A Bipartisan Lifeline for Alzheimer's: Relationships that are Good for the Heart.

From living rooms across the country to the floor of the United States Senate, one issue that we all agree on addressing is Alzheimer’s disease. Alzheimer’s and related dementias affect one in ten older Americans, and the consequences have become even graver during the coronavirus disease 2019 (COVID-19) pandemic due to social isolation and the inexorable links between social connectedness, mental health, and brain health (Administration for Community Living [ACL], 2021; Centers for Disease Control and Prevention [CDC], 2020b). (The prevalence of Alzheimer’s disease in the United States is 5.8 million according to the CDC, and the population of older adults aged 65 and older is 54.1 million according to the ACL.) The United States Senate Special Committee on Aging serves as a leader for Congress and the country as a whole in addressing Alzheimer’s disease, from advocating for increasing funding for biomedical research to charting new laws to build a better tomorrow for families facing dementia.

The Special Committee on Aging serves as a tugboat for Congress, calling attention to issues and making waves in major pieces of legislation. Under the leadership of Ranking Member Tim Scott (R-South Carolina), current Chairman Bob Casey (D-Pennsylvania), and former Chairman Susan Collins (R-Maine), the Committee has made investing in biomedical research a bipartisan priority. Funding for the nation’s premier biomedical research arm, the National Institutes of Health, has increased by more than 40% over the last six years, from $30.31 billion in 2015 to $42.94 billion in 2021 (Sekar & Congressional Research Service, 2021). Funding specifically for Alzheimer’s disease and related dementias has increased by a factor of five, from $0.63 billion in 2015 to $3.19 billion in 2021 (National Institutes of Health, 2021).

The Aging Committee annually convenes hearings on Alzheimer’s disease, which have highlighted the latest research, the personal and economic tolls of the disease, and what Congress is doing to help. Alzheimer’s affects nearly six million Americans and costs $355 billion annually (Alzheimer’s Association, 2021; CDC, 2020a). Hearings have also examined the potential of new public health approaches to rewrite the future of the disease, such as through prevention and risk reduction. These hearings have led several leaders of the Committee to develop legislation to address Alzheimer’s disease.

For example, former Chairman Collins authored the National Alzheimer’s Project Act of 2011 (P.L. 111-375), along with then-Senator Evan Bayh. This landmark legislation developed a National Plan that set five goals: (a) to prevent and treat Alzheimer’s disease by 2025; (b) to enhance care quality and efficiency; (c) to expand supports for people with Alzheimer’s disease and related dementias and their families; (d) to enhance public awareness and engagement; and (e) to improve data to track progress. In 2021, the Department of Health and Human Services announced a sixth goal: to promote healthy aging and risk reduction (Department of Health and Human Services, 2021). While we are making progress on each of these goals, we have a long way to go to achieve the hallmark National Alzheimer’s Project Act (NAPA) goal to cure Alzheimer’s disease.

As we adjust to a world forever altered by COVID-19, the Committee is poised to stand up for those living with Alzheimer’s disease, and we have turned our attention toward the roles of social and behavioral determinants that may work to prevent or delay the onset of Alzheimer’s disease and related dementias.

A growing body of evidence illustrates that social connectedness helps reduce cognitive and physical declines and maintain quality of life in older adults with dementia. Researchers are beginning to understand the biological underpinnings that may explain how social connectedness helps, from improving functional brain network activity to reducing brain atrophy (Perry et al., 2021; Salinas et al., 2022). A separate body of literature has established the perils of social isolation and loneliness, which are associated with a 50% increased risk of dementia, as well as a 29% increased risk of heart disease and a 32% risk of stroke (CDC, 2020b). The mantra “what is good for the heart is good for the brain” has traditionally been viewed from a physical perspective. The growing literature on social isolation demonstrates that we ought to view it from a social perspective, too: relationships that are good for the heart are good for the brain.

The mantra “what is good for the heart is good for the brain” has traditionally been viewed from a physical perspective. The growing literature on social isolation demonstrates that we ought to view it from a social perspective, too: relationships that are good for the heart are good for the brain.

Prior to the onset of the COVID-19 pandemic, the Special Committee on Aging highlighted the risks of social isolation among older adults. The Committee held the first Congressional hearings on the subject in 2017. These hearings laid the groundwork for the development of federal efforts to combat social isolation in the 2020 reauthorization of the Older Americans Act, which was signed into law in December 2020. The law tasks the Administration for Community Living with developing long-term plans to prevent and respond to negative health effects associated with social isolation and loneliness. In light of the pandemic, this task has become even more crucial, especially for people living with Alzheimer’s and related dementias, who require social connectedness to survive.

The new focus on healthy aging pairs well with another landmark law: the Building our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act (P.L. 115-406), signed into law in 2018. This law was led by then-Chairman Collins and Senator Catherine Cortez Masto (D-Nevada), a former member of the Committee on Aging. This law created a public health infrastructure to combat Alzheimer’s disease and preserve brain health. The BOLD Act applies a public health approach to reduce risks, detect early symptoms, enhance care, improve data, and ultimately change the trajectory of this disease (CDC, 2021). In implementing the BOLD Act, the CDC has so far awarded cooperative agreements to establish 3 Public Health Centers of Excellence and 23 Public Health Programs to Address Alzheimer’s Disease and Related Dementias (CDC, 2021). The awardees span local, state, tribal, and national organizations. This progress represents the beginning of a public health infrastructure for Alzheimer’s disease.

As we look to continue to change the trajectory of Alzheimer’s and related dementias, the pandemic continues to present a barrier. Leaders from the federal to the local levels must find bipartisan, evidence-based balance between protecting people with dementia from new COVID-19 variants while also protecting their relationships and ability to stay connected in person. Medical countermeasures for COVID-19, such as vaccines, tests, and personal protective equipment, can support this balance, together with increased telehealth adoption. Implementing complete social isolation for the most vulnerable populations with dementia ought not to be in the tool kit today.

Republicans and Democrats have debated and disagreed on how to address various aspects of the pandemic, but ultimately worked together with industry to develop vaccines, tests, and treatments at a record pace. This progress must now serve to support people living with dementia, and nonpartisan gerontological research can help demonstrate how to deliver this support. Supporting people with Alzheimer’s disease has always been a bipartisan priority, and now the future of this already-vulnerable population has become more vulnerable due to the pandemic. As we find ways to return to normal, we must keep in mind our most vulnerable populations, and utilize the model of countering one brand-new disease at a record pace to counter this century-old disease in time to meet the hallmark NAPA goal. Congress and the Aging Committee, with the support of researchers, advocates, and families, are poised to lead this charge.

Republicans and Democrats have debated and disagreed on how to address various aspects of the pandemic, but ultimately worked together with industry to develop vaccines, tests, and treatments at a record pace. This progress must now serve to support people living with dementia, and nonpartisan gerontological research can help demonstrate how.