Development of Extramural Research Program on Alzheimer NIANIH

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In the period shortly after WWII, the NIH began to emerge as a critical a catalyst in furthering biomedical research in very broad range of topics. The renaissance of great scientific fervor in the US after the war was primarily the results of: a) increases in the level of research support and, b) the import of scientific/technical know-how from other counties. In the 1950s, the NIH had begun to change from essentially a group of intramural research laboratories to an array of disease specific institutes. Most institutes expanded their research mission by supplementing intramural studies with investigations at academic institutions. This was the start of the extramural research/supported programs, via grants-in-aid to outside investigators. The National Institute for Neurological Disease and Stroke (NINDS) and the National Institute of Mental Health (NIMH) were established in the 1950s with the missions of finding solutions respectively for neurological and psychiatric disorders. The relatively rapid progress in AD research in recent years is primarily attributable to sustained investments in basic research on brain and behavior made by NINCDS and NIMH. The rich intellectual returns of these investments provided the scientific building blocks to the subsequent efforts in the 1970s and 1980s. The important consequences of the NIMH-NINCDS efforts were to: a) increase the number of talented investigators (through pre-and post-doctoral training programs) and, b) expand the base of extramural support for fundamental research.

The NIA was established in 1974 with an amorphous authorization to address the "problems and diseases of the aged". The implicit directive to NIA, by the US Congress, was to develop interdisciplinary research on healthy (normal) aging as well as disorders of aging. This provided the NIA a unique mandate that was substantially different than the other categorical institutes at NIH, which had responsibilities for specific disease e.g., cancer, diabetes, heart, stroke etc. In 1977, this author was recruited to translate NIA's broad legislative directive into 'a blue-print for action'. The NIA strategic plan for a national program of research on the neurobiology of aging and Alzheimer's disease outlined the details of the scientific content, organizational structure, mechanisms of support, resources and infrastructure needs, and professional judgment budget estimates for a comprehensive program. In 1978, however, the task of implementing NIA's broad legislative mandate, i.e., solving 'the problems and diseases of aging' faced a number of difficult hurdles [e.g., lack of funds, little or no academic interest in the topic, small cadre of investigators, the absence of a compelling scientific story, the lack of scientific credibility and inadequate resources/infrastructure].

The strategy for addressing these challenges required NIA to adopt a different model, for developing, organizing and managing the Institutes extramural program, than those used by other well established institutes at NIH e.g., NINCDS or NIMH. The complexities of the multi-facetted problem, such as contrasting normal "aging" from "diseases of aging", required that the program structure be based on the replica of a systems research. This approach to program development de-emphasized disciplinary "silos" and focused on building linkages for the integration of knowledge, skills and points of views across a wide rang of disciplines. The NIA's program development efforts stressed: a) vertically integration of basic research with clinical studies, b) funding mechanisms to promote collaborative research, e.g., program projects, centers, research consortiums, c) building-up resources and infrastructure for conducting longitudinal clinical research and/or clinical trials, e.g., ADCS, and d) developing the "capabilities" of the field for clinical research, including development of diagnostic criteria, standardization of assessment tools and the methodologies of clinical trials. Thus the NIA plan to develop the nascent fields of AD and brain aging stressed the importance of not only on mechanisms of support for investigator initiated projects but also initiatives that encouraged: coordination, organization, and infrastructure building.

Although NIA continued to share an interest in Alzheimer research with other Institutes, by the mid-1980's it had become the lead Institute at NIH; by acquiring administered responsibilities for nearly 70% of all Federal expenditures on AD. In the period since 1978-2006 the total Federal funding for Alzheimer's disease grew from less than $1.0 million per year in FY '78 to over $650 million per year in FY '06. The NIA acquired this leadership by assuming a more proactive role in: a) the recruitment of new investigators and/or programming collaborative program projects, b) the creation of novel mechanisms of support, c) building infrastructures and d) lobbying for specific Congressional mandates and new authorizations (e.g., Centers program) or targeted appropriations. In 1985, James Wyngarden, Director of NIH, directed NIA to establish the Office of Alzheimer's Research, as the NIH coordinating center for all Alzheimer's research. In 1986 the NIA extramural Neuroscience of Aging Program, which had begun in 1978, was reorganized as the current Neuroscience and Neuropsychology of Aging Program (NNA). This program now is one of three extramural components and administers nearly 50% of the Institute's grant budget.

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