This hearing will come to order. First of all, thank you for that wonderful welcome which i know was for Maria Shriver, but we senators will pretend that it was also for us. [applause] good afternoon to all of you. I am delighted to convene this annual hearing to assess the art of alzheimers from venting cognitive decline to assuring quality care for those living with dementia. It is also it is always inspiring to sit here and look , butt that sea of purple it is also a reminder that this terrible disease has affected each and every one of you in a personal way. Years, i have met family members who have sacrificed so much to care for their loved ones living with this disease. I have met americans living with alzheimers with determination. Many of you are here today and we welcome you. Okeefes ago, i met bob. Alzheimers ran in his family. His father and older brother both had it. Ob decided to get tested early he received his diagnosis in 2009 and immediately he became a fighter. He walks daily and breeds a couple of books a week. Inorganizes support groups his small, rural community. Daysld me that there are that are overwhelming, but he stressed, never quit. Every day is a new day. Today we should ask, what can we . O to help people like bob giffin of rapidly aging population, we cannot afford to do nothing. Alzheimers is a devastating disease that exacts a tremendous personal and economic told on the individual, families, and our health care system. Approximately 5. 5 million americans are living with the 27,000 in myluding state of maine. As ourmber is soaring overall population grows older and lives longer. Continue, trends alzheimers could affect as many as 14 million americans by the year 2050. In addition to the human suffering it causes, alzheimers nations costliest disease. The United States spends more than 259 billion per year, 170 5 billion in costs to the medicare and medicaid programs. It is the only one of our nations most deadly diseases without an effective means of , treatment, or a cure. If we do nothing, the Alzheimers Association forecasts that this disease will cost our country and astonishing 1. 1 trillion by 2050, and it will bankrupt the medicaid and medicare programs. That we are news is making progress. In 2011, the national alzheimers project act, which i coauthored with then senator became law. It created a National Plan to combat alzheimers that is updated annually. It focuses our efforts to towardste progress better treatments and means of prevention, and ultimately a cure. In the biomedical world of research, we are also making progress. Scientists are conducting prevention Clinical Trials that never would have been possible, even a few years ago, and i have had the great privilege of visiting with some of the Research Scientists who were on the cutting edge of doing Clinical Trials and laboratory work, and it is exciting. Senator casey, i went to the university of pennsylvania, which is doing tremendous work, and i am proud of the work that laboratories in my state is doing, harvard, and the list goes on and on. Today through advances in imaging technologies, we are able to identify some of those who are most at risk for alzheimers and test interventions before symptoms develop. Although we do not yet know how to prevent alzheimers, we are advancing in our understanding of the disease. Its progression does not happen overnight. It is preceded by years and perhaps even decades of changes ofthe brain and a continuum changes in behavior, including cognitive decline. A growing body of evidence, even suggests that lifestyle factors could decrease the risks of cognitive decline. Today, we will learn about the state of the research on factors such as cardiovascular risks, physical activity, diet, sleep, social engagement, and cognitive training. If we start today, i Public Health approach to improve rain health may well be possible. For those living with the disease today and given the rising projections for the future, we need to ask, are we equipped to provide the best care across various settings . From homes to hospitals, we know that the number of geriatricians falls short of the growing demand. We know that for those living in rural areas such as in my state respite care is far to scare us. We will discuss innovative approaches to delivering dementia training to Healthcare Providers across the spectrum, from primary care physicians and nurses to social workers and Community Health workers. And family caregivers are especially important as part of this picture. Last year, more than 15 million americans provided eight teen billion hours of unpaid care to family members and friends with alzheimers. Than 230lued at more billion. We will shine a light on how to better support these efforts. C of i look at the alzheimers, i recognize both the progress we have made and how far we still have to go. Inhave come along way advancing research through more robust funding. Last congress, we increased funding for Alzheimers Research by 60 to almost 1 billion. The fiscal year 2017 appropriations as reported by the Appropriations Committee on which i serve would take us to nearly 1. 4 billion. Now why are those figures important . Well, the experts have calculated that we need to invest 2 billion a year in Research Funding to achieve our goal. We certainly cannot afford to go backwards at a time of such , and urgency and progress that is why i so strongly oppose plans toistrations slash funding for the National Institute for health. That is the last thing we should do. [applause] i want to thank all of our witnesses for joining us today. Eachecially want to thank and every one of you who have traveled from your home states to be with us. Some of you remember from last year that i wore this same purple suit because it is the color we are all using today. ,his suit is like 15 years old and i really want to retire it, but i have made this pledge that until we have an effective treatment, this suit stays in my closet. [applause] so, senator casey, i am delighted to recognize you for your Opening Statement. Sen. Collins thank you very much, and for saying some things that elicit some applause for that does not happen often in hearings. I want to thank you for calling this hearing and your dedication on this issue. It is a topic that touches everyone in this room one way or another, some more directly obviously when it is a family member, but whether it is a parent or grandparent, sibling, youd, or even a neighbor know what this fight is all about. Our Witnesses Today come to us in that fight as well from all across the country. And i know that a little bit later i will have the opportunity to introduce Phyllis Gallagher from pennsylvania, not far from my hometown of scranton, and we appreciate her being here today. Phyllis cared for her husband john who began showing signs of early onset alzheimers at 49, and we are grateful she is willing to do that today to provide the testimony. It is also an honor to have Maria Shriver with us here today. And to help raise awareness situations families face, like her and the gallagher family. Alzheimers disease severely impacts the lives of those who are diagnosed with it, and the lives of those who care for them. This, in one state, pennsylvania, 270,000 people aged 65 and older currently live with alzheimers. Providing much of the care for these individuals is an enormous, but often unseen army of caregivers, including friends, families, and neighbors just as senator collins alluded to earlier. In my home state of pennsylvania, an estimated 673,000 people provided unpaid care to a person with alzheimers related dementia just in 2016, so 270,000 People Living with alzheimers, and 673,000 providing assistance. So those numbers will only grow, not only in a state like ours, but in states across the country. So that is why we are here today to talk about how we can slow down this disease and ensure those who develop the disease itself received the best medical best support possible. Scientific research is providing us with new insights into how we can better control the impacts of alzheimers disease. For example, we are discovering that physical activity can prepare our brains to fight back against alzheimers and to potentially delay the onset of symptoms. Increasingly we are hearing the experts tell us what is good for your heart is good for your brain. We must continue to support research and the quest for s that can help us prevent the onset of the disease in one day develop a cure. Until that time, we must focus on making sure that those who are already living with the disease can get the best care possible. This requires that we have a Health Care Workforce properly trained to address the unique needs of individuals with dementia. This must include care providers across a continuum of care, from primary care providers to nurse practitioners, two of course direct care workers. We must also grow the number of doctors specializing in Health Issues that affect Older Americans more broadly. Ineone living a farm inia or pennsylvania must both have access to care when they need it. Will not be enough though if we dont also engaged the largest component of our caregiving workforce, our family caregivers, as senator collins reminded us. Caring for a loved one is emotionally, physically, and financially draining. We know that. We also know that family caregivers require our support and need to be provided the resources they need to properly care for both their loved ones and themselves. As experts tell us, we have made progress in all of these areas, research, workforce, and fargiving, but our work is from over, and in some cases, it is just beginning. Collins justnator told us, funding, funding is critical, and i join her in that disagreement i will even add them in titian or condemnation of any Budget Proposal that nih the way the Budget Proposal does. [applause] have not madeg we progress on funding. Lester, we had a breakthrough. Our great bipartisan moment which guarantee to did not get a lot of coverage, but a great moment. [laughter] at to that time, we moved in the right direction in terms of funding. This Budget Proposal would be a backwards, orstep more than one step, so i am pleased to join her in that effort. I am also committed to helping us get to the point where we are getting closer and closer to the 2 billion funding targets that experts tell us we need. Over the past several years, with the hope help of so many people in this room, we have made Real Progress in funding, but we have a long way to go. Let me just wrap up with this one message. In addition to focusing on these priorities, we have to make sure that this stays in front of the American People on a regular basis and the leaders here in the senate and the house. We cant look at the faces in this audience, people who have come here year after year, and the pain and the heartbreak so many have suffered with regards to this terrible disease and not insist that more has to be done. We need to keep investing in science, keep supporting Clinical Trials and keep supporting families. That is why this gathering today so essential for parents patients and for families. Welle just conclude as with a preference to two programs i think are critical to this, medicaid and medicare. That was effort undertaken must recently, which in my judgment would have heard medicaid terribly. We have to make sure that we stop efforts that are headed in that direction. We have to step up the fight against alzheimers, if anything , and increased the pace and intensity we bring to this issue. I am grateful you are all here on thursday and we are grateful for your continuing commitment and grateful for the witnesss testimony as well as our chair getting us together today. Thank you, chairman collins. [applause] thank you very much. Thent to acknowledge presence of many of my colleagues who are here today, senator fischer, sender gillibrand, and i know senator warren will be back as well, and i suspect we will be joined by others. I am now delighted to introduce our first witness, Maria Shriver. Mrs. Shriver is a journalist and the founder of the Womens Alzheimers Movement. Mrs. Shriver is a champion in fighting alzheimers disease. She founded the Womens Alzheimers Movement to advance twoarch and to find out why out of three brains that developed this disease belong to women. She has kicked off the move for mines, a partnership to raise money for research and praise awareness about Lifestyle Changes that one can make to promote brain health. Shriver, i so remember your 2009. Us testimony here in you testified so poignantly about the story of your father, and i will never forget youre telling me that when he could no longer remember the names of his loved ones, he could still recite the hail mary, and that was such a poignant moment in your testimony. I also want to acknowledge that your daughter christine is here today, and we are delighted to have her as well. Thank you for all your work, and please proceed with your testimony. Andshriver good afternoon thank you chairman collins, Ranking Member casey and members of the committee for inviting me here today. It is an honor to be here with so many extraordinary people. Every Single Person behind the could be testifying and tell an i amdible story, so honored to be here speaking on behalf of all of these incredible people. As chairman collins mentioned and as some of you may know, i have in here before. Exact. Ears ago to be in march 2009, i sat here and testified about how alzheimers had taken up residence in what had been my fathers beautiful brain. Father Sargent Shriver was an idealistic, intelligent, optimistic, and dedicated public servant. He is mind was as sharp as they, a beautifully tuned instrument that left people in we and inspired. He was an expert at sharing his general passions with the public, thought leaders, and people like yourself. L toften came to the hil advocate for funding on the peace corps and the programs he created, including headstart, this took him a job corps, and Legal Services for the poor. He loves working this building and was really good at it and he knew every senator and congressman by name, and if he were here today, he would know every single thing about each and every one of you, about your careers, your interests, your politics, your families, and yes, your soft spots. He would know a lot about that. So imagine how painful it was to watch when this walking encyclopedia of a man went from knowing every fact about everything that had ever happened in the history of this country to not knowing what a spoon or fork was, to not knowing what my name was or not knowing his own name. I testified, my father died of alzheimers disease, and now i am back. I am back again to testify, back alarm aboutnd a 911 the biggest biomedical crisis facing the world today. I say it is a world crisis. Back again to focus your brains on this killer ravaging brains and families across this great country of ours. Believe me, i wish i did not have to come back here to testify. It wasnt on my calendar, but when i learned the funding for nih and Alzheimers Research might be in jeopardy, i practically ran here to say, this cannot be. Wait a minute, there must be some mistake here. I know that this committee is well aware of this crisis unfolding in homes across this country. I know you know about it first hand, and i know you know about it from the people you represent, but let me use this moment to remind you here on the committee and the American Public just what the uptodate facts really are, and trust me, these are real facts. Every 66 seconds, another brain will develop alzheimers disease , and two thirds of those brains along to women, two thirds of them, and no one knows why that is. Isoman in her early 60s twice as likely to get alzheimers in her lifetime than she is to get breast cancer, and the statistics are even more alarming for women of color. African american women are twice as likely to develop alzheimers has caucasian women, and latinas, 1. 5 times more likely. On top of that, more than 15 million americans are caring for someone with alzheimers or other forms of dementia while parenting and holding down fulltime jobs, and just as you know, two thirds of those caregivers are also women. Founded theis why i Womens Alzheimers Movement to educate all of us about the disproportionate effects of this disease on women. I believe that determining why women are more affected by alzheimers will help us unlock some of the mysteries of this diso of the mysteries of this disease. Instead of focusing only on the formation of black and tangles in the brain, lets focus on womens brains and their bodies, on their chromosomes, their hormones, and on the way they process information. This could help us learn more about alzheimers progression and its prevention. In fact, i believe studying women and getting more women into Clinical Trials could possibly lead to the cure for all of us. I dont believe this is sexist. I believe it is just plain old smart. It is smart. Thank you. [applause] it is smart because alzheimers is the most complex, esthers and expensive disease in the United States, more expensive than Heart Disease and cancer, and it is the only one of the top 10 diseases without a means to prevent, cure, or slow its progress. Number, since 2000, the of deaths fr