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Outlook For The Future

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By 1999 Progress Report by the NIA/NIH • • December 13, 1999

Alzheimer's is an old disease. Ancient Greek and Roman writers described symptoms similar to those that we know as AD. In the 16th century, Shakespeare wrote about very old age as a time of "second childishness and mere oblivion," suggesting that the symptoms of AD, or something quite like it, were known and recognized then. For many years, the clinical signs and symptoms of Alzheimer's disease were seen as an inevitable part of growing older.

In the last 25 years, scientists have produced an extraordinary body of research findings on AD. Many of these findings have defined the genetic and biologic changes that underlie AD and offer possible targets for treatment. Researchers have identified drugs and other agents that could potentially counteract or compensate for the pathologic changes that occur in AD. They have made gains in identifying the means of detecting persons at high risk of developing AD. As methodologies are refined, scientists and clinicians will be able to investigate and understand the very earliest pathological and clinical signs of AD--perhaps 10 to 20 years before an actual clinical diagnosis is made. A variety of approaches also have been applied to improve methods of providing quality care for AD patients, reduce caregiver burden, and decrease the need for institutionalization. In seeking to understand AD, investigators are also describing normal aging. The research is beginning to shed light on healthy cognition and how to minimize normal age-related cognitive decline.

Federal support of AD research has been the foundation of many of these breakthroughs in our understanding of the disease. This funding has also helped establish an infrastructure that will continue to facilitate research advances. Novel grant award mechanisms, such as the Alzheimer's Disease Centers Program and the Leadership and Excellence in Alzheimer's Disease award, have attracted distinguished scientists to AD research promoted interdisciplinary research collaborations enhanced coordination of research data from multiple studies developed patient examination facilities and biologic resources that are necessary for research on the disease and enabled patient outreach efforts.

These scientific advances, and the research infrastructure that supports them, have made it possible for the NIH to launch a new initiative that builds on current activities and gives a new focus to future work. This initiative, the NIH Alzheimer's Disease Prevention Initiative, is designed to expedite the progress toward finding effective medications and other approaches to delaying or preventing the onset of Alzheimer's disease. In collaboration with other Federal agencies and the private sector, this initiative is moving forward on several fronts simultaneously:

1. fostering new approaches to basic biologic and epidemiologic research

2. increasing the focus on drug discovery and development

3. improving methods to identify early those people who are at increased risk of developing AD

4. facilitating movement of possible new treatments into the clinic for testing in clinical trials

5. actively pursuing research into drug and non-drug strategies for treating behavioral disturbances in AD patients

Potential targets for AD prevention have been identified. These include estrogen-like compounds, anti-inflammatory agents, and antioxidants, as well as drugs that target cell death, the accumulation of abnormal insoluble molecules, and other harmful processes involved in AD. These targets were completely unknown only a few years ago, and the pace of discovery is accelerating. The AD Prevention Initiative will stimulate laboratory and clinical research in these areas.

Some of the clinical trials that are part of the AD Prevention Initiative are already underway, and many more are planned. For example, the first NIH clinical trial aimed at preventing or delaying the onset of clinically diagnosed AD in persons at risk--the Memory Impairment Study--was launched in March 1999. Other trials will be added onto already ongoing trials that are investigating treatments or prevention strategies for other conditions. This "piggy-backing" approach will produce results much more swiftly and cost-effectively than will newly initiated, freestanding studies.

Importantly for those who now have the disease, NIH also is intensifying its AD research and information efforts on issues related to supporting patients and the family members, friends, and providers who care for them. These efforts will include a special emphasis on the needs of a diverse patient population.

A defining aspect of the AD Prevention Initiative is collaboration among NIH institutes and with other Federal agencies, private pharmaceutical companies, and the private sector. The major NIH funders of AD research-- the National Institute on Aging, the National Institute of Neurological Disorders and Stroke, the National Institute of Mental Health, and the National Institute of Nursing Research--make up the NIH AD Working Group that will coordinate and direct the Prevention Initiative. Other NIH institutes that fund AD research also will be closely involved in the initiative.

For several years, NIA staff have worked with other Federal agencies, including the Health Care Financing Administration, the Department of Veterans Affairs, the Food and Drug Administration, and the Centers for Disease Control and Prevention on various areas related to AD. These areas include developing data sets for research purposes, collaborating in research, developing appropriate standards for testing drug efficacy, and pursuing outreach and education efforts. NIH will continue this collaboration, as well as efforts to develop relationships with State and local agencies so that effective AD prevention and treatment strategies can be successfully carried out in the community.

The NIH also will continue to cooperate with pharmaceutical companies in basic research, drug development, and testing and, in particular, will continue to encourage small companies to apply for drug development grants. As part of this aspect of the Prevention Initiative as well as for other future research initiatives, NIH will continue to identify partners for collaboration and to encourage its grantees to build collaborative research relationships with the private sector.

Last, but by no means least, the NIH will continue to work closely with voluntary organizations such as the Alzheimer's Association. One example of this partnership is NIH/Alzheimer's Association co-sponsorship of conferences on different aspects of AD research. The Alzheimer's Association also collaborates in research, education, and outreach at the local and national levels with Alzheimer's Disease Centers, NIH-supported AD investigators, and the NIA's ADEAR Center. Executives of the Institute for the Study of Aging, Inc., a non-profit organization recently established primarily to facilitate development and testing of effective drugs for AD, also will be discussing possible joint initiatives with the NIH. The AD Prevention Initiative will work to expand and strengthen these interactions.

This multifaceted collaborative AD Prevention Initiative, which combines an accelerated search for causes, an assault on the effects of the disease, and vigorous efforts to prevent onset, will energize the fight against AD and bring us closer to the day when we will be able to prevent or even cure this terrible disease, which robs our older relatives and friends of their most precious faculty--their minds.

National Institutes of Health
National Institute on Aging

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