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Extending Life, Enhancing Life: A National Research Agenda on Aging
in the use of molecular biological tools that delve into genetic regulatory processes that underlie the control of both normal and abnormal molecular and cellular processes. To gain an understanding of age-related pathophysiology, the medical and scientific community must exploit the most fundamental techniques of molecular and cell biology and apply them to the investigation of normal human aging. There is reason to be optimistic that a better-understood and better-mapped human genome, coupled with the application of now-standard techniques of reverse genetics, will allow the genetic contributions to many of these diseases to be defined specifically. This development, plus the extension to actual gene therapy of current techniques to introduce cells carrying engineered genes, may allow us to prevent, cure, or otherwise substantially modify many of these diseases.
Cardiovascular disorders are a major target, for cardiac disease is the number one cause of death in persons over the age of 65 and cerebral vascular disease is the third most common cause of death in elderly persons (National Center for Health Statistics, 1989). Most of these disorders are due to atherosclerosis: excessive thickening and narrowing of coronary, cerebral, and peripheral arteries. Unfortunately, inadequate data address these problems because, to date, elderly persons have not been represented adequately in clinical studies of cardiovascular therapies. Thus, increased research on cardiovascular disorders among older persons is needed. Emphasis should be placed (1) on understanding the genetic as well as the environmental risk factors and the molecular basis of atherosclerosis, and (2) on developing standard and recombinant-based drug technologies as well as new approaches to prevent (in younger adults) and treat hypertension, lipid disorder, and the thrombotic complications of atherosclerosis. The role of nutrition, and the interaction of genetic and nutritional factors in the cause and prevention of these diseases, are important areas for future research.
Dementia, Pseudodementia, and Psychiatric Disorders
Recent studies have shown that dementia after age 75 reaches well over 40 percent; an overwhelming proportion of these patients have senile dementia of the Alzheimer's type (Hagnell et al., 1983; Sayetta, 1986). If dementia were cited on the death certificates of persons in whom it was a primary underlying disease, it would be the