I 

111TH CONGRESS 

1ST SESSION H. R. 2987 

To amend the Public Health Service Act to ensure sufficient resources and 

increase efforts for research at the National Institutes of Health relating 

to Alzheimer’s disease, to authorize an education and outreach program 

to promote public awareness and risk reduction with respect to Alzheimer’s disease (with particular emphasis on education and outreach 

in Hispanic populations), and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 19, 2009 

Ms. LINDA T. SA ́NCHEZ of California (for herself, Ms. BERKLEY, Mr. BISHOP

of Georgia, Ms. BORDALLO, Mr. BRADY of Pennsylvania, Mr. GRIJALVA, 

Mr. HOLT, Ms. KAPTUR, Ms. LEE of California, Mr. MCGOVERN, Mr. 

NADLER of New York, Mrs. NAPOLITANO, Mr. PAYNE, Mr. PIERLUISI, 

Mr. REYES, Ms. ROS-LEHTINEN, Mr. RYAN of Ohio, Mr. SERRANO, Mr. 

SIRES, Ms. WATERS, Mr. WEXLER, and Mr. WU) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to ensure sufficient 

resources and increase efforts for research at the National Institutes of Health relating to Alzheimer’s disease, to authorize an education and outreach program 

to promote public awareness and risk reduction with 

respect to Alzheimer’s disease (with particular emphasis 

on education and outreach in Hispanic populations), and 

for other purposes. 

mstockstill on PROD1PC66 with BILLS

2 

•HR 2987 IH

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Cure and Under5 standing through Research for Alzheimer’s Act of 2009’’ 

6 or the ‘‘La Cura Act of 2009’’. 

7 SEC. 2. FINDINGS. 

8 The Congress finds as follows: 

9 (1) Alzheimer’s disease is the seventh leading 

10 cause of death of all ages in the United States (and 

11 the fifth leading cause of death for people over 65 

12 years of age), with 5.2 million individuals in the 

13 United States living with Alzheimer’s disease. Cur14 rently, one of each eight individuals in the United 

15 States over age 65 has Alzheimer’s disease. Every 

16 71 seconds, an individual in the United States devel17 ops Alzheimer’s disease, and by 2050, every 33 sec18 onds an individual in the United States will develop 

19 this disease. By 2050, the number of individuals in 

20 the United States age 65 and over with Alzheimer’s 

21 disease will range from 11 million to 16 million indi22 viduals. 

23 (2) The prevalence of Alzheimer’s disease and 

24 dementia seems to be higher among individuals with 

25 fewer years of education. Individuals with fewer than 

mstockstill on PROD1PC66 with BILLS

3 

•HR 2987 IH

1 12 years of education have a 15 percent greater risk 

2 of developing dementia than individuals with 12 to 

3 15 years of education and a 35 percent greater risk 

4 of developing dementia than individuals with more 

5 than 15 years of education. 

6 (3) Hispanics are the fastest growing popu7 lation in the Nation and by 2050, will have a life ex8 pectancy of 87 years, longer than any other ethnic 

9 or racial group. The Hispanic community in the 

10 United States is projected to experience a six-fold in11 crease in Alzheimer’s disease (from fewer than 

12 200,000 to as many as 1.3 million) by 2050. 

13 (4) Hispanics may be at a greater risk of devel14 oping dementia than other ethnic or racial groups: 

15 Hispanics’ 64-percent higher incidence of diabetes 

16 than non-Hispanic White Americans is of particular 

17 concern in light of new findings that diabetes is the 

18 one vascular risk factor that, in the absence of 

19 stroke, is related to an increased risk of Alzheimer’s 

20 disease. 

21 (5) Research on disparities in Alzheimer’s risk 

22 factors between Hispanic and other ethnic and racial 

23 groups is only beginning to sort out complex dif24 ferences: for example, even in the absence of the 

25 APOE-e4 allele, the one known genetic risk factor 

mstockstill on PROD1PC66 with BILLS

4 

•HR 2987 IH

1 for late onset Alzheimer’s, Caribbean Hispanics have 

2 a cumulative risk for Alzheimer’s twice that of non3 Hispanic Whites. 

4 (6) The shortage of bilingual health profes5 sionals, combined with the large population of 

6 monolingual Spanish-speaking seniors, makes ade7 quate testing and diagnosis of Alzheimer’s among el8 derly Hispanics difficult and may lead to cultural bi9 ases in cognitive testing. Moreover, inadequate 

10 translation of diagnostic tools can lead to improper 

11 diagnoses, and there may be poor understanding of 

12 recommended treatment and self-care even among 

13 those who are properly diagnosed. 

14 (7) Hispanics are far more likely to be unin15 sured than any other ethnic group: the Bureau of 

16 the Census reports that 34.1 percent of the Hispanic 

17 population in the United States is uninsured, com18 pared to 10.8 percent for non-Hispanic Whites and 

19 15.3 percent for all United States residents. 

20 (8) Lack of access to health care and a strong 

21 cultural commitment to caring for one’s elders with22 in the family are among the factors that make His23 panics with dementia less likely than non-Hispanics 

24 to see a physician and use related services provided 

25 by formal health professionals. Hispanic caregivers 

mstockstill on PROD1PC66 with BILLS

5 

•HR 2987 IH

1 surveyed were significantly more likely (33 percent) 

2 than caregivers of other races (23 percent) to believe 

3 that Alzheimer’s disease is a normal part of the 

4 aging process and were also significantly more likely 

5 (67 percent) to dismiss the symptoms of Alzheimer’s 

6 disease as old age than other respondents of other 

7 races (53 percent). Delays in diagnosis and lack of 

8 early and consistent treatment can lead to higher 

9 levels of impairment and increased stress on family 

10 caregivers. 

11 (9) Hispanic elders are second most likely, after 

12 Asian-Americans, to live with their families rather 

13 than in long-term care facilities. More research is 

14 needed to better understand the effects of differing 

15 care settings on family caregivers and Alzheimer’s 

16 patients. 

17 (10) Alzheimer’s disease costs the United 

18 States $148 billion each year in direct and indirect 

19 costs to business, the Medicare program, and the 

20 Medicaid program (not including private health in21 surance costs). If the prevalence of Alzheimer’s dis22 ease continues to increase as expected, the $91 bil23 lion spent in 2005 on Medicare costs for care of in24 dividuals with Alzheimer’s disease and dementia pamstockstill on PROD1PC66 with BILLS

6 

•HR 2987 IH

1 tients is projected to increase to $189 billion by 

2 2015. 

3 SEC. 3. NIH RESEARCH AND EDUCATION ON ALZHEIMER’S 

4 DISEASE. 

5 Subpart 5 of part C of title IV of the Public Health 

6 Service Act (42 U.S.C. 285e et seq.) is amended by adding 

7 at the end the following new section: 

8 ‘‘SEC. 445J. NIH RESEARCH AND EDUCATION ON ALZ9 HEIMER’S DISEASE. 

10 ‘‘(a) RESEARCH ACTIVITIES.—In conducting re11 search relating to Alzheimer’s disease, the Director of the 

12 National Institutes of Health shall ensure sufficient re13 sources for activities relating to Alzheimer’s disease and 

14 Hispanic communities, including by— 

15 ‘‘(1) increasing efforts in epidemiological work 

16 in Hispanic subgroups; 

17 ‘‘(2) allocating resources to the National Insti18 tute on Aging Alzheimer’s disease research centers 

19 and other academic centers involved in Alzheimer’s 

20 disease research to increase participation of His21 panics and other underrepresented ethnic groups in 

22 research and clinical trials in sufficient numbers to 

23 draw valid conclusions; and 

24 ‘‘(3) conducting social, behavioral, and health 

25 services research— 

mstockstill on PROD1PC66 with BILLS

7 

•HR 2987 IH

1 ‘‘(A) to understand more fully the under2 lying reasons that Hispanic individuals delay di3 agnosis and underutilize services; 

4 ‘‘(B) to identify culturally and linguis5 tically appropriate approaches for addressing 

6 such delays and underutilization; and 

7 ‘‘(C) to identify approaches for providing, 

8 and improving the quality of, culturally com9 petent care. 

10 ‘‘(b) EDUCATION ACTIVITIES.—The Director of the 

11 National Institutes of Health shall expand and intensify 

12 efforts of the National Institutes of Health— 

13 ‘‘(1) to educate communities about the impor14 tance of research relating to Alzheimer’s disease; 

15 and 

16 ‘‘(2) to respond effectively to cultural concerns 

17 about participation in such research, especially with 

18 respect to sensitive matters like the collection of 

19 brain tissue and genetic information.’’. 

20 SEC. 4. INCREASED FUNDING FOR ALZHEIMER’S DISEASE 

21 DEMONSTRATION GRANTS. 

22 Section 398B(e) of the Public Health Service Act (42 

23 U.S.C. 280c–5(e)) is amended— 

24 (1) by striking ‘‘and such’’ and inserting 

25 ‘‘such’’; and 

mstockstill on PROD1PC66 with BILLS

8 

•HR 2987 IH

1 (2) by inserting before the period at the end ‘‘, 

2 $25,000,000 for fiscal year 2010, and such sums as 

3 may be necessary for each of the fiscal years 2011 

4 through 2014’’. 

5 SEC. 5. CDC OUTREACH AND EDUCATION. 

6 Part B of title III of the Public Health Service Act 

7 (42 U.S.C. 243 et seq.) is amended by inserting after sec8 tion 317T the following: 

9 ‘‘SEC. 317U. EDUCATION AND OUTREACH ON ALZHEIMER’S 

10 DISEASE. 

11 ‘‘(a) PURPOSES.—The purposes of this section are 

12 the following: 

13 ‘‘(1) To reduce the risk of Alzheimer’s disease 

14 through reduction of vascular risk factors. 

15 ‘‘(2) To encourage early recognition and diag16 nosis of dementia. 

17 ‘‘(3) To train public health personnel to recog18 nize, assess, diagnose, and treat Alzheimer’s disease 

19 in ways that are culturally appropriate and sup20 portive of families. 

21 ‘‘(b) EDUCATION AND OUTREACH.—To achieve the 

22 purposes of this section, the Secretary, acting through the 

23 Centers for Disease Control and Prevention, shall conduct 

24 an aggressive, evidence-based education and outreach pro25 gram to promote public awareness and risk reduction with 

mstockstill on PROD1PC66 with BILLS

9 

•HR 2987 IH

1 respect to Alzheimer’s disease. In conducting the outreach 

2 program, the Secretary shall consult with State Health 

3 Departments and may consult with other appropriate enti4 ties, including the Alzheimer’s Association and the Alz5 heimer’s Foundation of America. 

6 ‘‘(c) EMPHASIS.—In carrying out this section, the 

7 Secretary shall give particular emphasis to education and 

8 outreach in Hispanic populations.’’. 

Æ 

mstockstill on PROD1PC66 with BILLS