By Sandy K. Johnson

In the 1950s, some medical schools advised students not to bother learning about Alzheimer’s disease because it was so rare. That turned out to be drastically wrong: Fifty million people now have dementia across the world.

In the United States, dementia has an economic impact of $200 billion. The need for diagnoses and treatment is so urgent that Congress has given the National Institute on Aging a “bypass” around the normal federal funding process, said Dr. Eliezer Masliah, director of the division of neuroscience at the National Institute on Aging, a division of the National Institutes of Health. With bipartisan support, NIA’s budget has tripled in recent years, to $2.3 billion.

It is a “golden era of research,” said Dr. Marilyn Albert, director of the division of cognitive neuroscience at Johns Hopkins University, which is a grantee of NIA. The need is urgent – there has been no new drug therapy approved since 2003.

NIA funds 30 centers similar to Johns Hopkins around the country. At Johns Hopkins, 150-200 researchers work with a population of 500 people to conduct research on a range of dementia issues; the other 29 centers operate similarly. Data from all 30 is collected at the National Alzheimer’s Coordinating Center, based at the University of Washington in Seattle. (Journalists can request the data.)

One challenge is that dementia is hard to detect. People normally begin to lose cognitive function as they age, a silent phase called “preclinical.” After that, they slip into the phase where they noticeably have trouble with daily tasks or with memory; that’s called “mild cognitive impairment.” The last phase – when most people are actually diagnosed – is dementia in its many forms.

Researchers are working hard to identify potential dementia in those first two phases – through the discovery of biomarkers (perhaps in the next year or two, Masliah said), genetic research and preclinical trials. NIA has 140 clinical trials under way on dementia. Pharmaceutical companies have many more; as Albert noted, a successful treatment would mean billions of dollars in profits.

Scientists are also studying how lifestyle factors can influence brain decline. A recent National Academy of Medicine study suggested that cognitive activity and physical activity could delay or prevent the onset of dementia. Albert also chairs the Global Council on Brain Health, funded by AARP and focused on prevention.

There is also a demographic disparity. African-Americans and Hispanics are more likely to develop dementia than Caucasians, another mystery that researchers are trying to unravel.



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