Fiscal Year 2023 Budget

The full Congressional Budget Justification (PDF, 930K) is available in both PDF, and in accessible HTML format below.

Table of Contents

• Director's Overview
• IC Fact Sheet
• Major Changes in Budget Request
• Budget Mechanism Table
• Appropriations Language
• Summary of Changes
• Budget Graphs
• Organization Chart
• Budget Authority by Activity
• Justification of Budget Request
• Program Descriptions
• Appropriations History
• Authorizing Legislation
• Amounts Available for Obligation
• Budget Authority by Object Class
• Salaries and Expenses
• Detail of Full-Time Equivalent Employment (FTE)
• Detail of Positions

Director’s Overview

In 2021, an estimated 57.8 million Americans were age 65 and older. This number could rise to nearly 81 million in 2040. The rising number of older Americans represents a demographic shift that will continue to have profound social, economic, and health impacts on our nation for many decades to come. The National Institute on Aging (NIA) leads the federal government in conducting and supporting research on aging and the health and well-being of older people. We seek to understand the nature of aging and the aging process, and diseases and conditions associated with growing older. Now more than ever, it is critical that we support research on factors throughout the life course that promote healthy aging and research that will enable Americans to be independent throughout their lives.

Aging itself remains the most important risk factor for many devastating diseases and conditions, including Alzheimer’s disease and related dementias (AD/ADRD), most forms of cancer, many types of heart disease, osteoporosis and hip fracture, kidney failure, and diabetes. We are meeting the challenges presented by a growing percentage of older Americans through our ongoing mission to:

• Support and conduct genetic, biological, clinical, behavioral, social, and economic research on aging;
• Foster the development of research and clinician scientists in aging;
• Provide research resources; and
• Disseminate information about aging and advances in research to the public, health care professionals, and the scientific community, among a variety of audiences.

Since 1974, we have pursued this mission by funding extramural research at universities and medical centers across the United States and around the world; conducting a vibrant intramural research program at NIA laboratories in Baltimore and Bethesda, Maryland; and maintaining an active communications and outreach program. We also support robust programs designed to train the next generation of diverse researchers to investigate aging. Fundamentally, we support science to enhance human health. It is our broad, ongoing research investments that enabled us to pivot quickly to address critical needs associated with the COVID-19 pandemic. COVID-19 has disproportionately impacted older adults, especially racial and ethnic minorities and people living in care facilities. It also has had a devastating impact on people living with AD/ADRD and their families and caregivers. These impacts have underscored the importance of our efforts to drive research and innovation, with the goal of addressing urgent public health needs, as well as understanding and responding to health disparities related to aging.

Understanding the Dynamics of the Aging Process

Aging is associated with changes in dynamic biological, physiological, environmental, psychological, behavioral, and social processes. Some age-related changes are benign, such as graying hair, whereas others result in declines in function and increased susceptibility to disease, frailty, or disability. To develop new interventions for the prevention, early detection, diagnosis, and treatment of aging-related diseases, disorders, and disabilities, we must first understand their causes and the factors that place people at increased risk. NIA-supported researchers are engaged in basic science studies to understand the processes of aging and the factors that determine who ages “well,” with resiliency, and who is susceptible to age-related disease and disability. Research is also ongoing to identify the interactions among genetic, environmental, lifestyle, behavioral, and social factors, and their influence on age-related diseases and degenerative conditions.

Aging is the major risk factor for chronic diseases and frailty in people over the age of 55. Researchers hypothesize that slowing the rate of aging will have a beneficial impact on the health of older adults by delaying the onset or reducing the severity of these conditions. As a result, we not only support clinical trials of interventions for a range of disorders and conditions related to aging, including cardiovascular diseases, osteoporosis, arthritis, cancer, and pain, but we are also focused on accelerating the development of treatments to address chronic conditions by intervening in the process of aging. One such NIA-supported project is the Translational Geroscience Network, which supports trials of interventions that target mechanisms of biological aging. Researchers in this network are conducting early trials of repurposed drugs for which preclinical or clinical data already exist (e.g., the diabetes drug metformin) in altering fundamental aging processes, among other activities.

A particularly promising avenue of research involves cellular senescence, a process in which cells lose normal function, including the ability to divide and replicate, but continue to release molecules that may damage neighboring cells. With our involvement, the Cellular Senescence Network (SenNet) was approved in FY 2020 as a Common Fund project by the NIH Council of Councils and launched in early 2021. Through this program, researchers seek to identify and characterize how different types of senescent cells affect multiple tissues to impact human health, disease, and lifespan. In addition, NIA-supported investigators have found that treatment with senolytics, compounds that selectively remove senescent cells, extended lifespan and healthspan in naturally aging mice.¹ Separately, investigators have also demonstrated that clearing senescent cells from the brain preserves cognition in a mouse model of Alzheimer’s disease.² In other aging-related research supported by NIA, senolytic compounds (drugs that destroy senescent cells) have moved into early-stage human trials, with researchers testing them for the prevention or alleviation of frailty, diabetic kidney disease, and idiopathic pulmonary fibrosis, a serious lung disease. This line of research also proved promising during the COVID-19 pandemic. NIA researchers found that senolytics decreased inflammation and improved survival rates of older mice infected with a beta-coronavirus that was closely related to the COVID-19 virus, suggesting that senolytics may boost protection of older adults from COVID-19. Clinical trials of a senolytic drug in hospitalized, older COVID-19 patients and older COVID-19 patients living in nursing homes are underway.

Additionally, we support behavioral science that is uncovering individual-level psychological, social, and behavioral factors throughout the life course that predict adaptive and healthy aging or confer risk for age-related decline. With many chronic conditions emerging in midlife, attention to the interplay of behavioral and social factors with biological processes during this life stage holds potential for identifying optimal times for interventions to reverse or slow aging processes. Moreover, health disparities in midlife can have a dramatic effect on critical population trends. As one example, we funded a report from the National Academies of Sciences, Engineering, and Medicine (NASEM) that examined recent declines in U.S. life expectancy, particularly among non-Hispanic whites and Black/African Americans, driven by increased mortality among adults between 25-64 years of age.³ The report found significant disparities in life expectancy across several dimensions, including geography, race, and socioeconomic status. In addition, we are also interested in facilitating research designed to better understand place-based inequalities in midlife.

Improving the Health, Well-Being, and Independence of Adults as they Age

NIA is the lead federal agency for research on AD/ADRD, the fifth leading cause of death for adults 65 and older and a major contributor to loss of independence; our portfolio reflects this important responsibility. More than half of our awarded grant dollars are dedicated to research on various forms of dementia. These funds support a broad range of projects, including basic molecular and cellular studies of the aging brain; large scale clinical trials of interventions to prevent symptoms of AD/ADRD; development of a robust infrastructure for drug discovery; and AD/ADRD population studies in different geographic, racial/ethnic, and socioeconomic groups. Increases in federal appropriations for AD/ADRD research have enabled us to bring additional focus to this critical area and to enhance investments in key research areas necessary for a precision medicine approach to treatment and prevention, towards the goal of delivering to each individual the right treatments in the right place at the right time.

We have launched multiple programs over the past several years to provide researchers and industry with an infrastructure for developing medicines and other products, including the Alzheimer’s Disease Sequencing Project, Accelerating Medicines Partnership ® for Alzheimer’s Disease (AMP ® AD), the Alzheimer’s Disease Neuroimaging Initiative (ADNI), and more. Many of these programs bring together scientists from academia and industry and from across many different disciplines. Working collaboratively, NIA-supported researchers employ an open-science/open-source approach at every step of the translational science process. They are discovering new and better targets for treatment, producing and analyzing comprehensive and shareable sets of molecular data, and developing high quality tools to move discoveries from the bench to the bedside. To date, AMP® AD researchers have identified more than 500 new potential AD/ADRD drug targets. Building on this success, we launched a second iteration of this program, AMP AD 2.0, in 2021 to further accelerate the discovery of new drug targets, biomarkers, and disease subtypes. For example, this new phase will analyze additional data and biosamples from populations most at risk for Alzheimer’s, including Black and Latinx populations, in support of its ultimate goal to enable a precision medicine approach to the discovery of novel targets and biomarkers.

These resources and support have also helped small businesses make significant advances in care interventions, diagnostic tools, and therapies for AD/ADRD. Over the past 11 years, we have invested $280 million through more than 600 grants to over 230 small businesses in 37 states. Thanks to NIA’s small business grants, the first blood test — PrecivityAD — for a protein called amyloid, plaques of which in the brain are hallmarks of Alzheimer’s, became commercially available in fall 2020. Other small businesses have used NIA support to identify promising new therapeutics for AD/ADRD, one of which is now in phase two clinical trials.

Complementing our translational infrastructure is funding for new cross-disciplinary training programs. Through these efforts, we are supporting a new and more diverse generation of translational scientists with expertise in biology, data science, behavioral research, engineering, and drug development, who can participate in and lead team-science programs from target discovery to clinical trials. In addition, the NIA-funded Alzheimer’s Clinical Trials Consortium (ACTC), a clinical trials infrastructure designed to accelerate and expand studies for therapies in AD/ADRD, continues to provide centralized resources and shared expertise to researchers nationwide to hasten the development of effective clinical interventions. In 2020, the ACTC launched a novel multidisciplinary clinical trial training program to help increase the pool of researchers with the proper training and expertise to conduct complex clinical trials. To date, two diverse cohorts, totaling 69 investigators, have completed the training.

To provide effective care for people living with dementia as well as support for their care partners, we also fund research targeting several areas: care and caregiving access and quality, improving models of care across different settings, and care coordination. Additionally, we support studies on how regulatory and socio-economic incentives and constraints affect access, quality, and health outcomes for affected individuals.

In early 2021, NASEM published a consensus study report assessing the evidence for care interventions for persons living with AD/ADRD. This report was the culmination of a collaborative process supported by the NIA, based on a systematic evidence review conducted by the Agency for Healthcare Research and Quality. The final report from this project identified a range of opportunities to improve the dementia care research base, such as including assessments of real-world effectiveness. We also held a National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers in summer 2020 to discuss the current state of dementia care and care partner research and identify gaps and opportunities that warranted additional focus. To stimulate research that addresses these needs, NIA released five new care research implementation milestones in late 2021, and planning is underway for another iteration of this summit in 2023.

Further, we are supporting multiple initiatives to strengthen behavioral intervention research as well as real-world clinical trials of dementia care and caregiving interventions. Older adults can take part in these trials where they already live and receive care, which should facilitate intervention testing in more diverse older adult populations. Further, we have invested in multiple infrastructure projects aimed at improving the rigor of behavioral intervention development for dementia care and caregiver research, including the Roybal Centers for Translational Research on Dementia Care Provider Support and the NIA IMbedded Pragmatic AD/ADRD Clinical Trials (IMPACT) Collaboratory. Launched in 2019, these projects were designed to catalyze widespread, system-level changes and establish a pipeline to fortify care and caregiving intervention research. As an example of the value of this type of infrastructure, the IMPACT Collaboratory (described below) used its established network of partner health care systems to help researchers quickly pivot and effectively respond to the COVID-19 pandemic and assess its acute impact on older adults, particularly those with dementia.

We also lead efforts focused on the prevention of age-related disease. Prevention can help people lead longer, healthier lives. For example, intensive management of blood pressure may reduce the risk for mild cognitive impairment and a growing literature supports a relationship between blood pressure control and AD/ADRD risk reduction. We support and conduct research to identify lifestyle factors and health behaviors that directly influence physical, cognitive, sensory, and emotional health and risk of disease as people age. NIA-funded studies are exploring lifestyle and behavioral interventions for people of all ages — such as cognitive training, a healthy diet, and exercise — as potential ways to increase their likelihood of aging well. As investigators more precisely identify the psychological, behavioral, and social processes that influence health and quality of life, we will be able to provide an evidence base for the development of public health initiatives to reinforce prevention efforts, enhance symptom management, and preserve function among older adults. To facilitate uptake of such efforts, we released new funding opportunities in early 2021 for research, including behavior change clinical trials on the psychology of motivation, value-based decision making, and social support to help investigators develop ways to help people choose and sustain healthy behaviors over many years.

Key to our efforts to treat and prevent diseases associated with aging are sustained initiatives to enhance recruitment and retention of participants in clinical research studies, particularly individuals from diverse backgrounds. In 2021, we launched OutreachPro, a web-based communication tool that enables health care professionals to more easily produce and brand tailored clinical trial recruitment materials and strategies. Designed to help reach multiple cultures as well as those who do not speak English, the tool enables the research community to access, adapt, and personalize materials that NIA has developed and tested — and will continue to create — for underrepresented communities. Additionally, we recently awarded a contract that will allow comprehensive management and tracking of clinical research recruitment, the identification of best practices from top-performing sites, and greater transparency regarding recruitment efforts and successes. This investment will also enable us to collect and communicate critical, timely information to ensure that NIA’s clinical trial sites are making appropriate progress toward reaching recruitment goals related to multiple underrepresented groups, and to take corrective action quickly for those that are not.

Enhancing recruitment and retention of participants from diverse backgrounds also requires understanding the health disparities faced by different groups of people. To date, we have funded more than 115 projects designed to examine health disparities related to AD/ADRD and strategies for recruitment and retention into clinical studies. Topics range from investigating racial and geographic disparities in AD/ADRD risk to exploring the effects of participation in long-term community-based trials on lifestyle and risk for these diseases. Funding opportunities to explore these questions remained active until November 2021, and planning for future initiatives is underway.

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IC Fact Sheet

Focus of NIA Research

The National Institute on Aging (NIA) leads the federal government in conducting and supporting research on aging and the health and well-being of older people. NIA is also the lead federal agency for research on Alzheimer’s disease and related dementias (AD/ADRD). NIA supports a strong, diverse, and balanced research program, focusing on the genetics and biology of aging; basic and clinical studies aimed at reducing disease and disability, including AD/ADRD; age-related cognitive change; and investigations of the behavioral and social aspects of aging.

Dr. Richard J. Hodes, Director

Richard J. Hodes, M.D., a leading researcher in the field of immunology, has served as NIA director since 1993. Under Dr. Hodes’ stewardship, the NIA budget has grown to ~$3.9 billion, reflecting increased public interest in aging research as America and the world grow older.

Current Activities

• The NIA-funded Imbedded Pragmatic Alzheimer’s disease and related dementias Clinical Trials (IMPACT) Collaboratory enables researchers to develop and test care interventions in real-world settings, as well as pivot to study the impact of evolving public health issues, such as the COVID-19 pandemic.
• NIA invests in the Clinical Research Operations & Management System, which will track, report, and manage clinical research enrollment data, study documents, activities, and portfolios in real-time across NIA clinical research projects. This will also enable critical, timely information for ensuring that NIA’s clinical trial sites are making appropriate progress toward reaching recruitment goals related to multiple under-represented groups.
• NIA leads efforts into investigating existing drugs that the U.S. Food and Drug Administration (FDA) has already deemed safe for people with other conditions via the Drug Repurposing for Effective Alzheimer’s Medicines (DREAM) study —some of these drugs could be repurposed to effectively prevent or treat AD/ADRD as well.

Recent Research Accomplishments

High blood pressure, or hypertension, is common in adults older than 50 and is a leading risk factor for heart disease, stroke, and kidney failure, and a growing body of research suggests that it may increase risk for dementia later in life. In 2019, results from the Systolic Blood Pressure Intervention Trial–Memory and Cognition in Decreased Hypertension (SPRINT-MIND) were the first to show beneficial effects of intensive lowering of high blood pressure for reducing risk of mild cognitive impairment, a known precursor for dementia.

NIA investments in less invasive and less expensive biomarkers for AD/ADRD continue to generate advances. In 2020, the first blood test for amyloid became commercially available and the FDA approved the first PET tracer for tau imaging. NIA-supported researchers continue to explore novel blood biomarkers for various forms of amyloid, tau, and other promising targets.

Cellular senescence — a process in which cells lose normal function — is a possible contributing factor to many age-related conditions. NIA and the National Cancer Institute launched the Cellular Senescence Network (SenNet), a $190 million NIH Common Fund initiative to coordinate the exploration, identification, and cataloging of differences in senescent cells throughout the body.

On the Horizon

The hallmarks of aging, such as genetic changes and breakdowns in communication between cells, have largely been studied in isolation. NIA investigators are working to understand interactions amongst these hallmarks as drivers of the aging process.

NIA continues to diversify the therapeutic pipeline for AD/ADRD, supporting the development of a variety of targets other than amyloid in recognition of the complex and heterogeneous nature of AD/ADRD.

In 2006, NIA launched the Alzheimer’s Drug Development Program (ADDP) to address the unmet need for therapeutics and counteract the biopharma investment gap. The ADDP has funded 41 drug development projects to date, and NIA seeks to reissue the ADDP to build on the gains made in the first 15 years of the program.

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Major Changes in the Fiscal Year 2022 President’s Budget Request

Major changes by budget mechanism and/or budget activity detail are briefly described below. Note that there may be overlap between budget mechanisms and activity detail, and these highlights will not sum to the total change for the FY 2023 President’s Budget request for NIA, which is $4,011.4 million, an increase of $112.2 million from the FY 2022 Continuing Resolution (CR) level. The FY 2023 President’s Budget reflects the administration’s fiscal policy goals for the federal government. Within that framework, NIA will pursue its highest research priorities through strategic investments and careful stewardship of appropriated funds.

Non-Competing Research Project Grants (+$298.7 million; total $2,152.2 million):
NIA will continue to support its established non-competing Research Project Grants (RPGs) awarding a total of 2,205 RPGs, an increase of 34 from FY 2022. This increase is the result of the increased number of competing RPGs that NIA awarded during previous fiscal years.

Competing Research Project Grants (-$231.7 million; total $625.7 million):
NIA will award a total of 940 competing RPGs, an increase of 21 from FY 2022. The decrease in competing RPG funds is based on the transition of previously awarded RPGs into non-competing status. NIA will be able to increase the number of awards while decreasing the funds available by reducing the average cost per RPG.

Intramural Research (+$18.1 million; total $232.1 million):
The Center for Alzheimer’s and Related Dementias (CARD) is a collaborative initiative of NIA and the National Institute of Neurological Disorders and Stroke (NINDS) that supports basic, translational, and clinical research on Alzheimer’s disease and related dementias. CARD’s central mission is to initiate, stimulate, accelerate, and support research that will lead to the development of improved treatments and preventions for these diseases. The CARD basic science research facility opens in spring 2022. In addition to ongoing staffing up and equipping of this facility, there will be a continued increase in research execution and output over the next three years. CARD will recruit leaders in the field over the next period and enact significant additional research programs reflected by increased staffing, equipment, and research as the Center reaches its research potential. Critically within this period, CARD has prioritized the recruitment of a Director for Clinical Translation, who will translate the findings within CARD and from the broader scientific community into therapeutic strategies. The recruitment of this individual and the creation of the capacity to have a transformative impact in this space will require significant investment.

Research Management and Support (+$10.7 million; total $136.2 million):
NIA oversees 4,067 research grants, 811 full-time training positions, and 49 research and development contracts. Funding will be used to cover the expenses associated with providing for the effective, administrative, planning and evaluation, public information and communications, and scientific leadership of the institute.

¹ doi: 10.1038/s41591-018-0092-9 (Back to text)

² doi: 10.1038/s41593-019-0372-9 (Back to text)

³www.nationalacademies.org/our-work/rising-midlife-mortality-rates-and-socioeconomic-disparities (Back to text)

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Program Changes	FY2022 Enacted #: FTEs	FY2022 Enacted Amount	FY2022 PB #: FTEs	FY 2022 PB Amount	Change from FY 2021: FTEs	Change from FY 2021: Enacted Amount
6. Intramural Research	260	$213,976	289	$232,089	29	$6,174
7. Research Management and Support	260	$125,528	311	$136,198	51	-$1,760
8. Construction	n/a	$0	n/a	$0	n/a	$0
9. Buildings and Facilities	n/a	$0	n/a	$0	n/a	$0
Subtotal, Program	520	$3,899,227	600	$4,011,413	80	$87,817
Total built-in and program changes	n/a	n/a	n/a	n/a	n/a	$112,186

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Fiscal Year 2023 Budget Graphs

History of Budget Authority and FTEs:

Distribution by Mechanism:

Change by Selected Mechanism:

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Organizational Chart

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