation which i first introduced in 2015 would encourage the building of treatment capacity for these Brain Disorders among caregivers in developing countries and support and increase International Cooperation and implementation of strategies on prevention and treatment. Id like to now yield to the doctor for any opening comments. Thank you, mr. Chairman. Thank you for having this hearing. It obviously is incredibly important. Anytime you can say neuro toxic plaques in congress, thats a good day. As a physician. So im trained in internal medicine and taking care of many alzheimers patients. The urgency of addressing this issue and looking for ways to mitigate the disease but ultimately looking for ways to reverse and cure disease are obviously our ultimate goals. I think we often focus here domestically on what we need to do to help address this issue. But i work pretty closely with our Alzheimers Association and i think the Alzheimers Association has done a wonderful job elevating the level of dialogue but also elevating the dialogue on, you know, why this is a global epidemic. Often when we think about Global Health were thinking about the Communicable Diseases that are out there, but there really is, as there are more developed nations, weve got to spend more time thinking about the impact of nonCommunicable Diseases like alzheimers disease. As we start to think about those Public Health approaches, from my Public Health background, theres a number of things that are the lifestyle modification, the things you can do to slow down and mitigate disease. A second step is building the Public Health infrastructure in the Global Community to help both families and patients manage and navigate that disease. Again, i do think we are going to see this coming tidal wave as people live longer in the Global Community, the lack of infrastructure and the lack of readiness to, you know, manage this tidal wave of folks with dementia and with alzheimers disease and other nonCommunicable Diseases for that matter. And then long term this is a global challenge. I look forward to hearing from the witnesses, you know, we can quantify the direct costs of alzheimers, but then also the indirect costs of alzheimers in terms of, you know, both the patient as well as the impact on families and caregivers. And then ultimately part of the reason why i am such a strong advocate for making the investments in the nih and making investments in research is the return on that investment, if we are able to find a cure or even better therapies to mitigate disease and slow down disease is going to be, you know, pretty significant. If we dont, we will be spending blss billions upon billions of dollars on the back end. This isnt just a u. S. Challenge. This is a global challenge. Mr. Chairman, i think this is incredibly timely topic. I look forward to hearing from the panelists. So thank you. I yield back. Thank you, doctor. Id like to yield for any comments you might have. Thank you for conducting this very important hearing. Many of the things this committee does deals with diseases and things people are suffering from that we dont suffer from in this country. When i came to congress, at 58 years old i had my very first baby. The mother describes her as my very last baby, by the way. But so all of a sudden Maternal Health and infant health, prenatal care became so important to me because it was personal to me. And i always say that on yellow Rose Katherine was, she hit the birth lottery. She was born on may 19th of 2015 on the same day tens of thousands of other children were born. Except she was born on Staten Island in new york city and has every one of her vaccinations, every one of her well visits, and children born that same day who didnt hit that birth lottery, didnt have the same advantages she did. So thats a lot of things that this committee has done thats been personal to me. I am also the only son of an alzheimers patient. My mother died the year before i was elected after suffering for four years. I was blessed. I had her until she was 89 years old. And her mother died when she was nine, so i always say i had my mother for 50 more years than she had her own mother. But i watched this woman become someone i didnt know. A woman who was always calm who became violent. A woman who would sit and just stare even when you were speaking to her because she could no longer communicator understand what you were saying. I learned a lot about the disease. Not as much as my friend dr. Bera, but about the proteins that grow on peoples brains and advancements in medicine that is finding ways to slow that growth down and maybe stop it and maybe at some point that can remove the proteins from peoples brains that may cure the disease is our hope. I know that we gave the National Institute of health in the 21st century cures act billions of dollars to help the advancement of some treatments and cures for things like alzheimers. I just wanted to tell my personal story just so i could tell you how much i appreciate you being here and how important this is in a Global Health environment but how personally its touched me. I thank you for being here. Thank you very much. Let me introduce our distinguished witnesses. And thank them for their leadership. Beginning with dr. Bernard who serves as Deputy Director of the National Institute on aging at the National Institute of health. Dr. Bernard serves as the principle adviser to the nia director working closely with the director in overseeing approximately 2 billion in aging Research Conducted annual lie by the institute. She chairs two department of health and human services, healthy people, 2020 objectives, older adults and dementia, including alzheimers disease. I will then hear from dr. Roger glass who id point out is also from new jersey. Originally from summerville new jersey. He serves as the Society Director at the National Institutes of health. Dr. Glass has maintained field studies in india, bangladesh, brazil. Mexico, china and elsewhere. Has received numerous awards. And the charles dr. Charles award of the for infectious diseases. For his work on developing vaccines in the world. Two experts and two very much welcomed witnesses to our subcommittee. Good afternoon, chairman smith, representative bera, representative donovan. Im happy and honored to represent the National Institute on aging, one of the 27 institutes and centers of the nih. We lead Alzheimers Disease Research. I bring my experience as an academic geriatrician. I can empathize with the prevalence on this illness and the impact it had on families. When i saw patients on a daily basis, it was heartbreaking to see the impact it had on those patients and on their family members and to recognize that i didnt have much that i could bring to the care of those individuals at that time. Its encouraging to be at nih at this point and to see the blossoming of more and more information thats developed with Global Partners, that will hopefully get us to the point that we will have a prevention or cure for this illness. We have, in fact, over the decade, supported a number of International Studies that have led us to a greater understanding of the illness. I will spend what time is allocated to me to briefly highlight three of those. First, were making significant advances in our understanding of the course of alzheimers disease from our health and retirement study. This is a 20yearold national sampling of older adults in the United States. People 50 years of age and older who have followed through to their death. And it has allowed us to see the natural course of aging as well as the natural course of the development of alzheimers. This study has had a new component added thats an international component. The har month nized assessment prot toll toe cal colonel or the h cap. We have the hope that if we can get researchers across the global to harmonize the way they go about cognitive assessments, we will be able to better know the course of the illness and to sort out the genetic social environmental influences that impact alzheimers disease. Were supporting the deployment of hcap and hrs and health and retirement studies as well as a smaller scale study in south africa. This will provide us some unprecedented scientific opportunity. A second important need is for means to make the diagnosis of alzheimers earlier than the current standard which is when a person has cognitive and functional problems. There are many promising new findings, particularly as a results of something called the alzheimers disease. Neweral imaging disease. Adney is a worldwide collaboration. It has led to the identification of biomarkers, proteins and images of the brain that allow us to measure on the set and progression of this disease. A decade ago the only way that you could definitively say that someone likely had alzheimers disease was by autopsy. But now we can see in a living brain the deposition of plaque in an individual and follow its course before they have clinical symptoms. As we make progress of validating this and other biomarkers, we hope to translate this into useful clinical tools. Third, and i supportive investigators have been conducting treatment trials that hav