Council Minutes - May 2016
The 128th Meeting
May 10–11, 2016
- REVIEW OF APPLICATIONS
- CALL TO ORDER
- REPORT: Task Force on Minority Aging Research
- REPORT: WORKING GROUP ON PROGRAM
- PROGRAM HIGHLIGHTS
The 128th meeting of the National Advisory Council on Aging (NACA) was convened on Tuesday, May 10, 2016, at 3 p.m. in Building 31, Conference Room 10, National Institutes of Health (NIH), Bethesda, MD. Richard J. Hodes, M.D., Director, National Institute on Aging (NIA), presided.
In accordance with the provisions of Public Law 92–463, the meeting was closed to the public on Tuesday, May 10, from 3 to 5 p.m. for the review, discussion, and evaluation of grant applications in accordance with the provisions set forth in Sections 552(b)(c)(4) and 552(b)(c)(6), Title 5, U.S. Code and Section 10(d) of the Public Law 92–463.1The meeting was open to the public on Wednesday, May 11, from 8 a.m. to 12:00 p.m.
Dr. Kimberly Acquaviva
Dr. Maria Carrillo
Dr. Eileen M. Crimmins
Dr. Steven R. Cummings
Dr. Kevin P. High
Dr. Bradley T. Hyman
Dr. James L. Kirkland
Dr. Richard Mayeux
Dr. Terrie E. Moffitt
Dr. Charles P. Mouton
Dr. Anne B. Newman
Dr. Norman E. Sharpless
Dr. Reisa A. Sperling
Dr. Debra Bailey Whitman
Absent Council Members
Ms. Jennie C. Hansen
Dr. Thomas A. Rando
Ex Officio Participants:
Dr. Richard M. Allman, Veterans Health Administration
Dr. Jane Tilly, Administration for Community Living
Absent Ex Officio Participants:
Dr. Kenneth G. Pugh, National Naval Medical Center
Edwin L. Walker, Administration on Aging
The Council Roster, which gives titles, affiliations, and terms of appointment, is appended to these minutes as attachment A.
In Addition to NIA Staff, Other Federal Employees Present:
Dr. Alexei Kondratyev, NIH Center for Scientific Review (CSR)
Dr. Bruce Reed, CSR
Dr. Elyse Schauwecker, CSR
Dr. Laurent Taupenot, CSR
Members of the Public Present:
Mr. Ryne Carney, Alliance for Aging Research
Dr. Navdeep S. Chandel, Northwestern University
Dr. Jason N. Doctor, University of Southern California
Dr. Laura N. Gitlin, Johns Hopkins University School of Medicine
Dr. J. Taylor Harden, National Hartford Center of Gerontological Nursing Excellence
Ms. Patricia Kobor, American Psychological Association
Dr. Rose Maria Li, Rose Li and Associates, Inc.
Ms. Laurie Lindberg, Gerontological Society of America
Dr. Eliezer Masliah, University of California, San Diego
Dr. Frances McFarland Horne, Rose Li and Associates, Inc.
Dr. Libby O'Hare, Lewis-Burke Associates
Dr. William Sansalone
Dr. Peter J. Snyder, University of Pennsylvania School of Medicine
REVIEW OF APPLICATIONS
This portion of the meeting was closed to the public, in accordance with the determination that it concerned matters exempt from mandatory disclosure under Sections 552(b)(c)(4) and 552(b)(c)(6), Title 5, U.S. Code and Section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. Appendix).2
A total of 1392 applications requesting $2,619,516,347 for all years underwent initial review. The Council recommended 799 awards for a total of $1,726,388,730 for all years. The actual funding of the awards recommended is determined by the availability of funds, percentile ranks, priority scores, and program relevance.
CALL TO ORDER
Dr. Hodes welcomed members to the open session of the 128th NACA meeting and called the meeting to order at 8:00 a.m. on Wednesday, May 11, 2016.
Director’s Status Report
Dr. Hodes reported that the NIH appropriation for FY2016 totals $32 billion, including targeted allocations of $200 million for the Precision Medicine Initiative, $85 million for the Brain Research through Advancing Innovative Neurotechnologies Initiative (BRAIN), and $350 million for Alzheimer's disease (AD) research. The NIA appropriation increased to $1.6 billion, which includes growth in funding for both AD- and non-AD–related research.
The table below shows paylines for FY 2016 and the more generous funding for early stage and new investigators:
Requested Direct Costs & Allocation
|<500 K: General||<500 K: AD||>500 K: General||>500 K: AD|
All Applications Except for New Investigators and Early Stage Investigators
New Investigators (R01)
Early Stage Investigators (R01)
Dr. Hodes noted that in the previous year, the NIA was able to increase the payline by foregoing full payment of noncompeting applications. Because of the 4.2% increase in our general appropriation as well as the $350 million increase for Alzheimer's research NIA has been able to achieve full payment of noncompeting applications and increase the payline for general, lower-cost applications from 8% to 9%.
Dr. Hodes also discussed the AD bypass budget and reminded the Council of the planning process to develop priorities, milestones, and budget estimates. The FY2018 bypass budget will be based on a preliminary report from a 2016 meeting on AD-related dementias. The estimate for the bypass budget also will assume a relatively flat budget from FY2016 to FY2017. Dr. Hodes also noted that the NIA and NIH are tracking expenditures. The Research, Condition, and Disease Categorization (RCDC) has reported on both AD and AD-related dementias for FY2015 and will continue to do so. Overlaps have been eliminated, and the International AD Research Portfolio will continue to provide detailed tracking of research initiatives and awards.
Dr. Hodes then provided the following NIA, NIH, and HHS updates:
- The expected increase in global life expectancy will cause an almost-doubling of the global population aged 65 years and older by 2050, and the tripling of the global population aged 80 years and older by 2050. Although these trends arise primarily from advances in technology and medicine, they will have societal implications associated with challenges in maintaining a healthy lifespan.
- An article in the New England Journal of Medicine based on the Framingham Heart Study reports substantial decreases in dementia incidence between the late 1970s/early 1980s and the late 2000s/early 2010s, primarily because of changes in and reduction of cardiovascular risk factors, as well as increases in years of education in the later cohort.
- The NIA and the National Institute of Neurological Disorders and Stroke have launched the Molecular Mechanisms of the Vascular Etiology of Alzheimer's consortium (M2OVE AD), a 5-year, $30 million initiative to examine the influence of vascular risk factors on AD and to identify new therapeutic targets.
- A publication by Snyder, et al. (2016) reported that testosterone treatment in older men improves sexual activity and confers some benefit with respect to mood and depressive symptoms, but provides no benefit with respect to vitality or walking distance (see Program Highlight, below).
- In April, the Geroscience Interest Group (GSIG) held its second Geroscience Summit, "Disease Drivers of Aging: 2016 Advances in Geroscience Summit," with support from the NIH, the Gerontological Society of America, the American Federation for Aging Research, and the New York Academy of Sciences. The GSIG published several papers based on its first Geroscience Summit in supplements to the Journal of Gerontology. GSIG participants also contributed to an edited volume, Advances in Geroscience, which was published in November 2015.
Dr. Hodes also noted the NIA's long history of collaboration to maximize funding for meritorious research beyond the payline. By law, the NIA is unable to forward applications it has reviewed to its collaborators; however, the Institute can inform applicants that they could approach these other organizations. In response to a congressional request, the NIH, biomedical foundations, and industry have developed OnPAR, a web-based system to provide meritorious applications a second chance at funding. Dr. Hodes invited Council members to visit the site.
Dr. Hodes concluded his report by announcing that Dr. Eric Dishman has been appointed as the Director of the Precision Medicine Initiative (PMI) Cohort Study and that Vice President Joe Biden will chair the White House Cancer Moonshot Task Force to maximize investments and initiatives to support cancer research and progress in treatment and care. He also congratulated current NACA member Dr. Eileen Crimmins, and former NACA member Dr. Helen Blau, who were inducted into the National Academy of Sciences.
In response to questions from Dr. Norman Sharpless, Dr. Hodes acknowledged that the NIA remains tied with the Eunice Kennedy Shriver National Institute of Child Health and Human Development for the lowest payline. He and Dr. Robin Barr cited an increased number of applications as one reason for the low payline. Dr. Barr added that a growing number of applications are focused on AD; the proportion of small business applications focused on AD has increased to approximately 75%, an increase from the typical 50%.
Future Meeting Dates
September 27-28, 2016 (Wednesday and Thursday, Building 31)
January 17-18, 2017 (Tuesday and Wednesday, Building 31)
May 16-17, 2017 (Tuesday and Wednesday, Building 31)
September 26-27, 2017 (Tuesday and Wednesday, Building 31)
Consideration of Minutes of the Last Meeting
The minutes of the January 2015 meeting were considered. A motion was made, seconded, and passed unanimously to approve the minutes.
Dr. Charles Mouton reported on presentations given to the Task Force by Lisa Evans, Science Workforce Diversity Specialist at the NIH, and Dr. Roland Thorpe of Johns Hopkins University. Ms. Evans discussed the importance of diversity overall and the need for more diversity in the extramural workforce. She described the NIH Office of Scientific Workforce Diversity, which focuses on the science of diversity and evidence-based approaches toward recruitment and training, and the new Division of Biomedical Research Workforce, which employs diversity as a cross-cutting theme as it develops a strategic policy to ensure a well-trained biomedical research workforce. Ms. Evans also discussed the 2016–2020 NIH Research Workforce Strategic Plan and highlighted upcoming activities related to each of its goals.
Dr. Thorpe's presentation focused on minority men's health and life expectancy. The extent of the difference between the health of minority men and others varies across races and ethnicities. Dr. Thorpe discussed the importance of studying men's health in the context of the overarching goals of Healthy People 2020. He also described what men born in 1935 might have witnessed and participated in as an example of how cohorts differ in their experiences and exposures, which can ultimately influence health. Dr. Thorpe also discussed masculinity and residential segregation as other key determinants in men's health, particularly for older African American men. He highlighted major contributions, particularly from the NIA, to the literature in minority men's health, and he emphasized the role of NIA support in his own career development. He also noted the importance of the health disparities research framework to future work.
REPORT: WORKING GROUP ON PROGRAM
The Working Group on Program heard a report from the Clinical Trials Advisory Panel (CTAP) and considered six concepts for requests for proposals (RFPs) or applications (RFAs).
Dr. Kevin High reported that the CTAP reviewed the Targeting Aging with Metformin (TAME) protocol and recommended that it move forward into grant submission and review. No further action was required from the Council on this report.
RFA/RFP Concept Clearances
A motion was forwarded and seconded to approve six concepts en bloc. The motion passed unanimously.
NIA Research Centers Coordinating Network
The NIA has six productive research networks across its divisions. As noted by reviews of the Division of Aging Biology (DAB) and the Division of Geriatrics and Clinical Gerontology (DGCG), however, interactions among these networks should be increased substantially. The concept proposes a modest level of funding to support scientific meetings, collaborative projects, mentorship models, and dataset integration to foster interaction and synergies among these research networks. The Working Group on Program endorsed this concept. There was no further discussion from the Council.
Alzheimer's Disease Sequencing Project (ADSP) Follow-Up Study
The concept proposes to extend an NIA program studying the genetics of AD to a second set of 10,000 controls and individuals with AD. This extension would move away from exome sequencing to whole genome sequencing, fill in gaps, and generate a replication dataset. The Working Group on Program endorsed this concept. There was no further discussion from the Council.
Complex Biology of Resilient Phenotypes
This concept proposes a set-aside to use Big Data generated from research consortia to identify factors that confer resilience in individuals who are genetically or epigenetically predisposed to various phenotypes. The proposal emphasizes data integration, transcriptomic and proteomic data, data-sharing, and some validation of candidate features. The Working Group on Program endorsed this concept. There was no further discussion from the Council.
Translational Bioinformatics and Network Pharmacology
The proposed RFA will support research to (1) mine information on approved drugs to identify those that could be used toward AD and (2) explore the underlying biology and pharmacology of combination therapies for AD. The Working Group on Program endorsed this concept. There was no further discussion from the Council.
Mobile Monitoring of Cognitive Change
For AD and other dementias, cognitive changes may appear long before the time at which traditional measures would identify them. The proposed concept would support the use of mobile phones to monitor cognitive changes over time. The Working Group suggested that mobile phone apps should not only incorporate cognitive tests, but also link to data on sleep and activity. The Working Group on Program endorsed this concept. There was no further discussion from the Council.
Basic and Translational Research on Decision-Making in Aging and AD
The proposed concept supports research on ways to help older adults make better decisions in health and personal finance and thereby reduce their risk of falling prey to fraud, exploitation, and mistreatment, and to reduce stress on older adults and their caregivers. The proposed research will bring together multiple disciplines and require collaboration between basic decision scientists and clinical scientists working with AD patients. The Working Group recommended that the research participants in these studies include representation from populations with low education and low net worth, because these populations are particularly vulnerable to the deleterious consequences of poor decision-making. The Working Group endorsed this concept. There was no further discussion from the Council.
- Statement of Understanding
The Statement of Understanding is an agreement between the NACA and NIA on the management of Council-related activities that do not require a Council meeting. Such activities usually include small administrative supplements, reinstatement of funds, and early concurrence for applications with direct costs up to $500,000. All interim actions are reported in the electronic Council book. Dr. Barr commented that because of the late date for the September Council meeting, the Council will likely be asked to conduct early concurrence on applications.
A motion to renew the Statement of Understanding was forwarded and seconded. The motion passed unanimously.
- Statistical Package
Dr. Barr reported that there were 400 more applications for the May Council meeting than for immediate prior Council rounds and that approximately half of them had been submitted in response to funding opportunity announcements and AD-targeted initiatives. The statistical package now includes a table looking at all applications for the May Council meeting and a table looking at only those that have a preliminary AD code generated by the RCDC. The majority of applications with an AD code are under consideration by the Division of Neuroscience (DN), and an additional 10% are under consideration by the Division of Behavioral and Social Research (DBSR). Of all applications submitted for May Council, those submitted to the NIA were somewhat less likely to be discussed in review compared to applications submitted in the preceding two Council rounds.
Division of Aging Biology (DAB): Mitochondria as Signaling Organelles
Dr. Navdeep Chandel, of Northwestern University, described work in his laboratory studying mitochondria as signaling organelles. Mitochondria are well known as bioenergetic organelles and are identified as having an important role in biosynthesis. A key feature of the bioenergetics role is the coupling of the respiratory chain, which generates Adenosine Triphosphate—a coenzyme—to the tricarboxylic acid (TCA) cycle. Hydrogen peroxide has been assumed to be a harmful by-product of respiration. However, Dr. Chandel reported that some work in his laboratory establishes that mitochondria release low levels of hydrogen peroxide, which in turn can induce transcription factors under different conditions. In addition, the TCA cycle itself is a critical substrate for factors that play a role in epigenetics. In this way mitochondria serve a signaling function beyond their role in bioenergetics and biosynthesis.
Dr. Chandel and his colleagues have been using conditional knockout mice to look at various components of the respiratory chain. He showed unpublished data for a model looking at the role of complex III in the function of regulatory T cells. He also presented data from a study examining the effects of metformin, which may inhibit respiratory chain complex I and has been associated with anti-inflammatory and anti-cancer effects, on tumorigenesis in mice. Dr. Chandel discussed the implications of these data for the traditional hypothesis that aging is associated with declines in mitochondrial respiratory function to the point where increased reactive oxygen species, oxidative stress, and/or a bioenergetics crisis leads to pathology. He made the observation that mice in his laboratory with only 50% of the bioenergetics capacity of control mice show no ill effects of the loss and even appear resilient under several stressors.
Questions compared the alterations observed in regulatory T cells to senescent cells, raised concern about the complexity of the pathway metformin must take to be biologically effective, and, based on older adults showing neuropathy and slower walking speed with only 5% to 10% loss of ATP capacity, sought clarification of the relevance of the mice studies to older humans.
Discussion focused on the technical aspects of Dr. Chandel's work and further implications for aging.
- Division of Neuroscience (DN): Nonpharmacological Strategies for Dementia-Related Behaviors: State-of-the-Art Science and Where Do We Go from Here?
Dr. Laura Gitlin, of the Johns Hopkins University School of Medicine, described work examining nonpharmacological ways to intervene against symptoms in the moderate to severe stage of dementia. Among the three clinical features of dementia, behavioral symptoms play a large role in the stress experienced by patients, their families, and their caregivers. For the patient, behavioral symptoms are associated with poor quality of life, more rapid disease progression, increased safety concerns, and increased health care utilization and cost. For the caregiver, these symptoms increase the risk for depression, the amount of time devoted to vigilance and caregiving, cost in terms of missed time from work and the involvement of formal care providers, and risk for placing their loved ones in nursing homes. Although the symptoms are unique to each family, behavioral symptoms cluster in the areas of apathy, aggression, agitation, depression, and psychosis. Agitation and aggression are the most prevalent in community-dwelling adults living with dementia.
Dr. Gitlin's group has developed a conceptual framework suggesting that behavioral symptoms occur as a consequence of a neurodegenerative process associated with dementia. Although this process could be a target for drug discovery, a concomitant set of processes, including changes in cognitive function and vulnerability to physical and social environments, also could be targets for intervention.
Dr. Gitlin presented data from Project ACT, which employs a home-based, targeted approach that identifies the most distressing behavior, then identifies and addresses the factors and triggers associated with it. In the intervention group, 70% of patients showed reductions in behavioral symptoms, compared with 20% in the control group. Less than 20% of patients showed worse symptoms, and approximately 10% of patients stayed the same. Dr. Gitlin also stated that 35% of the study population had untreated medical issues contributing to their symptoms. Dr. Gitlin also presented a phase II proof-of-concept trial that combines good dementia care, caregiver support, and an approach in which occupational therapists give patients activities tailored to their abilities and interests. Almost 80% of patients in the tailored group showed an improvement in symptoms, compared with 40% in the control group, and caregivers in the tailored intervention group showed improved efficacy. Because of these successes, pilot trials of the tailored approach are under way across the nation and in other countries.
In response to questions from the Council, Dr. Gitlin clarified that the control differs by trial, her data show results for up to 9 to 12 months, and she and her colleagues have seen the need for boosters especially as behaviors change during the course of the disease.
- Division of Geriatrics and Clinical Gerontology (DGCG): Testosterone Trial
Dr. Peter Snyder, of the University of Pennsylvania School of Medicine, showed data from three of seven trials evaluating the efficacy of testosterone therapy, for men's health compared with placebo. Testosterone levels decline with age in men. Terms such as "male menopause," "late-onset hypogonadism," and "andropause" imply that this change is a pathologic one, and that notion is further supported by parallels between the effects of age-associated declines in testosterone and those associated with frank hypogonadism. However, previous studies of older men with slightly lower testosterone levels have shown equivocal results. Following an evaluation of the evidence regarding the effects of declining testosterone, the Institute of Medicine recommended that the NIA conduct clinical trials of testosterone therapy in older men with low testosterone levels, initial trials to assess efficacy, and studies assessing long-term risk and benefits be conducted only if the initial trials documented a clinically significant benefit.
The trials included 790 men older than 65 years with testosterone levels lower than 275 ng/dL in the early morning. The three trials specifically evaluated effects on sexual function, physical function, and vitality. Whereas testosterone levels remained below normal in the placebo group, testosterone levels in the treatment group rose to that considered mid-normal for younger men. Testosterone therapy was associated with increased sexual activity, both among men eligible specifically for the sexuality trial and among men enrolled across all testosterone trials. Libido and erectile dysfunction also improved in response to testosterone therapy. Testosterone therapy appeared to confer some benefit with respect to physical activity; although there was no statistically significant difference in 6-minute walk distance between the testosterone group and the placebo group, among men selected for the trial because of their slow walking speed, all men across the three trials did increase walking speed significantly compared to the placebo group. Testosterone therapy had no effect on vitality, but it appeared to improve positive mood and decrease negative mood and depressive symptoms. The study sample was not large enough for the investigators to draw conclusions about adverse events. However, there did not appear to be any difference between the placebo and testosterone groups in prostate cancer, lower urinary tract symptoms, or major adverse cardiovascular events.
Because only 790 men were found to be eligible for the trials, out or more than 51,000 screened, there was some discussion about the population for which testosterone therapy would be most appropriate. Dr. Snyder pointed out that efficacy results are not yet available for all seven trials and that no results about risk are available yet. Thus, he did not suggest that all men older than 65 years be screened for low testosterone. In response to other questions, Dr. Snyder noted that a cognition trial is among the four remaining testosterone trials under way.
- Division of Behavioral and Social Research (DBSR): Behavioral Economic Approaches to Curbing Antibiotic Over-Prescribing
Dr. Jason Doctor, of the University of Southern California, noted that initial models of decision-making and behavioral change assume that clinicians are reflective, rational, and deliberate and therefore require only education and reminders. In reality, however, physicians are constrained, work in fast-paced environments, make decisions quickly, and can be influenced by emotional and social factors. Thus, behavior change approaches should incorporate an understanding of cognitive bias, appeal to clinicians' self-image, and consider other forms of socialization.
He briefly described the two cognitive systems at work in decision-making and the effects of "nudges," which are gentle, non-intrusive persuaders that influence choice by targeting automatic thinking. He then described work assessing antibiotic prescribing practices for acute respiratory infections. One study found that, overall, two-thirds of antibody prescribing was inappropriate and that the rate of over-prescribing increased throughout a clinician's shift. Another study found that aggressive antibiotic treatment was reduced by 12% when potential treatment orders were grouped together, rather than listed separately. Yet another study found that inappropriate prescribing was reduced by 20% among clinicians who had posters in examining rooms during the cold and flu season to explain the problem of antibiotic over-prescribing.
Dr. Doctor then discussed a national trial evaluating three electronic health record–based interventions: (1) suggested alternatives, a clinician would see a pop-up suggesting alternatives in cases for which antibiotics were not appropriate; (2) accountable justification, in which a screen would pop-up asking the clinician to justify an antibiotic prescription; and (3) peer comparison, which would rank performance based on how often antibiotics were prescribed inappropriately and send monthly emails informing clinicians whether they were top performers. The trial randomized 47 primary care practices in three health systems. The suggested alternatives intervention was associated with a general downward trend in inappropriate prescribing, although this trend was not statistically significant. However, the accountable justification and peer comparison interventions were both associated with statistically significant reductions in antibiotic over-prescribing. On the basis of these results, Dr. Doctor and his colleagues concluded that traditional approaches to behavioral change were less effective than those based on social motivation.
Discussion focused on potential differences in prescribing behaviors between physicians and physician assistants or nurse practitioners, patients wanting antibiotics and how that affects physician ratings based on patient satisfaction, comparisons of high- versus low-cost interventions, long-term effects for having a poster on the wall, and alert fatigue.
The open session of the 128th meeting of the National Advisory Council on Aging adjourned at 12:00 p.m. on May 11, 2016. The next meeting is scheduled for September 27–28, 2016.
I hereby certify that, to the best of my knowledge, the foregoing minutes and attachments are accurate and complete.3
Richard J. Hodes, M.D.
Chairman, National Advisory Council on Aging
Director, National Institute on Aging
Prepared by Robin Barr, D.Phil.
With assistance by Rose Li and Associates, Inc.
- For the record, it is noted that members absented themselves from the meeting when the Council discussed applications (a) from their respective institutions or (b) in which a conflict of interest may have occurred. This procedure only applied to applications that were discussed individually, not to “en bloc” actions. (Back to text)
- For the record, it is noted that members absented themselves from the meeting when the Council discussed applications (a) from their respective institutions or (b) in which a conflict of interest may have occurred. This procedure applied only to applications that were discussed individually, not to “en bloc” actions. (Back to text)
- These minutes will be approved formally by Council at the next meeting on September 27–28, 2016, and corrections or notations will be stated in the minutes of that meeting. (Back to text)
Attachment A: Roster of the National Advisory Council on Aging
NATIONAL ADVISORY COUNCIL ON AGING
NATIONAL INSTITUTE ON AGING
HODES, RICHARD J., MD
NATIONAL INSTITUTE ON AGING
NATIONAL INSTITUTES OF HEALTH
BETHESDA, MD 20892-2292
ACQUAVIVA, KIMBERLY DEANNE, PHD
ASSOCIATE DEAN FOR FACULTY AFFAIRS
SCHOOL OF NURSING
THE GEORGE WASHINGTON UNIVERSITY
WASHINGTON, DC 20036
CARRILLO, MARIA C, PHD
CHIEF SCIENCE OFFICER, MEDICAL & SCIENTIFIC RELATIONS
CHICAGO, IL 60601
CRIMMINS, EILEEN M, PHD
AARP PROFESSOR OF GERONTOLOGY
ANDRUS GERONTOLOGY CENTER
DAVIS SCHOOL OF GERONTOLOGY
UNIVERSITY OF SOUTHERN CALIFORNIA
LOS ANGELES, CA 90089
CUMMINGS, STEVEN RON, MD
SAN FRANCISCO COORDINATING CENTER
SAN FRANCISCO, CA 94158-2549
HANSEN, JENNIE CHIN, FAAN, RN
SENIOR STRATEGIC CONSULTANT
AMERICAN GERIATRICS SOCIETY
NEW YORK, NY 10038
HIGH, KEVIN P., MD
PROFESSOR AND EXECUTIVE VP
WAKE FOREST SCHOOL OF MEDICINE/WAKE FOREST BAPTIST HEALTH
WINSTON-SALEM, NC 27157
HYMAN, BRADLEY T., MD, PHD
PROFESSOR AND DIRECTOR
DEPARTMENT OF NEUROLOGY
MASSACHUSETTS GENERAL HOSPITAL
CHARLESTOWN, MA 02129
KINGTON, RAYNARD S., PHD, MD, MBA
PRESIDENT AND PROFESSOR
GRINNELL, IA 50112
KIRKLAND, JAMES L., MD, PHD
DEPARTMENT OF GENERAL INTERNAL MEDICINE
ROCHESTER, MN 55905
MAYEUX, RICHARD P, MD
SERGIEVSKY PROFESSOR AND CHAIRMAN, DEPT OF NEUROLOGY
NEW YORK, NY 10032
MOFFITT, TERRIE E, PHD
NANNERL O. KEOHANE UNIVERSITY PROFESSOR
DEPARTMENT OF PSYCHOLOGY AND NEUROSCIENCE
DURHAM, NC 27708
MOUTON, CHARLES P., MD
SENIOR VICE PRESIDENT & DEAN
DEAN, SCHOOL OF MEDICINE
MEHARRY MEDICAL COLLEGE
NASHVILLE, TN 37208
NEWMAN, ANNE B, MD
DEPARTMENT OF EPIDEMIOLOGY
UNIVERSITY OF PITTSBURGH
PITTSBURGH, PA 15213
RANDO, THOMAS A., MD, PHD
DEPARTMENT OF NEUROLOGY AND NEUROLOGICAL SCIENCES
STANFORD UNIVERSITY SCHOOL OF MEDICINE
STANFORD, CA 94304-5235
SHARPLESS, NORMAN E, MD
LINEBERGER COMPREHENSIVE CANCER CENTER
SCHOOL OF MEDICINE
UNIVERSITY OF NORTH CAROLINA
CHAPEL HILL, NC 27514
SPERLING, REISA A., MD
PROFESSOR OF NEUROLOGY
HARVARD MEDICAL SCHOOL
CENTER FOR ALZHEIMER RESEARCH & TREATMENT
MEMORY DISORDERS UNIT
BRIGHAM AND WOMEN'S HOSPITAL
BOSTON, MA 02115
WHITMAN, DEBRA BAILEY, PHD
EXECUTIVE VICE PRESIDENT, POLICY, STRATEGY, AND INTERNATIONAL AFFAIRS
WASHINGTON, DC 20049
ALLMAN, RICHARD M., MD
GERIATRICS AND EXTENDED CARE SERVICES
DEPARTMENT OF VETERANS AFFAIRS
WASHINGTON, DC 22150
BURWELL, SYLVIA M.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
WASHINGTON, DC 20201
COLLINS, FRANCIS S., MD, PHD
NATIONAL INSTITUTES OF HEALTH
BETHESDA, MD 20892
PUGH, KENNETH G.
DEPARTMENT OF MEDICINE
NATIONAL NAVAL MEDICAL CENTER
BETHESDA, MD 20889-5600
TILLY, JANE A, DRPH
AGING PROGRAM SERVICES SPECIALIST
TEAM LEADER, BRAIN HEALTH AND DEMENTIA
OFFICE OF SUPPORTIVE AND CAREGIVER SERVICES
ADMINISTRATION FOR COMMUNITY LIVING/ADMINISTRATION ON AGING
WASHINGTON, DC 20001
WALKER, EDWIN L
DEPUTY ASSISTANT SECRETARY FOR AGING
ADMINISTRATION ON AGING
ADMINISTRATION FOR COMMUNITY LIVING
DEPARTMENT OF HEALTH AND HUMAN SERVICES
WASHINGTON, DC 20201
BARR, ROBIN, D.Phil.
OFFICE OF EXTRAMURAL ACTIVITIES
NATIONAL INSTITUTE ON AGING
BETHESDA, MD 20814