[Congressional Record Volume 163, Number 180 (Monday, November 6, 2017)]
[Senate]
[Pages S7017-S7019]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Ms. Cortez Masto, Mrs. Capito, and 
        Mr. Kaine):
  S. 2076. A bill to amend the Public Health Service Act to authorize 
the expansion of activities related to Alzheimer's disease, cognitive 
decline, and brain health under the Alzheimer's Disease and Healthy 
Aging Program, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Ms. COLLINS. Mr. President, I rise today with my colleague from 
Nevada, Senator Cortez Masto, to introduce the Building Our Largest 
Dementia Infrastructure for Alzheimer's--or BOLD--Act. I am pleased 
that Senator Capito and Senator Kaine are also joining us as original 
cosponsors.
  Our legislation would create a public health infrastructure aimed at 
combating Alzheimer's disease and preserving brain health. Alzheimer's 
disease is one of the greatest and most under-recognized public health 
threats of our time. Former Surgeon General David Satcher has said that 
it is the most under-recognized public health threat of the 21st 
century. Five and a half million Americans are living with the disease, 
and that number will soar as our population continues to grow older and 
lives longer.
  In addition to the human suffering it causes, Alzheimer's is our 
Nation's most costly disease. The United States spends more than $259 
billion per year, including $175 billion in Medicare and Medicaid 
costs. The financial impact of this dreadful disease will only continue 
to grow. In fact, it is estimated that by the year 2050, Alzheimer's 
will cost our country $1 trillion and afflict 16 million Americans.
  While Alzheimer's is the only one of our Nation's most deadly 
diseases without an effective treatment or cure, tantalizing new 
research suggests that there are steps we can take to promote 
prevention and improve treatment.
  The first step we should take is to recognize Alzheimer's as a public 
health crisis. It is because of public health advancements that we have 
safe water to drink, vaccines to prevent deadly diseases, interventions 
to quit smoking, and emergency preparedness tools to save lives. The 
effort to combat Alzheimer's disease requires a similar unified, 
national public health effort. That effort is gaining steam.
  In 1999, when I founded the Bipartisan Congressional Task Force on 
Alzheimer's, there was virtually no focus in Washington on this 
devastating disease. In fact, people were afraid to even refer to the 
disease, just as years ago people did not talk about cancer.
  Seven years ago, I coauthored with then-Senator Evan Bayh the 
bipartisan National Alzheimer's Project Act, which set the primary goal 
of preventing and effectively treating the disease by the year 2025. 
That bill created an expert council, which has calculated that $2 
billion in Federal funding per year is needed to achieve that goal.
  On the Appropriations Committee, I have worked hard with Senator 
Blunt and others to turn the words of that recommendation into action. 
The funding bill for this year provides another $2 billion increase for 
the National Institutes of Health, and that includes a $414 million 
increase for Alzheimer's research--the largest in history. That brings 
the total for Alzheimer's research to $1.8 billion--well within reach 
of the $2 billion goal, which the experts tell us is necessary for 
breakthroughs.
  While this research is moving forward, we must put into practice what 
we know and enhance the quality of care and support for those living 
with Alzheimer's and their families. In March, the Aging Committee, 
which I chair, held a hearing on the arc of Alzheimer's, from 
preventing cognitive decline to ensuring quality care for those living 
with dementia. The hearing shed light on the fact that although we do 
not yet know how to prevent Alzheimer's, we are advancing in our 
understanding of the disease. Its progression does not happen 
overnight; it is preceded by years and perhaps decades of changes in 
the brain and a continuum of changes in behavior, including cognitive 
decline. A growing body of evidence suggests that lifestyle factors, 
such as regular physical activity and attention to heart health, may 
reduce the risk of cognitive decline. There is so much we have yet to 
know.
  Alzheimer's is a public issue for those living with the disease, for 
those caring for their loved ones with the disease, for all of us as 
taxpayers, and for those who know that our brain is our most precious 
resource. Alzheimer's exacts a tremendous personal and economic toll on 
families and communities. More than 40 million Americans know all too 
well the compassion, commitment, and endurance that it takes to be a 
caregiver of a loved one facing a chronic disease like Alzheimer's.
  The legislation we are introducing today would apply a new public 
health approach to Alzheimer's disease. It would establish Centers of 
Excellence in Public Health Practice dedicated to promoting effective 
Alzheimer's disease management and caregiving interventions, as well as 
educating the public on the disease, cognitive decline, and brain 
health.
  The Centers for Disease Control and Prevention is already doing 
tremendous work to combat Alzheimer's within the Public Health Road Map 
of the Healthy Brain Initiative. This legislation would create centers 
of excellence across the country to implement the CDC's Public Health 
Road Map. The centers would take a number of key steps against 
Alzheimer's. They would work to support early detection and diagnosis, 
lessen the risk of avoidable hospitalizations, reduce the risk of 
cognitive decline, enhance support to meet the needs of caregivers, 
reduce health disparities, and support care planning and management for 
those with the disease. The Centers' activities would support health 
and social services professionals as well as families and communities.

  In addition to establishing the Centers of Excellence in Public 
Health Practice, this bill would spread the opportunity for communities 
across America to create the necessary core capacity to combat 
Alzheimer's and to enhance existing efforts in this regard. The 
legislation would establish and distribute cooperative agreements to 
public health departments to support systems change, communications, 
and programmatic interventions. These agreements would also support the 
actions in the CDC Healthy Brain Initiative's Public Health Roadmap.
  Finally, at the heart of public health is data. This legislation 
would direct the CDC to collect data on cognitive decline, cognitive 
impairment, caregiving, and health disparities within its current 
systems. The bill would also create cooperative agreements for the 
analysis and reporting of data to ensure that the results are 
disseminated to the public and are used, ultimately, to improve brain 
health.
  For far too long, we have viewed Alzheimer's disease as an aging 
issue that plagues our seniors today and threatens to affect many more 
tomorrow. In fact, the disease is far more than that.

[[Page S7018]]

It is a public health issue with a course that we can change. If we do 
not take action, both in this new public health approach and by 
continuing to build on the research, this disease will bankrupt the 
Medicare and the Medicaid Programs. We cannot afford to spend over $1 
trillion in the year 2050 on just this one disease. We cannot afford to 
lose 16 million Americans by that year to this devastating disease. We 
cannot afford to allow the heartache and devastation of this disease to 
affect more and more American families.
  There are steps that we can take today to prevent cognitive decline 
and to improve the lives of those who are living with Alzheimer's and 
the lives of their caregivers. This public health approach is not only 
empowering, but it is key to avoiding the terrible impacts that I have 
outlined.
  After decades of expanding much needed biomedical research in 
Alzheimer's, we are ready for the next step--to translate research into 
policy. The BOLD bill would create a new, enlightened public policy out 
of promising research by creating the first ever national public health 
infrastructure for Alzheimer's disease.
  I am pleased to say that the bipartisan bill that the Senator from 
Nevada and I have introduced, with our colleagues from Virginia and 
West Virginia, is endorsed by the Alzheimer's Association, the 
Alzheimer's Impact Movement, the National Association of Chronic 
Disease Directors, and the National Association of Counties.
  I ask unanimous consent that their letters of support be printed in 
the Record at the conclusion of my remarks.
  I urge my colleagues to support this critical and bipartisan 
legislation.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                  Alzheimer's Impact Movement,

                                 Washington, DC, November 6, 2017.
     Hon. Susan Collins,
     U.S. Senate,
     Washington, DC.
     Hon. Shelley Moore Capito,
     U.S. Senate,
     Washington, DC.
     Hon. Catherine Cortez Masto,
     U.S. Senate,
     Washington, DC.
     Hon. Tim Kaine,
     U.S. Senate,
     Washington, DC.
       Dear Senators Collins, Cortez Masto, Capito and Kaine: On 
     behalf of the Alzheimer's Association and the Alzheimer's 
     Impact Movement (AIM), including our nationwide networks of 
     advocates, thank you for your continued leadership on issues 
     and legislation important to Americans with Alzheimer's and 
     other dementias, and to their caregivers. The Alzheimer's 
     Association and AIM are pleased to support the bipartisan 
     Building Our Largest Dementia (BOLD) Infrastructure for 
     Alzheimer's Act, which would create an Alzheimer's public 
     health infrastructure across the country to implement 
     effective Alzheimer's interventions focused on public health 
     issues such as increasing early detection and diagnosis, 
     reducing risk and preventing avoidable hospitalizations.
       More than 5 million Americans are living with Alzheimer's 
     and, without significant action, as many as 16 million 
     Americans will have Alzheimer's by 2050. Today, another 
     person develops the disease every 66 seconds; by 2050, 
     someone in the United States will develop the disease every 
     33 seconds. This explosive growth will cause Alzheimer's 
     costs to increase from an estimated $259 billion in 2017 to 
     $1.1 trillion in 2050 (in 2017 dollars). These mounting costs 
     threaten to bankrupt families, businesses and our health care 
     system. Unfortunately, our work is only growing more urgent.
       As scientists continue to search for a way to prevent, 
     cure, or slow the progression of Alzheimer's through medical 
     research, public health plays an important role in promoting 
     cognitive function and reducing the risk of cognitive 
     decline. Investing in a nationwide Alzheimer's public health 
     response will help create population-level change, achieve a 
     higher quality of life for those living with the disease and 
     their caregivers, and reduce associated costs. The BOLD 
     Infrastructure for Alzheimer's Act would provide this crucial 
     investment by establishing Alzheimer's centers of excellence 
     across the country and funding state, local and tribal public 
     health departments to increase early detection and diagnosis, 
     reduce risk, prevent avoidable hospitalizations, reduce 
     health disparities, support the needs of caregivers and 
     support care planning for people living with the disease. 
     These important public health actions allow individuals with 
     Alzheimer's to live in their homes longer and delay costly 
     institutionalized care. These goals are consistent with the 
     National Plan to Address Alzheimer's Disease, which includes 
     a strategy to ``work with state, tribal, and local 
     governments to improve coordination and identify model 
     initiatives to advance Alzheimer's disease and related 
     dementias awareness and readiness across the government.''
       The BOLD Infrastructure for Alzheimer's Act would also 
     increase the collection, analysis and timely reporting of 
     Alzheimer's data. This data is critical to identifying 
     opportunities for public health interventions, helping 
     stakeholders track progress in the public health response, 
     and enabling state and federal policymakers to make informed 
     decisions when developing plans and policies. Finally, the 
     bill would also strengthen implementation of the Center for 
     Disease Control and Prevention's Public Health Road Map, 
     which includes strategic action items for state and local 
     public health departments and their partners to promote 
     cognitive functioning, address cognitive impairment and help 
     meet the needs of care partners.
       The Alzheimer's Association and AIM deeply appreciate your 
     continued leadership on behalf of all American's living with 
     Alzheimer's and other dementias. We look forward to working 
     with you to advance this important bipartisan bill. If you 
     have any questions about this or any other legislation, 
     please contact Rachel Conant, Senior Director of Federal 
     Affairs.
           Sincerely,
     Robert Egge,
       Chief Public Policy Officer, Executive Vice President, 
     Government Affairs, Alzheimer's Association.
                                  ____

                                                 November 6, 2017.
     Hon. Susan Collins,
     U.S. Senate,
     Washington, DC.
     Hon. Shelley Moore Capito,
     U.S. Senate,
     Washington, DC.
     Hon. Catherine Cortez Masto,
     U.S. Senate,
     Washington, DC.
     Hon. Tim Kaine,
     U.S. Senate,
     Washington, DC.
       Dear Senators Collins, Cortez Masto, Capito and Kaine: On 
     behalf of the undersigned organizations, thank you for your 
     leadership on the important public health issues facing our 
     nation, including the urgent issue of Americans with 
     Alzheimer's and other dementias. We are pleased to support 
     the bipartisan Building Our Largest Dementia (BOLD) 
     Infrastructure for Alzheimer's Act, which would create an 
     Alzheimer's public health infrastructure across the country 
     to implement effective interventions focused on public health 
     issues such as increasing early detection and diagnosis, 
     reducing risk and preventing avoidable hospitalizations.
       Former Surgeon General and Director of the Centers for 
     Disease Control and Prevention (CDC) Dr. David Satcher 
     recently said, ``Alzheimer's is the most under-recognized 
     threat to public health in the 21st century.'' More than 5 
     million Americans are currently living with Alzheimer's and, 
     without significant action, as many as 16 million Americans 
     will have Alzheimer's by 2050. Today, another person develops 
     the disease every 66 seconds; by 2050, someone in the United 
     States will develop the disease every 33 seconds. This 
     explosive growth will cause Alzheimer's costs to increase 
     from an estimated $259 billion in 2017 to $1.1 trillion in 
     2050 (in 2017 dollars). These mounting costs threaten to 
     bankrupt families, businesses and our health care system.
       Public health plays an important role in protecting the 
     health and well-being of Americans, including promoting 
     cognitive function and reducing the risk of cognitive 
     decline. Investing in a nationwide Alzheimer's public health 
     response will help create population-level change, achieve a 
     higher quality of life for those living with the disease and 
     their caregivers, and reduce associated costs. The BOLD 
     Infrastructure for Alzheimer's Act would provide this crucial 
     investment by establishing Alzheimer's centers of excellence 
     across the country and funding state, local and tribal public 
     health departments to increase early detection and diagnosis, 
     reduce risk, prevent avoidable hospitalizations, reduce 
     health disparities, support the needs of caregivers and 
     support care planning for people living with the disease. 
     These important public health actions allow individuals with 
     Alzheimer's to live in their homes longer and delay costly 
     institutionalized care.
       The BOLD Infrastructure for Alzheimer's Act would also 
     increase the collection, analysis and timely reporting of 
     data. This data is critical to identifying opportunities for 
     public health interventions, helping stakeholders track 
     progress in the public health response, and enabling state 
     and federal policymakers to make informed decisions when 
     developing plans and policies. Finally, the bill would also 
     strengthen nationwide implementation of the CDC's Public 
     Health Road Map, which includes strategic action items for 
     state and local public health departments and their partners 
     to promote cognitive functioning, address cognitive 
     impairment and help meet the needs of care partners.
       We deeply appreciate your leadership on behalf of the 
     public health community and

[[Page S7019]]

     all American's living with Alzheimer's and other dementias. 
     We look forward to working with you to advance this important 
     bipartisan bill.
           Sincerely,
     Alzheimer's Association,
     Alzheimer's Impact Movement,
     National Association of Chronic Disease,
     Directors, National Association of Counties.

  Ms. COLLINS. I am now very pleased to yield to the coauthor of this 
important bill. Senator Cortez Masto has been an extraordinary member 
of the Senate Special Committee on Aging. She attends every single 
hearing, which is amazing, given our schedules, and she contributes so 
much to the debate and questioning in those hearings. I am delighted to 
join in this effort with her.
  The PRESIDING OFFICER. The Senator from Nevada.
  Ms. CORTEZ MASTO. Mr. President, I rise to thank my colleague from 
Maine, whose amazing work as chair of the Aging Committee continues to 
inspire me.
  I also rise to share a story that is very personal to me. It is a 
story about one of the smartest people whom I have known, my 
grandmother Katherine, whom I was named after. She was the daughter of 
an Italian immigrant and his Italian-American wife. She was exactly the 
kind of person you think of when you think of an Italian grandmother. 
If you have ever had one, you know that she loves to feed people and 
invite the whole family--aunts, uncles, cousins, everyone--over to her 
house for dinner on Sunday nights. The other 6 days of the week, she 
worked on volunteer projects throughout Las Vegas with her sorority, 
Beta Sigma Phi.
  She never graduated from college, but she was a leader in our 
community, and she was always reading. If you walked into her house, it 
was full of books. In fact, the first thing that you saw when you 
walked into her house was, on one wall, floor to ceiling, a bookcase 
with all of the books that she had read.
  She was brilliant. She was one of my greatest inspirations. Her work 
in our community in Las Vegas is one of the reasons that I decided to 
pursue a career in public service.
  Unfortunately, in the 1990s, my grandmother was diagnosed with 
Alzheimer's disease. At first, you could barely notice a difference. 
There were small things, things that could happen to anyone--lost keys, 
mismatched socks, books left in odd places. Then a woman who had spent 
her entire life loving to cook for her family and grandchildren had 
suddenly stopped cooking.
  Over the next 10 years, she got progressively worse. We could see the 
changes in her every single day, but our lives changed too. My 
grandfather became her caregiver. My mother became her caregiver. My 
aunt became her caregiver. My cousins and I and my sister all became 
caregivers. That is what happens when someone is diagnosed. It does not 
affect just one person; it affects an entire family.
  There is a common misconception that people who are suffering from 
Alzheimer's are not aware of what they are losing, that their memories 
are gone but not missed. That was not the case for my grandmother. I do 
not think it is the case for anyone who is struggling with this 
disease. My grandmother frequently had these moments of clarity when it 
was clear that the losses were just as painful for her as they were for 
all of us.
  One thing that happens to many people with Alzheimer's is that they 
tend to wander. They wander away from home or they get lost. She had 
had one of those moments of clarity after she had wandered away from 
home one day, and the entire family had spent an afternoon looking for 
her in our neighborhood. My aunt and I had found her and had gone to 
pick her up in a car. I will never forget it, as I sat in the back seat 
while my aunt drove.
  My grandmother, who had been seated on the front passenger's side, 
asked my aunt: Why am I doing this? Why am I in my housecoat and 
slippers? Why am I doing this?
  My aunt looked at her and she said: Mom, you are sick. You have 
something they call Alzheimer's, and that means that it is impacting 
your brain and your memories, and you are forgetting.
  We were so powerless. We couldn't do anything but make her 
comfortable and bring her home.
  For many, many families who are dealing with Alzheimer's, they have 
gone through those same moments--those moments when they are dealing 
with their loved ones either trying to explain to them what is 
happening or giving them comfort because they know their memories are 
gone, and they want to make sure they are giving them the comfort they 
need and they deserve.
  We know, unfortunately, that there is no cure for Alzheimer's. My 
grandmother passed away, as many people with Alzheimer's do, when her 
illness got so bad that she lost the ability to eat or drink, but the 
experience of caring for my grandmother opened my eyes to the true 
impact of this disease. I saw that when one person is diagnosed, whole 
families' lives are transformed too. I think about my grandmother every 
day. Every day, I return to some piece of wisdom or guidance that she 
shared with me. I am committed now to honoring her memory by fighting 
to prevent Alzheimer's and to provide caregivers with the support they 
need and deserve.
  When my grandmother was first diagnosed, we did not understand 
Alzheimer's like we do today. We did not have enough healthcare 
programs for it or support for the caregivers. It was seen as an 
individual disease that struck at random, with no cure and no hope. 
Although there is still no cure, we know now that there are things that 
we can do to help to keep the brain healthy longer and possibly reduce 
the risk of Alzheimer's and that there are things that we can do now to 
promote prevention.
  For those who are already living with Alzheimer's and for their 
caregivers, like my family was for my grandmother, there are things 
that we can do to dramatically improve their experiences and to help 
lessen some of that burden. Today there are things we can do to invest 
in finding that cure for Alzheimer's. It is just a petri dish away, but 
we have to believe that it is there and that we can continue and 
support that investment. I have visited the Lou Ruvo Center for Brain 
Health in Las Vegas and met with its director, Dr. Jeffrey Cummings. I 
have seen the incredible work they have done, including their methods 
for the early detection of Alzheimer's, which simply did not exist only 
a few years ago. Yet education in the community and the spreading of 
best practices still lag behind.
  There is no longer any doubt that this is a public health crisis. 
That is why I am so grateful and proud to be sitting on a committee and 
working with a chairwoman, my colleague from Maine, who has made an 
effort here in Congress to really bring attention to Alzheimer's 
disease and to help to fight for funding and investment in a cure.
  I am proud to join my colleagues from Maine, West Virginia, and 
Virginia in introducing legislation that is known as the BOLD 
Infrastructure for Alzheimer's Act. This bill will create Centers of 
Excellence that will be dedicated to promoting effective interventions 
and educating the public on Alzheimer's disease, cognitive decline, and 
brain health. It will provide grants to State and local health 
departments to build the infrastructure that is necessary to address 
this public health crisis, and it will collect the data that is 
necessary to keep pushing the frontiers of what we know about this 
disease.
  I urge my colleagues to support this vital, bipartisan piece of 
legislation that has the potential of having a positive impact on 
millions of Americans across this country.

                          ____________________