Legislature(2011 - 2012)

01/31/2012 03:00 PM HSS

Download Mp3. <- Right click and save file as

Audio Topic
03:05:53 PM Start
03:07:03 PM HCR20
03:34:17 PM Presentation: Alzheimer's Resource of Alaska
04:40:11 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
                         JOINT MEETING                                                                                        
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                        January 31, 2012                                                                                        
                           3:05 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                             
 Representative Wes Keller, Chair                                                                                               
 Representative Alan Dick, Vice Chair                                                                                           
 Representative Bob Herron                                                                                                      
 Representative Paul Seaton                                                                                                     
 Representative Bob Miller                                                                                                      
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                            
 Senator Bettye Davis, Chair                                                                                                    
 Senator Dennis Egan                                                                                                            
 Senator Fred Dyson                                                                                                             
MEMBERS ABSENT                                                                                                                
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                             
 Representative Beth Kerttula                                                                                                   
 Representative Charisse Millett                                                                                                
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                            
 Senator Johnny Ellis                                                                                                           
 Senator Kevin Meyer                                                                                                            
COMMITTEE CALENDAR                                                                                                            
HOUSE CONCURRENT RESOLUTION NO. 20                                                                                              
Designating February 2012 as American Heart Month.                                                                              
     - MOVED OUT OF COMMITTEE                                                                                                   
PRESENTATION:  ALZHEIMER'S RESOURCE OF ALASKA                                                                                   
     - HEARD                                                                                                                    
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: HCR 20                                                                                                                  
SHORT TITLE: AMERICAN HEART MONTH                                                                                               
SPONSOR(s): REPRESENTATIVE(s) P.WILSON                                                                                          
01/25/12       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/25/12       (H)       HSS                                                                                                    
01/31/12       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
WITNESS REGISTER                                                                                                              
REPRESENTATIVE PEGGY WILSON                                                                                                     
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced HCR 20 as the prime sponsor of                                                                
the bill.                                                                                                                       
JAMIE MORGAN                                                                                                                    
Senior Government Relations Director                                                                                            
American Heart Association (AHA)                                                                                                
Western States Affiliate                                                                                                        
Sacramento, California                                                                                                          
POSITION STATEMENT:  Testified in support of HCR 20.                                                                          
BOB URATA, MD                                                                                                                   
Family Physician                                                                                                                
American Heart Association Volunteer                                                                                            
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HCR 20.                                                                          
JIM FOSTER                                                                                                                      
American Heart Association volunteer                                                                                            
POSITION STATEMENT:  Testified in support of HCR 20.                                                                          
DULCE NOBRE, Executive Director                                                                                                 
Alzheimer's Resource of Alaska                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented an overview of Alzheimer's and                                                                 
related diseases.                                                                                                               
AMBER SMITH, Education Specialist                                                                                               
Alzheimer's Resource of Alaska                                                                                                  
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during the discussion of                                                                       
Alzheimer's and related diseases.                                                                                               
CHERYL PUTNAM, Family Care Giver                                                                                                
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:     Testified   during  the   discussion  of                                                             
Alzheimer's Disease and related disorders.                                                                                      
PATRICK CUNNINGHAM, DSW                                                                                                         
Member, Board of Directors                                                                                                      
Alzheimer's Resource of Alaska                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Testified during discussion  of Alzheimer's                                                             
and related diseases.                                                                                                           
ACTION NARRATIVE                                                                                                              
3:05:53 PM                                                                                                                    
CHAIR  WES KELLER  called the  meeting  of the  House Health  and                                                             
Social  Services  Standing  Committee   to  order  at  3:05  p.m.                                                               
Representatives Keller, Miller, Dick,  and Herron were present at                                                               
the call to order.   Representative Seaton arrived as the meeting                                                               
was in progress.                                                                                                                
                  HCR 20-AMERICAN HEART MONTH                                                                               
3:07:03 PM                                                                                                                    
CHAIR KELLER announced that the  first order of business would be                                                               
HOUSE CONCURRENT RESOLUTION NO.  20, Designating February 2012 as                                                               
American Heart Month.                                                                                                           
3:07:19 PM                                                                                                                    
REPRESENTATIVE  PEGGY  WILSON,  Alaska State  Legislature,  prime                                                               
sponsor of HCR 20, paraphrased from her sponsor statement:                                                                      
     HCR 20  raises awareness of the  nation's leading cause                                                                    
     of death,  cardiovascular disease, by having  the State                                                                    
     of  Alaska  join  the  American  Heart  Association  in                                                                    
     celebrating  February  2012  as American  Heart  Month.                                                                    
     This  unfortunate  disease  causes an  average  of  one                                                                    
     American death every 39 seconds  or nearly 2,200 deaths                                                                    
     each day.   It is the costliest disease  in the nation,                                                                    
     with  direct   and  indirect  costs  estimated   to  be                                                                    
     $297,700,000  a year.   Research  shows that  there are                                                                    
     clear preventative and  community based strategies that                                                                    
     can  increase survival  rates from  this disease.   The                                                                    
     American Heart Association's 2020  impact goal seeks to                                                                    
     improve cardiovascular  health of  all Americans  by 20                                                                    
     percent  while  reducing   deaths  from  cardiovascular                                                                    
     disease  and stroke  by  20  percent through  research,                                                                    
     population-level  and   community-level  interventions,                                                                    
     and public health and policy  measures.  The passage of                                                                    
     this  resolution would  join  Alaska  and the  American                                                                    
     Heart Association in raising  awareness of this disease                                                                    
     by celebrating February 2012  as "American Heart Month"                                                                    
     and  promoting education  and awareness  by encouraging                                                                    
     citizens  to learn  the warning  signs of  heart attack                                                                    
     and stroke.                                                                                                                
3:09:39 PM                                                                                                                    
REPRESENTATIVE MILLER  asked if  HCR 20 was  intended to  only be                                                               
designated for this year.                                                                                                       
3:09:56 PM                                                                                                                    
REPRESENTATIVE P.  WILSON, in response, said  that, currently, it                                                               
was just for this year, but that  she would like to see it become                                                               
REPRESENTATIVE MILLER  expressed his agreement, and  asked if HCR                                                               
20  included  any  planned  programs   for  exercise,  diet,  and                                                               
REPRESENTATIVE P.  WILSON replied that a  representative from the                                                               
American Heart Association would answer that question.                                                                          
3:10:49 PM                                                                                                                    
REPRESENTATIVE   HERRON   offered    his   belief   that   annual                                                               
introduction of the resolution "keeps it on the forefront."                                                                     
3:11:44 PM                                                                                                                    
CHAIR KELLER opened public testimony.                                                                                           
3:12:03 PM                                                                                                                    
JAMIE  MORGAN,  Senior  Government Relations  Director,  American                                                               
Heart Association (AHA), Western  States Affiliate, expressed her                                                               
appreciation  to the  House Health  and Social  Services Standing                                                               
Committee for its  support of HCR 20.  In  response to an earlier                                                               
question by  Representative Miller,  she said  that AHA  had many                                                               
educational  programs   in  the  community,  as   well  as  other                                                               
available resources  and materials  posted on  its website.   She                                                               
urged support for HCR 20.                                                                                                       
3:13:07 PM                                                                                                                    
BOB  URATA,  MD,  Family Physician,  American  Heart  Association                                                               
Volunteer, stated  that he supported  HCR 20.  He  confirmed that                                                               
heart  disease  and  stroke  were  a major  cause  of  death  and                                                               
disability.    He  pointed  out  that many  of  the  deaths  from                                                               
cardiovascular disease  could be  prevented by avoiding  key risk                                                               
factors and treating  those which were abnormal.   He stated that                                                               
"maintaining  a  healthy  weight,  blood  pressure,  cholesterol,                                                               
sugar, and  not smoking are key  risk factors that can  lead to a                                                               
longer life."   He  referenced the  National Institute  of Health                                                               
(NIH), stating that  1.6 million lives had been  saved since 1977                                                               
with an estimated 44 percent due  to a reduction of risk factors.                                                               
He reported  that overweight and  obesity was the new  threat, as                                                               
27  percent of  high school  students were  overweight or  obese.                                                               
"This will lead to an  increase in high blood pressure, diabetes,                                                               
and  heart  disease."    He  noted that  although  there  was  an                                                               
increased  awareness  for the  signs  of  heart attack,  only  27                                                               
percent  knew  to  call  911.   He  emphasized  that  "increasing                                                               
awareness of risk  factors and emergency care is a  first step in                                                               
reducing the  risk of  death and  disability from  this disease."                                                               
He offered his support for passage of HCR 20.                                                                                   
3:15:37 PM                                                                                                                    
REPRESENTATIVE   HERRON  reflected   that  the   statistics  were                                                               
sobering.    He  pointed  out  that  food  manufacturers  created                                                               
complex  formulas   to  make  food   taste  better,   though  not                                                               
necessarily healthier, and asked if  AHA was attempting to combat                                                               
3:16:40 PM                                                                                                                    
DR.  URATA replied  that AHA  scientists  maintained a  nutrition                                                               
3:17:07 PM                                                                                                                    
MS. MORGAN, acknowledging the issue,  stated that AHA had not yet                                                               
taken a  position.  She offered  to update the committee  as more                                                               
information became available.                                                                                                   
3:17:43 PM                                                                                                                    
REPRESENTATIVE HERRON  opined that  although everyone  liked food                                                               
that  tasted  good, he  questioned  whether  it was  healthy  for                                                               
companies to create  compounds to enhance flavor  solely in order                                                               
to get people to eat more of that food.                                                                                         
3:18:15 PM                                                                                                                    
DR. URATA,  reflecting on the  elimination of salt from  his diet                                                               
in  order to  combat rising  blood pressure,  suggested that  his                                                               
taste  buds had  adjusted to  this change  and that,  after time,                                                               
salty foods began to taste bitter.                                                                                              
3:19:27 PM                                                                                                                    
JIM FOSTER,  Paramedic, stated that  having a month  dedicated to                                                               
cardiovascular   disease  allowed   the   opportunity  to   bring                                                               
awareness to  the epidemic  problem.   He reported  that although                                                               
this was the number  one cause of death in America,  it was not a                                                               
"media event" so it was not recognized.                                                                                         
3:20:49 PM                                                                                                                    
CHAIR KELLER closed public testimony.                                                                                           
3:21:04 PM                                                                                                                    
REPRESENTATIVE HERRON  moved to  report HCR  20 out  of committee                                                               
with individual recommendations and  the accompanying zero fiscal                                                               
notes.   There being no objection,  HCR 20 was reported  from the                                                               
House Health and Social Services Standing Committee.                                                                            
3:21:29 PM                                                                                                                    
The committee took an at-ease from 3:21 p.m. to 3:33 p.m.                                                                       
3:33:34 PM                                                                                                                    
SENATOR BETTYE  DAVIS called the  joint meeting of the  House and                                                             
Senate Health  and Social Services  Standing Committees  to order                                                               
at   3:33   p.m.     Senators   Davis,   Egan,  and   Dyson   and                                                               
Representatives Keller  and Miller  were present  at the  call to                                                               
order.   Representative  Seaton  arrived as  the  meeting was  in                                                               
^Presentation:  Alzheimer's Resource of Alaska                                                                                
         Presentation:  Alzheimer's Resource of Alaska                                                                      
3:34:17 PM                                                                                                                    
SENATOR DAVIS announced that the  only order of business would be                                                               
a presentation on Alzheimer's Resources of Alaska.                                                                              
3:34:31 PM                                                                                                                    
DULCE NOBRE, Executive Director,  Alzheimer's Resource of Alaska,                                                               
shared that  the Alzheimer's Resource of  Alaska had incorporated                                                               
as a 501(c)(3)  in 1984 and that  the 17 members on  the board of                                                               
directors reflected  a good geographic  diversity.   She reported                                                               
that the organization served all  of Alaska primarily through its                                                               
four offices:   Anchorage,  Juneau, Palmer,  and Fairbanks.   She                                                               
shared that  the organization hired people  in local communities,                                                               
and that it  currently had 117 active  in-home workers throughout                                                               
the state,  44 percent of who  were in rural areas.   They served                                                               
any age  group with Alzheimer's  disease or related  dementia, as                                                               
well  as frail  elders over  60  years of  age without  cognitive                                                               
impairments, who  needed assistance.   She  pointed out  that the                                                               
organization also served the family  care givers, as the majority                                                               
of service  was in the  home.  She  noted that the  recipients of                                                               
service were 65 percent clients and  35 percent care givers.  She                                                               
reported that  the organization supplied  a variety  of services,                                                               
including care  coordination, in-home service, and  education and                                                               
support services.                                                                                                               
3:40:56 PM                                                                                                                    
MS. NOBRE reported that Alaska's  senior population, 60 and over,                                                               
was  growing at  five times  the  national rate.   She  explained                                                               
that, as age was a risk  factor for Alzheimer's Disease, the over                                                               
60 population  had almost tripled  in the  last 20 years  to more                                                               
than 6000 people  today.  She opined that in  the next ten years,                                                               
this population would double again.                                                                                             
3:44:22 PM                                                                                                                    
MS. NOBRE confirmed  that this fast rate of  growth would stretch                                                               
the resources  of the  organization.   She directed  attention to                                                               
the  Alzheimer's Disease  & Related  Disorders  (ADRD) grant  for                                                               
$127,118, which had  only been increased once, by  10 percent, in                                                               
the last 20  years.  She compared this 10  percent grant increase                                                               
to the 300  percent increase in the AARD population  served.  She                                                               
pointed out  the social and  financial savings generated  by this                                                               
program,  as  it  delayed  the   placement  of  individuals  into                                                               
facilities.  She  offered her belief that the  grant increase was                                                               
a good investment in the prevention of crisis.                                                                                  
3:48:03 PM                                                                                                                    
CHAIR  KELLER  asked   to  clarify  that  the   growth  rate  was                                                               
proportional  to  the  population  and not  an  increase  in  the                                                               
incidence of Alzheimer's Disease.                                                                                               
MS.  NOBRE  replied  that  the  Alzheimer's  incidence  rate  had                                                               
remained constant.                                                                                                              
CHAIR KELLER asked how many frail elders were served.                                                                           
MS. NOBRE clarified that the  frail elders were served by another                                                               
3:49:11 PM                                                                                                                    
SENATOR EGAN asked if dementia and Alzheimer's were the same.                                                                   
MS. NOBRE,  in response to  Senator Egan, said that  dementia was                                                               
an  umbrella term,  to describe  a variety  of conditions,  which                                                               
included Alzheimer's Disease.                                                                                                   
SENATOR EGAN relayed a personal story.                                                                                          
MS. NOBRE  clarified that Alzheimer's Disease  was only diagnosed                                                               
with certainty  after an  autopsy.  She  noted that  dementia was                                                               
often  used when  there was  no other  diagnosis, but  that other                                                               
diseases such as Parkinson's could  cause dementia.  Dementia was                                                               
described as  a set of  symptoms.  Everyone with  Alzheimer's has                                                               
dementia, but  everyone with dementia  does not  necessarily have                                                               
3:51:28 PM                                                                                                                    
SENATOR EGAN asked  about the dramatic increase in  the number of                                                               
MS.  NOBRE  opined  that  the senior  population  in  Alaska  was                                                               
growing five times  faster than other states.   She declared that                                                               
age  was the  greatest  risk  factor and  that  the incidence  of                                                               
Alzheimer's increased by 47 percent after the age of 80.                                                                        
3:53:03 PM                                                                                                                    
SENATOR  DYSON  respectfully  asked  what  Ms.  Nobre  wanted  to                                                               
accomplish  with this  presentation and  what she  would like  to                                                               
have from the committee.                                                                                                        
MS. NOBRE requested  the opportunity to educate the  public.  She                                                               
requested a $223,000 increase in the grant money from the state.                                                                
3:54:24 PM                                                                                                                    
SENATOR DYSON asked  if this had been included  in the governor's                                                               
MS. NOBRE replied that the incremental increase was not.                                                                        
SENATOR DYSON summarized  the request to be an  increase in money                                                               
for ADRD.                                                                                                                       
3:54:50 PM                                                                                                                    
REPRESENTATIVE  MILLER asked  if Alzheimer's  Resource of  Alaska                                                               
worked with preventative treatments.                                                                                            
MS.  NOBRE  said that  they  offered  mental fitness,  diet,  and                                                               
exercise programs.                                                                                                              
3:56:13 PM                                                                                                                    
AMBER  SMITH,  Education   Specialist,  Alzheimer's  Resource  of                                                               
Alaska,  relayed  that  she  travelled  around  Southeast  Alaska                                                               
providing  education and  support services.   She  described that                                                               
anyone  can  make  an  anonymous phone  call  to  discuss  memory                                                               
concerns or  to receive  a free memory  screening.   She declared                                                               
that, based  on concerns  and the  screening results,  the person                                                               
may be  encouraged to schedule with  a health care provider.   If                                                               
this is the  case, she offered counseling on what  to expect from                                                               
the  health  care  provider.    She  reported  that,  with  early                                                               
diagnosis of any disorder, the  ADRD program offered early memory                                                               
loss  support  groups.    She detailed  that  these  groups  were                                                               
facilitated by  an education  specialist and  offered interaction                                                               
with other  people with similar diagnosis,  understanding of what                                                               
to expect, advance  planning, and realization that  they were not                                                               
alone.  She informed the  committee that family care givers would                                                               
also  contact  the  program  in  search  of  resources,  support,                                                               
education, and  training.  She  shared that she  offered training                                                               
to professional care givers, as  well, and this training improved                                                               
the  quality of  life for  both the  providers and  the patients.                                                               
She mentioned that she and  her colleagues attended health fairs,                                                               
hosted awareness  events, and spoke  with community  groups about                                                               
Alzheimer's  and  related dementias  and  warning  signs to  help                                                               
reduce the  stigma and isolation.   She requested that  the grant                                                               
funding from the state be increased.                                                                                            
4:03:06 PM                                                                                                                    
CHERYL PUTNAM,  Family Care Giver,  established that she  was the                                                               
adult long  distance care giver  to her mother in  Skagway, while                                                               
she [Cheryl]  lived in a  nursing home  in Juneau.   She declared                                                               
that her family  and friends had banded together  to bring health                                                               
care services to  her 84 year old mother in  Skagway, who did not                                                               
want  to  leave  her  home  of 50  years.    Since  her  mother's                                                               
development  of   dementia,  Ms.  Putnam  had   worked  with  the                                                               
organization  for  help with  the  planning  for  her mom.    She                                                               
detailed that dementia  was much more than a memory  issue, as it                                                               
included logic, perception,  and cognition.  She  lauded the ADRD                                                               
program and the support it had provided.                                                                                        
4:08:01 PM                                                                                                                    
MS.  PUTNAM relayed  that  as her  mom's  condition continued  to                                                               
deteriorate, she  had approached Ms.  Smith to develop a  plan of                                                               
action for  her mother.   She  confirmed that  there was  a great                                                               
relief in developing  the plan, and in knowing  there were others                                                               
to ask for  help.  She emphasized that the  ADRD program had kept                                                               
her mom out of a nursing  home and better prepared the family for                                                               
what  was  ahead.   She  declared  her  support for  the  funding                                                               
request,  pointing to  a  need due  to the  aging  of the  Boomer                                                               
4:12:49 PM                                                                                                                    
PATRICK CUNNINGHAM, DSW, Member,  Board of Directors, Alzheimer's                                                               
Resource of Alaska, reading from a prepared statement:                                                                          
     My name is Patrick Cunningham and  I am a member of the                                                                    
     Board of  Directors of Alzheimer's Resource  of Alaska.                                                                    
     I am also an Associate  Professor of Social Work in the                                                                    
     College of Health, University of Alaska Anchorage.                                                                         
     Thank you  for the opportunity  of meeting with  you to                                                                    
     present information  regarding Alzheimer's  Disease and                                                                    
     Related Dementia.   Related  to this,  I wish  to thank                                                                    
     Senator Bettye  Davis for  introducing Senate  Bill 179                                                                    
     creating missing  vulnerable adult prompt  response and                                                                    
     notification  plans.   This  is  similar  to the  Amber                                                                    
     Alert  for   missing  children,  but   targets  adults.                                                                    
     Victims  of Alzheimer's  disease  and related  dementia                                                                    
     have a tendency to wander  as one of the manifestations                                                                    
     of the condition  and are at risk.  Just  last month in                                                                    
     Fairbanks,  a   63  year   old  woman   suffering  from                                                                    
     Alzheimer's  Disease froze  to death  after she  became                                                                    
     disoriented while  driving, ran  out of gas,  and tried                                                                    
     walking several miles to seek help.                                                                                        
     A  number of  University of  Alaska Anchorage  Bachelor                                                                    
     and  Master of  Social Work  graduates are  employed by                                                                    
     Alzheimer's  Resource of  Alaska and  provide education                                                                    
     and  support services  as  well  as care  coordination.                                                                    
     Last  July,  I  attended  the  Alzheimer's  Association                                                                    
     International  Conference  on Alzheimer's  disease,  in                                                                    
     Paris, France.                                                                                                             
     Attending  this Conference  were over  5,000 scientists                                                                    
     from all  over the world  who are engaged in  a variety                                                                    
     of research ventures seeking the  causes of the disease                                                                    
     and  developing treatment  interventions.    I had  the                                                                    
     opportunity   of  reporting   on  challenges   of  care                                                                    
     coordination  in  Alaska   listing  20  challenges  and                                                                    
     proposing  20 solutions.   Among  the solutions  was an                                                                    
     emphasis  on proactive  early detection  and engagement                                                                    
     in services.   I learned  at the Conference that  it is                                                                    
     possible to  identify individuals  who are at  risk for                                                                    
     the Disease  ten years prior  to onset with  80 percent                                                                    
     accuracy.   The identification  of biomarkers  that may                                                                    
     be measured  with brain  scans, spinal  fluid analysis,                                                                    
     blood, and  cognitive markers  consisting of  tests for                                                                    
     mild cognitive  impairment are  methods that  are being                                                                    
     used.   At  the Conference,  the results  of The  World                                                                    
     Alzheimer  Report  2011  provided evidence  that  early                                                                    
     dementia  diagnosis, coupled  with early  intervention,                                                                    
     is  cost-effective,   as  the   costs  of   an  earlier                                                                    
     diagnosis are more than offset  by savings from the use                                                                    
     of       antidementia      drugs       and      delayed                                                                    
     institutionalization.  Other key findings were:                                                                            
   · when people with dementia are well prepared and                                                                            
     supported, their initial feelings  of shock, anger, and                                                                    
     grief  often give  way to  a sense  of reassurance  and                                                                    
   · earlier diagnosis allows patients to plan ahead while                                                                      
     they  can still  make important  decisions about  their                                                                    
     future  care  and allows  them  and  their families  to                                                                    
     access timely practical advice and  support, as well as                                                                    
     to access  available therapies  that may  improve their                                                                    
     cognition and enhance their quality of life; and                                                                           
   · most people with early-stage dementia would want to be                                                                     
     told of their diagnosis.                                                                                                   
     The  Alaska  Division  of Public  Health  conducts  the                                                                    
     Behavioral  Risk  Factor Surveillance  System  (BRFSS).                                                                    
     Data  are collected  on risk  and preventive  behaviors                                                                    
     and  chronic  disease  prevalence that  are  especially                                                                    
     useful  for   planning,  initiating,   supporting,  and                                                                    
     evaluating  health  promotion  and  disease  prevention                                                                    
     programs.   Although Alzheimer's  disease is  listed as                                                                    
     the 8th leading cause of  death in Alaska and predicted                                                                    
     to  increase,  it  is not  referenced  in  the  section                                                                    
     dealing with  chronic disease.   The Center  of Disease                                                                    
     Control Healthy  Aging Program has developed  an Impact                                                                    
     of Cognitive  Impairment Module  to assess  and monitor                                                                    
     the  public's beliefs  about  the  impact of  cognitive                                                                    
     impairment.   So far,  20 states have  added it  to the                                                                    
     Behavioral  risk   Factor  Surveillance  System.     It                                                                    
     consists of 10  questions.  The CDC  has also developed                                                                    
     a  Caregiver  Module  to  examine  various  aspects  of                                                                    
     caregiving.   It also  contains 10  questions.   If the                                                                    
     Division  of  Public  Health   were  to  include  these                                                                    
     modules  in  the  survey, this  would  provide  service                                                                    
     providers  like  Alzheimer's  Resource of  Alaska  with                                                                    
     essential   information  to   assist  them   in  health                                                                    
     promotion and disease prevention programs.                                                                                 
     To  date,   treatment  interventions   for  Alzheimer's                                                                    
     disease    and    Related    Dementia    consists    of                                                                    
     pharmacological  and   non-pharmacological  approaches.                                                                    
     Some   medication  has   been   found   to  delay   the                                                                    
     progression of  the disease,  if identified  early, but                                                                    
     not cure it.   Among the non-pharmacological approaches                                                                    
     are  prevention of  risk factors,  psychological, diet,                                                                    
     exercise,   and  cognitively   stimulating  activities.                                                                    
     Some experts  are advocating for a  paradigm shift away                                                                    
     from the current approach of  treating symptoms as they                                                                    
     emerge to  targeting the disease in  its very earliest,                                                                    
     preclinical  stage.   These are  individuals with  mild                                                                    
     cognitive  impairment   who  have  not   progressed  to                                                                    
     Alzheimer's   disease.       This   offers   the   best                                                                    
     opportunity,  to  date,  to  prevent  or  substantially                                                                    
     delay the Disease.                                                                                                         
     A  study reported  at the  Conference  that I  attended                                                                    
     stated that up to 50%  of Alzheimer's Disease cases are                                                                    
     potentially   attributable   to  7   preventable   risk                                                                    
     factors.   These include smoking,  physical inactivity,                                                                    
     midlife  obesity,   midlife  hypertension,  depression,                                                                    
     diabetes,  and cognitive  inactivity.    This is  where                                                                    
     interventions  to   increase  education   and  physical                                                                    
     activity and reduce smoking  rates and depression could                                                                    
     potentially  have  a  dramatic  impact  on  Alzheimer's                                                                    
     prevalence  over   time.     At  the   national  level,                                                                    
     government action on AD does  not reflect the expanding                                                                    
     human, social,  and economic burden of  the disease for                                                                    
     American  families.    Today   there  are  5.4  million                                                                    
     Americans  with Alzheimer's  disease  and  by 2050.  As                                                                    
     many as 16 million  Americans will have Alzheimer's and                                                                    
     the  cost of  care will  surpass $1  trillion annually.                                                                    
     There  is currently  no  cure for  AD  and no  disease-                                                                    
     modifying treatment,  so the current best  hope lies in                                                                    
     identifying prevention strategies.                                                                                         
     Psychological   interventions  target   behavioral  and                                                                    
     psychological symptoms  of dementia.  The  most obvious                                                                    
     are   agitation,   aggression,   mood   disorders   and                                                                    
     psychosis.   Some  examples of  interventions are  art,                                                                    
     music, activity, and validation therapy.                                                                                   
     In  terms  of  diet,  a  study  of  relatively  healthy                                                                    
     elderly  adults found  that those  with  diets rich  in                                                                    
     several vitamins B, C, D,  E or omega-3 fatty acids had                                                                    
     better  cognitive  function   and  less  brain  atrophy                                                                    
     associated  with Alzheimer's  disease than  their peers                                                                    
     with  diets less  abundant in  these nutrients.   Those                                                                    
     who  ate a  diet rich  in red  meat and  full-fat dairy                                                                    
     foods  were  more  likely to  get  Alzheimer's  disease                                                                    
     compared to those  who ate a diet  consisting mostly of                                                                    
     nuts,  poultry,  fish,  fruits,   and  vegetables.    A                                                                    
     chemistry professor  at UAA has been  recently rewarded                                                                    
     a  grant to  study  the effect  of  bog blueberries  on                                                                    
     dementia.   Circumin  derived from  the spice  turmeric                                                                    
     reduces  amyloidal  accumulation  and  synaptic  marker                                                                    
     loss  associated with  Alzheimer's disease.   There  is                                                                    
     currently a  clinical trial  underway to  determine the                                                                    
     effect of  the herb sage  as a potential  treatment for                                                                    
     the  disease.   Sage has  been demonstrated  to enhance                                                                    
     memory and mental function.                                                                                                
     Mounting evidence  suggests that physical  activity may                                                                    
     have benefits  beyond a healthy heart  and body weight.                                                                    
     Through  the  past  several years,  population  studies                                                                    
     have suggested  that exercise  which raises  your heart                                                                    
     rate for at  least 30 minutes several times  a week can                                                                    
     lower your risk  of Alzheimer's.  A  number of clinical                                                                    
     trials  are examining  the  effect  of aerobic  fitness                                                                    
     training  on  human  cognition,  brain  structure,  and                                                                    
     brain  functioning  in older  adults.    The use  of  a                                                                    
     Nintendo gaming console called WII  Fit is being tested                                                                    
     for   aerobics,   strength,    training   and   balance                                                                    
     improvement with  individuals with a diagnosis  of mild                                                                    
     dementia.   A  nurse  at the  University Of  Washington                                                                    
     School Of Nursing is evaluating  an exercise and health                                                                    
     promotion  program for  older adults  with mild  memory                                                                    
     loss.    And lastly,  an  even  more promising  program                                                                    
     included   exercise   and   mental   activity.      The                                                                    
     participants rode  recumbent bikes for an  average of 3                                                                    
     rides  per  week,  plus  they  had  a  virtual  reality                                                                    
     display that  allowed them to  ride in  a 3-dimensional                                                                    
     landscape  and  race against  a  ghost  rider based  on                                                                    
     their last best performance.                                                                                               
     In a group of  healthy elderly individuals, researchers                                                                    
     found  that greater  participation  throughout life  in                                                                    
     cognitively  stimulating  activities such  as  reading,                                                                    
     writing, and playing  challenging games were associated                                                                    
     with  less  beta-amyloid  deposition in  the  brain,  a                                                                    
     hallmark  of AD.   Other  cognitive  activities for  AD                                                                    
     patients   is  to   engage   them   in  activities   of                                                                    
     recollection which are not only  general in nature, but                                                                    
     also can  focus on memory  skills that can  be directly                                                                    
     helpful to them in activities  of daily living, such as                                                                    
     where they  left a  purse or wallet,  or what  is their                                                                    
     living  address.    These  memory  exercises  are  also                                                                    
     beneficial   to  their   caregivers,   who  often   get                                                                    
     frustrated  with the  memory deficits  of their  family                                                                    
     One  of the  functions  of the  agency's Education  and                                                                    
     Support Program  is to provide education  to the health                                                                    
     care provider.   Since  it is  the primary  health care                                                                    
     provider  who  bears  the responsibility  for  managing                                                                    
     most of  the AD  patients, there clearly  is a  need to                                                                    
     assist   these    clinicians   with    best   practices                                                                    
     guidelines.   When best prepared, the  provider will be                                                                    
     able  to  make  the  appropriate diagnosis  and,  in  a                                                                    
     timely manner,  inform the patient  so that  crises can                                                                    
     be avoided, therapeutic  and rehabilitative support can                                                                    
     be  initiated,  and  the   patient  can  be  adequately                                                                    
     informed so  that choices  can be  made for  the future                                                                    
     while decision-making capability  remains.  The patient                                                                    
     and   family  face   many   short-term  and   long-term                                                                    
     decisions that are best made  based on knowledge of the                                                                    
     disease process, the range  of symptom progression, and                                                                    
     the  ultimate prognosis.    This  would include  making                                                                    
     decisions  about  advance   directives  to  physicians,                                                                    
     appointing  a   durable  medical  power   of  attorney,                                                                    
     discussing end  of life decisions with  whoever will be                                                                    
     designated as the surrogate  decision maker, and future                                                                    
     living arrangements.   This is where a  referral to the                                                                    
     agency education and support services is warranted.                                                                        
     In terms of an economy  of scale, when you consider the                                                                    
     services provided by this program  it becomes very cost                                                                    
     effective  when  it  may  prevent  the  development  of                                                                    
     Alzheimer's  Disease  or  delay  it  resulting  in  the                                                                    
     individual remaining  in their  home and  community for                                                                    
     as long  as possible,  extending their quality  of life                                                                    
     and  remaining out  of an  assisted living  facility or                                                                    
     nursing  home.   If the  services the  program provides                                                                    
     delays for  one year a  nursing home admission  for two                                                                    
     clients,  it   results  in  a  savings   of  well  over                                                                    
     $200,000.   When  you consider  this,  the request  for                                                                    
     $223,000  additional funding  for the  grant is  a very                                                                    
     modest one.   Even  more funding  would enable  an even                                                                    
     greater outreach program.                                                                                                  
4:27:55 PM                                                                                                                    
CHAIR DAVIS  asked for  the current  finances of  the Alzheimer's                                                               
Resource of Alaska.                                                                                                             
4:28:24 PM                                                                                                                    
MS.  NOBRE  replied  that  the  organization  currently  received                                                               
$127,000, which  included the one  increase of 10 percent  in the                                                               
past 20  years.  In  response to  Chair Davis, she  affirmed that                                                               
Alzheimer's Resource of  Alaska had spoken with the  of the House                                                               
Finance Committee's Budget Subcommittee.                                                                                        
CHAIR  DAVIS  opined  that the  organization  provided  "a  great                                                               
service" to both the patients and  the care givers.  She shared a                                                               
personal  story  of  her  mother's  affliction  with  Alzheimer's                                                               
4:30:43 PM                                                                                                                    
DR. CUNNINGHAM,  in response to Representative  Miller, said that                                                               
more research  was conducted outside  the U.S.  He  declared that                                                               
vitamins were  better received  from foods than  from pills.   He                                                               
listed Vitamins  B, C, D,  and E and the  Omega 3 fatty  acids as                                                               
good preventatives.   He also  touted turmeric,  stewed tomatoes,                                                               
strawberries,   and   artichokes    as   good   non-pharmalogical                                                               
4:32:22 PM                                                                                                                    
REPRESENTATIVE  MILLER,  reflecting   on  discussions  about  the                                                               
possibility  of  mad  cow  disease being  inherent  in  the  meat                                                               
supply,  asked   about  a  European  study   that  indicated  the                                                               
similarity between  mad cow disease and  Alzheimer's Disease, and                                                               
the subsequent misdiagnosis.                                                                                                    
DR.  CUNNINGHAM stated  that  he  was not  aware  of any  further                                                               
studies, but he shared that  depression was often misdiagnosed as                                                               
dementia.     He  agreed  with   Representative  Miller   to  the                                                               
importance of monitoring the food  chain.  He emphasized that the                                                               
cause for Alzheimer's was still unknown.                                                                                        
4:34:22 PM                                                                                                                    
MS. SMITH clarified that Alzheimer's  Disease and mad cow disease                                                               
were separate diseases, though both were causes of dementia.                                                                    
REPRESENTATIVE  MILLER  stated   that  the  aforementioned  study                                                               
indicated that many cases were  misdiagnosed as Alzheimer's, when                                                               
in fact, 20 - 30 percent were mad cow disease.                                                                                  
4:35:18 PM                                                                                                                    
CHAIR  KELLER  asked  if  the  bio markers  were  definite.    He                                                               
expressed  his astonishment  that  50 percent  of dementia  cases                                                               
were preventable by life style changes.                                                                                         
4:35:58 PM                                                                                                                    
DR. CUNNINGHAM, in response, said  that the presence of these bio                                                               
markers often did identify the presence of Alzheimer's.                                                                         
4:36:50 PM                                                                                                                    
SENATOR EGAN  expressed his pride  for the compassion  offered by                                                               
Alzheimer's Resource of Alaska and similar organizations.                                                                       
4:38:18 PM                                                                                                                    
REPRESENTATIVE SEATON  stated his agreement  with a focus  on the                                                               
prevention of disease.   He reflected on HCR 5,  which focused on                                                               
the prevention  of disease as  a model  for health care,  and was                                                               
adopted unanimously  by the entire  legislature.  He  shared that                                                               
Fraser   Health  in   British  Columbia,   Canada  had   recently                                                               
instituted  a weekly  dosage of  20,000 IU  of Vitamin  D to  all                                                               
patients in  the senior  residential care.   He pointed  out that                                                               
this had resulted in a 10  - 25 percent reduction in fractures, a                                                               
significant savings,  as the  cost of one  fracture was  equal to                                                               
the  cost  of the  entire  Vitamin  D  program.   He  lauded  the                                                               
benefits of a prevention model.                                                                                                 
4:40:11 PM                                                                                                                    
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:40 p.m.                                                                                                          

Document Name Date/Time Subjects