[Congressional Record Volume 163, Number 195 (Thursday, November 30, 2017)]
[Extensions of Remarks]
[Pages E1621-E1622]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 A GLOBAL UPDATE ON ALZHEIMER'S DISEASE

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                      Thursday, November 30, 2017

  Mr. SMITH of New Jersey. Mr. Speaker, yesterday I held a hearing on 
the global challenge of Alzheimer's Disease. There are an estimated 47 
million people in the world living with Alzheimer's disease and other 
forms of dementia--more than the entire population of Spain--according 
to a report by Alzheimer's Disease International.
   And according to Dr. Marie Bernard, Deputy Director of the National 
Institute on Aging who we heard from yesterday, this number is 
estimated to grow to 115 million by 2050 as populations around the 
world age. The total estimated global cost of addressing this condition 
today is $818 billion, but by as early as next year, it is estimated 
that this cost will rise to at least one trillion dollars.
   Alzheimer's is a cruel disease, robbing its victims of their 
memories and their very identities, and robbing their family and 
friends of the person they know and love. It is excruciatingly painful 
for someone to lose themselves gradually. But what of those who love 
them? Death can rob you of a loved one suddenly, but Alzheimer's 
gradually takes them from you before your very eyes. There are isolated 
points at which they may be back to themselves momentarily, only to 
fade away once more.
   In 1999, I co-founded the Congressional Task Force on Alzheimer's 
Disease, which I still co-chair today, to bring this disease to the 
forefront of the congressional agenda, advance support for federal 
research, and increase awareness. The Task Force worked in partnership 
with the Alzheimer's Association to unanimously pass the National 
Alzheimer's Project Act (PL 111-375) which established an Advisory 
Committee of private and federal experts to work with the Secretary of 
Health and Human Services to comprehensively assess and address 
Alzheimer's research, institutional services and home and community-
based care, with a goal to identify a cure or disease-modifying therapy 
for dementia by 2025. Today, there are over 170 Members in the House 
and Senate.
   This year, I worked with my Task Force Co-Chair, Representative 
Maxine Waters, to request an increase of $414 million to the 
Alzheimer's Research Funding at the National Institutes of Health. 
Under HHS Appropriations Chairman Tom Cole's extraordinary leadership, 
the Fiscal Year 2018 omnibus appropriations bill, passed on September 
14, 2017 included a $400 million increase for Alzheimer's disease 
research at NIH. This would bring total funding to $1.814 billion. 
Currently funded at $1.4 billion, NIH spending on Alzheimer's research 
has almost tripled since Fiscal Year 2015, when $589 million was 
allocated for research.
   The majority of people with Alzheimer's or other forms of dementia 
have not received a diagnosis so they are unable to access the care and 
treatment they so desperately need. This is true in the developed 
world, but it is even truer in the developing world. Michael Splaine 
points out in his testimony that detection and diagnosis are a stubborn 
problem everywhere. Research shows that most people currently living 
with dementia have not received a formal diagnosis. In high income 
countries, only 20-50% of dementia cases are recognized and documented 
in primary care. This `treatment gap' is certainly much greater in low 
and middle income countries. Without a diagnosis, there can't be 
treatment, care and organized support or opportunity to volunteer for 
clinical research.
   Of course, even when Alzheimer's or other forms of dementia are 
diagnosed, care is too often fragmented, uncoordinated and unresponsive 
to the needs of people living with this condition. In response, last 
Congress I introduced the ``Health Outcomes, Planning, and Education 
(HOPE) for Alzheimer's Act'' of 2015 to provide Medicare coverage for a 
care planning session for patients newly-diagnosed with Alzheimer's 
disease, family caregivers or legal representatives. In recognition of 
this great unmet need, this legislation garnered 310 bipartisan 
cosponsors. Ultimately, Medicare adopted an amended version of the HOPE 
benefit in the final rule for Calendar Year 2017 Physician Fee 
Schedule.
   Of course, Alzheimer's robs its victims not only of their memories 
and awareness, but also their lives. In the American Journal of Public 
Health Research survey of years of life lost versus number of deaths 
between 1995 and 2015, annual deaths due to Alzheimer's complications 
in the United States alone rose from 20,607 in 1995 to 110,568 in 2015. 
During that period, Alzheimer's rose from the 14th leading cause of 
death among ailments in this country in 1995 to number six in 2015.
   This was the fourth hearing I have chaired on Alzheimer's disease. 
On June 23, 2011 this Committee held a hearing on Global Strategies to 
Combat the Devastating Health and Economic Impacts of Alzheimer's 
Disease. On November 21, 2013 I chaired the Global Challenge of 
Alzheimer's: The G-8 Dementia Summit and Beyond. In December 2013, the 
G8 nations adopted a goal to identify a cure or disease-modifying 
therapy for dementia by 2025, which corresponds to the U.S. National 
Alzheimer's Project Act. The G8 agreement resulted in the creation of 
the World Dementia Council as a vehicle to drive forward the G8 
commitments. Despite this progress, the massive health and economic 
threat of Alzheimer's and dementia globally is growing. On January 15, 
2014, this Committee held a hearing to Report on the G8 Dementia 
Summit.
   Yesterday's hearing was intended to examine the existing and 
potential options for prevention and treatment of this often 
devastating disease, and the harrowing statistics cited earlier likely 
would be much worse in developing countries if they had accurate 
identification of Alzheimer's and records of victims and deaths.
   As our hearing testimony demonstrated, there is hope for Alzheimer's 
patients, their families and friends. For example, a research team from 
the Columbia University Medical Center in 2013 said they had finally 
traced Alzheimer's to its earliest developmental stages--a discovery 
that they believed could lead to more effective treatments. In Science 
Translational Medicine two years ago, Australian researchers explained 
a non-invasive ultrasound technology that clears the brain of 
neurotoxic amyloid plaques--structures that are responsible for memory 
loss and a decline in cognitive function in Alzheimer's patients. By 
2016, scientists at the Institute for Regenerative Medicine at the 
University of Zurich said they were amazed to find that patients 
treated with the highest dose of the antibody drug aducanumab 
experienced an almost

[[Page E1622]]

complete clearance of the amyloid plaques that prevent brain cells from 
communicating, leading to irreversible memory loss and cognitive 
decline.
   Our witnesses yesterday told us more about these and other advances 
that offer hope that Alzheimer's--if not effectively prevented--can at 
least be more successfully treated. Once we in developed countries can 
get a better handle on diagnosing and treating Alzheimer's, we hope to 
share what we know with developing countries so their citizens can 
better escape what has in the past been a very bleak future for all 
concerned.
   While we work to prevent and find a cure for Alzheimer's, we must 
not neglect those currently living with this disease and address the 
public health crisis we are currently facing. This Congress, I joined 
my colleagues in introducing the ``Building Our Largest Dementia (BOLD) 
Infrastructure for Alzheimer's Act''. This bill establishes Alzheimer's 
Centers of Excellence around the country, provides funding to state and 
local health departments to implement interventions and best practices 
from the Centers of Excellence; and increases the collection, analysis, 
and reporting of data on cognitive decline and caregiving to inform 
future public health actions.
   Additionally, I have re-introduced Kevin and Avonte's Law to 
reauthorize and expand the Missing Alzheimer's Disease Patient Alert 
Program to address the issue of wandering among individuals with 
Alzheimer's and children with disabilities. It's common for a person 
with Alzheimer's to wander and/or become lost, and it can happen at any 
stage of the disease. 6 in 10 individuals with Alzheimer's will wander 
at some point. They may try to go home when already there or attempt to 
recreate a familiar routine, such as going to school or work. Funding 
from this program could be used to provide proactive educational 
programing to prevent wandering to families & caretakers of individuals 
who wander, as well as training to first responders in order to 
recognize and respond to endangered missing individuals and facilitate 
their rescue and recovery. This funding could also be used for 
innovative locative technology for law enforcement that would 
facilitate rescue and recovery.
   Next week, I will re-introduce the Global Brain Health Act to 
increase research on prevention and treatment of autism, hydrocephalus, 
Alzheimer's and other forms of dementia. This legislation would 
encourage the building of treatment capacity for these brain disorders 
among caregivers in developing countries and support increased 
international cooperation in research and implementation of strategies 
on prevention and treatment. These actions also would benefit those 
with these disorders here in the United States.

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