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April 2009 | Return to issue home
The National Alzheimer's Coordinating Center:
By W.A. Kukull, Ph.D.
From the Alzheimer’s Association, we have the newest statistics: 5.3 million Americans have been diagnosed with Alzheimer’s disease (AD), and there’s a new case diagnosed every 70 seconds. It’s a tremendous burden on families, the health care system, and society, and as Americans age, the burden will only get heavier. To try to find ways to cure and perhaps even prevent the disease, the NIH’s National Institute on Aging funds 29 Alzheimer’s Disease Centers (ADCs) at major medical institutions across the US and also funds the National Alzheimer’s Coordinating Center to facilitate collaboration among the ADCs and to serve as a central data repository for all the ADCs.
As you might imagine, 29 Centers produce a lot of data. Enter the National Alzheimer’s Coordinating Center (NACC), here at the UW School of Public Health. Closely woven into the Alzheimer’s research community, NACC not only maintains the database but also produces two Center-wide Directors’ meetings each year and facilitates communication and interaction between the Centers. Yes, we are the eye of the storm—though sometimes it feels like Katrina is at our door. (Please visit our Web site for more information.)
NACC was first funded in 1999 as a five-year Cooperative Agreement; it was renewed in 2004 and again in March of this year. Each cycle includes about $15 million in funding.
Looking at the Data
Each of these data sets includes cognitively normal persons, people who have been diagnosed with dementia, and people who are just beginning to experience cognitive problems, termed Mild Cognitive Impairment. Most dementia subtypes are represented, though AD is the most common. NACC not only maintains the database but also provides funding (from the NACC grant award) to member Centers for collaborative research. NACC is currently collaborating with the Alzheimer’s Disease Genetics Consortium, the National Cell Repository for Alzheimer’s Disease, and the ADCs on a series of genome-wide association studies based on the NACC database. With these studies we hope to identify new genetic associations with disease as well as potential targets for intervention treatment or risk reduction.
There are many types of dementia. The most common type is believed to be AD, accounting for approximately 70% of dementia cases. But AD can coexist with other subtypes, such as vascular dementia (related to strokes, insufficiency, or white matter insults within the brain), Lewy body disease (a similar pathology to Parkinson’s disease but occurring in other brain regions), and frontotemporal lobar degeneration, which can cause frontotemporal dementia, primary progressive aphasia, semantic dementia, progressive supranuclear palsy and several other conditions.
Neurodegenerative dementias (i.e., those other than vascular dementia) appear to be caused when specific proteins in the brain misfold, aggregate, and act to destroy synapses (the connections between nerve cells) and kill the nerve cells themselves. The locations in the brain that are affected, along with the specific type of protein, seem to account for the observable clinical dementia symptoms that we characterize as AD, Dementia with Lewy Bodies (DLB), or frontotemporal dementia (FTD). While one set of symptoms may predominate clinically, such as memory loss in AD, sleep disturbance and visual hallucinations in DLB, or disinhibition in FTD, various combinations of the underlying misfolded proteins can be present in all brains. In fact, these protein aggregations may start forming a decade or more before any clinical dementia symptoms are observed—long before we, our spouses, or our children notice any subtle decline in our usual and customary abilities to reason, remember, plan, or think.
Looking to the Future
AD risk increases rapidly among those age 70 or greater. If we started with a group of people age 70 or greater who had no clinical symptoms, we would expect new AD cases to occur at an average rate of 1–2 per 100 per year. Alzheimer’s patients may live 5 to 15 years after being diagnosed, so it is pretty easy to guesstimate that the number of people with the disease—the public health burden—will rise dramatically as the population ages. The impact will be great in the US, as more people live into their 80s and 90s, but the phenomenon will be felt to an even greater degree in China and the western Pacific because of the sheer numbers of persons in those countries who will be living to advanced ages.
Currently, we have no approved treatments that will modify the underlying disease process or interventions that will prevent the disease pathologically or its clinical manifestations. Indeed, we are only at the threshold of being able to presumptively detect asymptomatic, pathologic disease through neuroimaging modalities such as MRI, FDG-PET, and amyloid imaging. There are not yet any blood tests or other simple biological specimen tests that can be used to detect AD pathology. Such tests must be discovered and developed if we hope to avoid the catastrophic public health burden and personal tragedy of AD.
Science must move forward rapidly.
NACC owes its accomplishments and continued existence not just to the cooperation and good will of the NIA and everyone at the Alzheimer’s Disease Centers nationwide but also to its dedicated faculty and professional staff.
April 2009 | Return to issue home