The problem of Alzheimer’s disease (AD) exemplifies the challenges of dealing with a broad range of aging related chronic disorders that require long-term, labor-intensive and expensive care. As the “baby-boom” generation ages and brain diseases become more prevalent, the need to confront the pending health care crisis is more urgent than ever before. Indeed, there is now a critical need to expand significantly the national effort to solve the problem of AD with special focus on prevention.
The “Prevent Alzheimer’s Disease 2020” (PAD 2020) initiative aims to create a new paradigm for planning and supporting the organization of worldwide cooperative research networks to develop new technologies for early detection and treatments of aging related memory and motor impairments. PAD 2020 is developing an implementation plan to justify: a) increasing the federal budget for research; b) developing novel national resources to discover new interventions for memory and motor disorders; c) creating innovative and streamlined decision-making processes for selecting and supporting new ideas.
Since 1978, the National Institute on Aging (NIA/NIH) established an extensive national network of AD research facilities at academic institutions including: AD Centers (ADCs), Consortium to Establish a Registry for AD (CERAD), AD Cooperative Study (ADCS), AD Drug Discovery Program, National Alzheimer’s Coordinating Center (NACC), National Cell Repository for AD (NCRAD), and AD Neuroimaging Initiative (ADNI). However, despite the success of these program and their critical contributions, they are no longer adequate to meet the challenges presented by AD.
PAD2020 is designed to address these changes by improving the efficiency and effectiveness of these programs. For example, the ADCs (P30s and P50s) can be enhanced by converting some into Comprehensive AD Centers (CADCs) to support not only research, but also by being demonstration projects on care/ treatment, clinical trials, and education as well as by seamlessly integrating multi-site collaborative studies (ADCS, ADNI, Patient Registries, Clinical Data Banks, etc.) into a cohesive structure that further enhances the original mission of the NIA ADCs.
Regional CADCs offer greater efficiency and cost savings while serving as coordinating hubs of existing ADCs thereby offering greater economies of scale and programmatic integration. The CADCs also broaden the scope of ADC activities to include research on interventions, diagnosis, imaging, prevention trials, and other longitudinal studies that require long-term support. Thus, CADCs can address the urgent need to identify subjects at high risk of AD for prevention trials and very early in the course of AD for clinical trials of disease modification. The enhanced CADCs will allow more flexibility among ADCs by supporting collaborative linkages with other institutions, and drawing upon a wider expertise from different locations.
This perspective paper describes the University of Pennsylvania (Penn) CADC Model as an illustrative example of how an existing ADC can be converted into a CADC by better utilization of Penn academic resources to address the wide range of problems concerning AD. The intent of this position paper is to stimulate thinking and foster the development of other or alternative models for a systems approach to the study of dementia and movement disorders.