Great work. Lets keep pushing. Theres more to do. As secretary sebelius said, we are starting to see some change. We are nowhere near the end of this road, but with every little bit that we do, we make a huge difference. Congratulations once again and keep up the great work. Thank you so much. [applause] [captioning performed by national captioning institute] [captions Copyright National cable satellite corp. 2014] all we are told there are sorts of citizens that occur. Sid isnt that occur. Rosa parks who was just so tired that she refused to get up from the bus and sparked the bus whoott and a young preacher the president referred to during one. He leads the africanamericans from nutrition. He could do this stuff. Then barack could fly. They sound good. They really simplify a much more complicated history. So manyy involves africanamericans who proactively dismantled racial segregation including rosa parks. Refuse to give this up. He specializes in the sub field of africana and what he causes calls a black power study. Sunday he will take your questions in depth. Live for three hours starting at noon eastern on cspans book television. Year in year out they thought this. They choked to death in the barren land. Stayed until machinery, boom, and even hope were gone. In 19 36 u. S. Resettlement administration documentary, the plow that broke the plains. A history of the Great Plains Region sunday at 4 00 p. M. Eastern on cspan3. Next, a Senate Appropriations subcommittee hearing looking at alzheimers disease. The witnesses included the church of the National Institute rogenlth and actor seth who talks about his motherinlaws ongoing struggle with the disease. This is two hours. The Senate Appropriations subcommittee on labor health, human services, education and related agencies will please come tord ore. Todays hearing is the sixth that this subcommittee has held since 2000 focusing on alzheimers disease, the burden of the disease, the state of the research and the challenges faced by caregivers. Going back many years, weve heard predictions from experts about the farreaching consequences this disease will have on the quality of life for American Families and the burden it will place on our economy in the years ahead. Last april, a major study predicts that these consequences will be far greater than anyone even previously imagined. Well hear from the author of that study today on the next panel. I wont steal his thunder, but i note this study commanded the attention of the nation, in particular this subcommittee. There are few americans whose life hasnt been touched in some way by alzheimers disease. Whether through a Family Member or a friend. Its the most common form of dementia among Older Americans and its risk increases with increasing age. For those living with the disease, its ravages get worse over time as does the burden on their families and on society. The number of americans living with alzheimers has doubled since 1980. The growth will almost certainly accelerate as the baby boom generation continues to retire in the future. The federal governments involvement in Alzheimers Disease Research began in 1976, when three institutes at the National Institutes of health invested a total of 3. 8 million in research into the cause of this disease. We now spend approximately half a billion dollars each year on research into alzheimers disease. Weve had some successes along the way, but the harsh reality is that we still do not know how to prevent, reverse, or definitively diagnose alzheimers disease. More research is desperately and urgently needed. This subcommittee has always adhered to a strong policy of not earmarking money for particular diseases, a good policy. Or definitively saying what diseases money has to go to. Instead, we allow the peerreview process to support the most promising science. However, we were able to provide 131 million increase for the National Institute on ageing in the recent fiscal year 2014 omnibus. Again, with the expectation that promising science in alzheimers disease will be supported. We have a distinguished panel of experts here today, scientists, economists, patients, Family Members. We also have quite an audience. Let me welcome representatives of the Alzheimers Association. Some of you came a long way to be here today. We thank you for your tireless work to educate members of congress and the press about the need to do more to help you and your loved ones. Also in the audience are students, i am told, from the university of virginia. These young people are spending a day here learning about budget and appropriations, and we welcome all of you here also. On our first panel, of course, well hear from dr. Francis collins, the distinguished director of the National Institutes of health, who will discuss the current state of science and what kinds of research are most likely to benefit from our appropriations. I would note we are also very fortunate to have both dr. Storey landis and dr. Richard hotus of the National Institute on ageing, also here to answer questions. On the second panel, well hear from dr. Michael herd, the researcher who wrote the landmark study i mentioned earlier. And well be joined by two individuals personally impacted by this devastating disease. Finally, former congressman dennis moore of kansas is here today as a longtime colleague and friend of his, i was saddened to learn of his alzheimers diagnosis so soon after his retirement from the house of representatives. Its no surprise to anyone who knows him, though, that his first instinct was to educate others and continue serving the public through advocacy and education. So i look forward to hearing from each of our distinguished experts, and before we turn to the first panel, ill yield to senator moran. Mr. Chairman, thank you very much. Ill make my remarks relatively brief because i would not want to detain or delay the testimony of our distinguished experts. But i very much appreciate what you just said and your willingness to conduct this hearing on alzheimers disease. In my view, this could be the defining disease of our generation. Im pleased, as you indicated, to have dennis moore testify on his experience of living with alzheimers. I appreciate dennis as a friend, and i also appreciate his desire to take his own difficult challenges and focus them in helping other individuals and families struggling with this horrific disease. He is used to the years since his diagnosis to advocate for those living with the disease, and in dennis words, we need to find a cure like next week. I could not agree more. Mr. Chairman, every 68 seconds someone in america develops alzheimers disease, a devastating, irreversible brain disease that slowly destroys an individuals cognitive functioning, including memory and thawing. Alzheimers currently affects more than 5. 2 Million People in the United States and more than 44 Million Worldwide according to the alzheimers disease international. As our population ages, the number of people diagnosed with alzheimers after the age of 65 will double every five years while the number of individuals 85 years and older with the disease will triple by 2050. Already alzheimers is the sixth leading cause of death in the United States and there is currently no cure, no diagnostic test, no treatment. With the baby boomer generation ageing, alzheimers disease becomes more prevalent and the need to confront the pending Health Care Crisis has become ever more urgent. As you indicated, the study by Rand Corporation stated the cost of dementia is projected to double over the next 30 years, surpassing Health Care Expenses for both Heart Disease and cancer. Alzheimers disease has become a disease to define a generation, but if we focus our priorities on our research capacity, it does not need to continue to be an inevitable part of the ageing process. For every 27 that medicaid and medicare spends caring for individuals with alzheimers, the federal government only spends 1 on Alzheimers Research. In fiscal year 2014, the omnibus appropriation bill provided for an increase in the way that you described for the 100 million for Alzheimers Research. I appreciate working with you to accomplish that goal. But without a way to prevent, cure, or effectively treat alzheimers, it will be difficult, if not impossible, to reign in our Nations Health care costs. In this committee and in the full committee, youve often heard me say i really appreciate the issue of dealing with health care and health research. Health research is an opportunity for those who are the most fiscally conservative and those who are the most caring and compassionate to come together because we can save tremendous amounts of money and we can improve peoples lives by doing so. Its an opportunity for all of us to Work Together to find a solution. One study has found that a breakthrough against alzheimers that delays the onset of the disease by five years would mean a total savings of 447 billion by 2050. Nows the time that as a nation that we fully commit to defeating one of the greatest threats to our health of americans and the financial well being of our country. 1962, president kennedy called the nation to action to reach the moon by the end of that decade. We need to commit ourselves to the goal of advancing Alzheimers Research with the same ambition and urgency. Over the next decade, we must strive to achieve not only an effective treatment but a cure for alzheimers. Alzheimers is, as i say, the defining challenge of our generation. We need to find a cure, like next week. The gift that we all could provide every american and every American Family is a special gift. Its called the gift of hope. Mr. Chairman, thank you very much. Thank you, senator moran. Now we welcome our first panel. Dr. Francis collins, the director of the National Institutes of health, overseeing the work of largest Biomedical Research entity in the world. It spans the spectrum from basic to clinical research. Dr. Collins is a physician geneticist noted for his landmark discoveries of diseased genes, his leadership of the human genome projects, which he started in 1993, culminated in april of 2003. But then continued on in that capacity until 2008 and has now come back as the director of the entire National Institute of health. He is an elected member of the institute of medicine, the National Academy of sciences, was awarded the president ial medal o of freedom in november of 2007 and received the National Medal of science in 2009 and i also want to welcome dr. Richard hotus, the director of the National Institute of ageing. Hes held his position since 1993. This is our primary federal agency supporting and conducting Alzheimers Disease Research. As director, dr. Hotus overseeing studies with a basic aspects of ageing. And dr. Story landus, serving since 2003. Supports and conducts basic Translational Research on the diseased brain system. So we welcome you all here. Dr. Collins, again, thank you for your leadership through all these years. Both first for the human genome project and now for the entire National Institute of health. Dr. Collins, welcome and please proceed. Thank you. Good afternoon, mr. Chairman and members of the subcommittee. As always, its great honor to appear before you along with my two distinguished colleagues. Were here to discuss the latest reserng into alzheimers disease and related dementias. Before getting into the science, i would like to thank you for the recent fy41 omnibus appropriation for nih. This subcommittee came together in a bipartisan way to reverse the deeply troubling downward spiral of support that nih has found costing us about 25 of our purchasing power for research over the last ten years. While difficult tradeoffs did not ultimately make it possible in fy14 to completely reverse the devastating effects of the fy13 sequester, we were gratified nih was able to turn that corner. Let me begin my report on the scientific challenges we face in alzheimers by underscoring that all of the work im going to discuss is really about helping patients and their loved ones. Thats what we are committed to and we know you are too. One of the most famous of those patients is Country Music star glen campbell. Along with a number of you, i was thrilled to be on hand last spring when glen was honored at the Alzheimers Association gala. Heres a photo of him and me with an autographed guitar pick that he gave me, which is a prized possession since im a musician also. To see his great talents, a National Treasure really, so compromised by this devastating disease is a reminder of just how much is at stake. Weve heard the sobering statistics, and theyve been already cited in Opening Statements by senator harkin and senator moran about the wave of diseases that will break over the United States as the baby boom generation ages. Already about 5 million americans have been diagnosed with alzheimers disease and hundreds of thousands more affected with other types of dementia. Without new scientific breakthroughs, those numbers will continue to rise along with the terrible toll on our Nations Health and its economy that this disease creates. As youve mentioned already, the Alzheimers Association estimates that our nation is currently spending more than 200 billion a year on care of people with alzheimers. And those costs are projected to soar to 1. 2 trillion annually by 2050. To put this into context, consider how much our nation is spending on medical research. Nihs budget was 29. 1 billion in fy13, with 504 million of that devoted to Alzheimers Disease Research. We are thrilled that the fy14 omnibus includes an additional 100 million for research on diseases of ageing, including alzheimers disease. In our effort to find ways to prevent, delay, or treat alzheimers and other dementias, we are bringing to bear all possible technologies from genomics to imaging to big data tools. But this task is immense. There are great many things we still dont know about how the normal brain functions, let alone a brain with alzheimers. In fact, this Months National geographic provides a glimpse at what nih funded researchers are doing to explore whats been called biologys last frontier, the human brain. And i couldnt help but notice Scientific American just on the newsstands has the brain on its cover also for the current issue. As you know, nih is leading the initiative called Brain Research through advancing innovative neurotechnologies. Thats an acronym, b. R. A. I. N. Were grateful for the subcommittees support for this venture in the omnibus. The Brain Initiative, which the president has called the next Great American project, will create tools capable of examining the activity of the brains billions of nerve cells, networks, and pathways in realtime. Thats sure to be a tremendous value to researchers who are working on autism, schizophrenia, epilepsy, traumatic brain injury, depression, parkinsons disease, and yes, all forms of dementia, including alzheimers. Let me tell you one recent finding in Brain Science thats generated a lot of excitement. It involves a protein called tau. This is one of the major culprits in alzheimers disease. The other one is amaloid. In normal brain cells, this tau protein stabilizes structures that are called microtube yules and that are involved in internal transport. Thats what you see happening here with this amazing machine inside the cell. But in alzheimers, the tau separates from those microtube yules, causing them to fall apart. Strands of this tau protein then combine to form tangles within the neuron, disabling the transport system and destroying the cell ultimately, as you see in this animation. Neurons in certain parts of the brain disconnect from each other and eventually they die, causing memory loss. The effect on the brain, the brain shrinks and begins to lose function, showing you here what happens in advanced alzheimers disease as the brains substance is gradually shrunken away by the loss of brain cells. Now, one exciting finding recently is weve discovered this tau protein, which we used to think was just inside cells and therefore kind of inaccessible, that its actually transferred from neuron to neuron, almost like an infection inside the brain. That may sound a little scary, but for us it means opportunities for therapy. Proteins that spend their whole existence inside cells, theyre hard to attack. But if we can find a way to prevent that celltocell transmission, perhaps by locking tau with an antibody, we might be able to stop alzheimers in its tracks. Still, new drugs wont do a whole lot of good unless we can identify accurately those who might benefit from them. To do that, we need better ways to diagnose alzheimers disease and to do so as early as possible. Until