[applause] this hearing will come in order. First of all, thank you all for that wonderful welcome, which i know was for Maria Shriver. [laughing] but we senators will pretendwhs [applause] good afternoon to all of you. Im delighted to convene this annual hearing to assess the art of alzheimers, from preventingm cognitive decline to ensuringo quality care for those living with dementia. Its always so inspiring to sit here and look out at betsy a purple. But its also a reminder that this terrible disease has affected each and every one of you in a personal way. Over the years i have met Family Members who have sacrificed so much to care for their loved ones living with this disease. Ive met americans living with alzheimers, with courage and determination. Many of you are here today, and we welcome you. Two years ago i met bob okeefe from waterbury domain. Alzheimers rant in his family. His father and older brotherr both had it. So bob decided to get tested early. He received his diagnosis in 2009, and immediately he became a fighter. A he walks daily and reads a couple of books a week. He organizes support groups ins his small rural community. He told me there are days that are overwhelming but, he stressed, never quit. Every day is a new day. Today we should ask what can we do to help people like bob. Given our rapidly aging population we cannot afford to do nothing. Alzheimers is this devastating disease that affects a tremendous personal and economic toll on individuals, families, and our healthcare system. Approximately 5. 5 million americans are living with the disease, including 27,000 in my state of maine. That number is soaring as our overall population grows older and lives longer. Its Current Trends if Current Trends continue, alzheimers could affect as many as 14 million americans by the year 2050. Init in addition to the human suffering and costs, designers is our nations costliest disease. The United States spends more than 259 billion per year, including 175 billion in costs to the medicare and medicaid programs. It is the only one of our nations most deadly diseasest without an effective means of prevention, treatment or a cure. If we do nothing, the Alzheimers Association forecast that this disease will cost our country and astonishing 1. 1 trillion by 2050, and it will bankrupt the medicaid and medicare programs. Now, the good news is that wern making progress. In 2011, the National National alzheimers project act, known as napa, which i coauthored with then senator evan bayh, became a law. It created a National Plan to combat alzheimers that is updated annually. Napa focuses our efforts to accelerate progress toward better treatments and means of, prevention, and ultimately a cure. In the biomedical worlds of research, were also making progress your sciences are conducting scientists are conducting trials that never wouldve been possible even ale few years ago. And i bet a great privilege of visiting with some of the Research Scientists who are on the cutting edge of doing Clinical Trials and laboratory work, and it is exciting. In fact, senator casey, i went to the university of pennsylvania, which is doing tremendous work, and im proud of the work that jackson laboratories in my state is doing, and harvard, and the list goes on and on. Today through advances in imaging technologies, we are able to identify some of those 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 in the brain and a continuum of changes in behavior, including cognitive decline. A growing body of evidence even suggests that factors could decrease the risk of cognitive decline. Today we will learn about the state of the research on factors such as cardiovascular risk, physical activity, diet, sleep, social engagement and cognitive training. If we start today, a Public Health approach to improve brain health, may well be possible. For those living with theay disease today, and given the rising projection 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, that respite care is far too scarce. We will discuss innovative approaches to delivering dementia training to healthcaret providers across the spectrum, from primary care physicians and nurses and social workers and Community Health workers. And family caregivers are especially important as part of this picture. Last year more than 15 milliongt americans provided 18 billion hours of unpaid care to Family Members and friends with alzheimers disease. This is valued at more than 230 billion. We will shine a light on how to better support these efforts. When i look at the arc of alzheimers, i recognize both the progress we have made and how far we still have to go. We have come a long way andh advancing research through more robust funding. Last congress increased funding for Alzheimers Research by 60 to almost 1 billion. The fiscal year 2017ations appropriations bill, as reported by the Appropriations Committee on which i serve, with a custer nearly 1. 4 billion. Now, why are those figures informed . 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 great urgency and progress. And that is why i so strongly oppose the administrations plann to slash funding for the National Institutes for health. Thats the last thing we should do. [applause] i want to thank all of our witnesses for joining us today. And i especially want to thank each and every one of you who have traveled from your home state to be with us. Some of you remember from last year that i wore this same purple suit, because its like, that we are all using today. This suit is like 15 years old, and i really want to retire it, but ive made this pledge that until we have an effective treatment, this suit stays in my closet. [applause] so senator casey, im delighted to recognize you for your Opening Statement. Is a topic that digital newsroom in one way or another. Some more directly when its a Family Member but whether its a parent or a grandparent, a sibling or a friend or even a neighbor, everyone, you know what this site is all about. Our Witnesses Today, to us in t that fight as well from alll across the country. And i know that a little bit later i will have an opportunity, Phyllis Gallagher from brockville pennsylvania, not far from my hometown of scranton, we appreciate her in here today. Phyllis care for her husband john who began showing signs of early onset also at the age of just 49. We are grateful she is willing to do that today to provide that testimony here its also in honor of course of Maria Shriver here with us today and to helpis raise awareness about the issues the families across the country face and families like yours Alexa Gallagher family. Alzheimers disease syndrome and packs both the lives of those are diagnosed with it and the lives of those who care for them. Just consider this. Just in one state, pennsylvania, 270,000 people ages 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 france, family, and neighbors, just as senator collins alluded to earlier. In my home state ofme pennsylvania, an estimated 673,000 people provide unpaid care to a person with alzheimers relator dementia just in 2016. So 270,000 People Living with alzheimers, 673,000 providingl assistance. So those numbers will only grow, not only in a state like ours, but in states across the country. So thats why were here today to talk about how we can slow down this disease and ensure that sosa develop the disease itself receive the best medical care and the best support possible. Scientific research is provided as with new insights into how we can better control the impact, 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 interventions that can help us prevent the onset of the disease and one day develop the 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 Healthcare Workforce properly trained to address the unique needs of individuals with dementia. This must include care providers across a continuum of care, froo primary care providers to Nurse Practitioners to of course direct care workers. We must also grow the number of doctors specializing in Health Issues that affect Older Americans more broadly. Someone living in an Apartment Building in philadelphia or on a farm in washington county,t both pennsylvania must both have access to care when they need it. All of this will not be enough though if we dont also engage the largest component of our caregiving workforce, our famils caregivers, as senator collins reminders. Caring for a loved one is emotionally, physically, and financially draining. Nd 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 the experts tell us, weve made progress in all of these areas, research, workforce, and caregiving. But our work is far from over and in some cases its justwe k beginning. We know as senator collins and just told us, funding, funding is critical. And i join her in that disagreement, ill add even, enunciation or condemnation of any Budget Proposal that cuts nih the way that the Budget Proposal does it for too long [applause] for too long we havent made progress on funding. Last year we had a breakthrough. Our great bipartisan moment which guaranteed it didnt get a lot of coverage but it was a great moment [laughing] and at the time we booked in the right direction in terms of finding nih. This budget idea or proposal iwo could say would be a giant step backward, or more than one step. So im pleased to join her in that effort. Im also committed to helping us get to the point where were getting closer and closer to the 2 billion funding targets that experts tell us that we need. Over the past several years with the help of so many people in this room, weve made Real Progress in funding, but we hav a long way to go. Let me just wrap up with this one message. In addition to focusing on these priorities, weve got to make sure that this stays in front of the American People on a regular basis, and the leaders here in the senate and in the house. We cant look at the faces in this audience, people have come here year after year, and the pain and heartache that so many have suffered with regard to w 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. Thats why this gathering today is so essential for parents and for patients and for families. Let me just conclude as well with a reference to two programs that i think are critical to this, medicaid and medicare. We had an effort that was undertaken most recently, whichy in my judgment would avert medicaid terribly. We have to make sure that we stop efforts that are headed in that direction. Weve got to step up the fight against alzheimers, if anything, if anything increase the pace and of the intensity that we bring to this issue. Im grateful that you are all here on this day. We are grateful for your continued commitment, and im grateful for the witnesses testimony as well as our cherry getting us together today. Thank you, chairman collins. [applause] thank thank you very much. I want to acknowledge the presence of many of my colleagues who are here today, senator fischer, senator tillis, senator tillis rent, and i know senator warren will be back as well. And i suspect will be joined by others. I am now delighted to introduce our first witness, Maria Shriver. Ms. Shriver is a journalist and the founder of the Womens Alzheimers Movement. Ms. Shriver is a champion in fighting alzheimers disease. She founded the womensme alzheimers moment to advance research and find out why two out of three brains that develol this disease belong to women. She has kicked off the move termites, a partnership to raise money for research and raise awareness about Lifestyle Changes that one can make to promote brain health. Ms. Shriver, iso remember your previous testimony here in 2009. He testified so poignantly about the story of your father. And ill never forget your telling me that when he could nd longer remember the names of his loved ones, he gets to recite the hail mary, that was just such a poignant moment in your testimony. I also want to acknowledge that your daughter, christina, is here today, and were delighted to have her as well. Thank you for all your work, and please proceed with your testimony. Good afternoon and thank you, chairman collins, Ranking Member casey, and the members of the committee for inviting me here today. Its an honor to be here with so many extraordinary people. Every Single Person behind the could actually be testifying and tell incredible story. So im honored to be here speaking on behalf of all of these incredible people. As chairman collins mentioned and at some of you may know, i have been near before. Eight years ago to be exact. In march 2009 i sat here and testified about how alzheimers had taken up residence in what f had been my fathers beautiful brain. My father Sargent Shriver was an idealistic, intelligent, optimistic and dedicated public. Servant. His mind was as sharp as they come. A beautifully tuned instrument that left people in awe and inspired. He was an expert in sharing his passions with the general public, without leaders and with people like yourselves. He often came here to the hill to advocate for increased funding for his beloved peace corps and all the war on poverty programs that he created, including head start, vista, job corps and Legal Services for the poor. He loved working this building, and he was really good at it. 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 com, boucher interests under politics, your families and yes, your sauce pot pic you 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 it ever happened in history of this country, not knowing what a spoon or a forky was, to not knowing what my name was, or not knowing his own name. Two years after i testified, my father died of alzheimers disease. And now im back. I begin to testify. Back in again to set a 911 alarm about the biggest biomedical crisis facing the world today. And i say it is a world class 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 didnt have to come back here to testify. It wasnt on my calendar, that when i learn that the funding for nih and Alzheimers Research might be in jeopardy, i practically ran here to say, this just 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 that 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 twothirds of those brains belong to women. Twothirds of them. And no one knows why that is. A woman in her early 60s is twice as likely to get alzheimers in a lifetime than she is to get breast cancer. And the statistics are even more alarming for women of color. Africanamerican women are twice as likely to develop alzheimers as caucasian women and latinas, 1. 5 times more likely. On top of that more than 15 million americans are caring for someone with alzheimers oro other forms of dementia, while they are also parroting and holding down fulltime jobs. Just so you know, twothirds of those caregivers are also women. All of that is why i founded the Womens Alzheimers Movement come to educate all of us about the disproportionate effects of this disease on women. I believe the determining why women are more affected by alzheimers will help us unlock some ministries of this disease. Instead of focusing only on the formation of plaque sentinels and to bring lets focus on womens brains and on their bode bodies. On their chromosomes, other hormones and on the way theyoc process information. T