Little is known about Alzheimer's disease (AD) and related neurodegenerative diseases in American Indian (AI) populations. To provide appropriate health care to elder AIs, whose population is expected to increase dramatically during the next 50 years, it is imperative to attain a better understanding of the interaction of culture and disease in this underserved population. Raising awareness in the AI population regarding the nature of dementia as it compares to normal aging and the development of culturally appropriate instruments to detect and stage AD are essential for future health care efforts. Barriers restricting clinical service to this population include historical factors relating to access to health care, cultural beliefs regarding aging, demographic diversity of the population, competing epidemiologic risk factors, and lack of proper assessment tools for clinicians.

Over the years, frequent conversations with Drs. Dale Walker and Pat Silk-Walker impressed upon me the careful thought that had been invested in their longitudinal study of alcohol use and abuse among a large sample of urban Indians, with special emphasis on the mother/child dyad. As we talked, there was little doubt in my mind that the empirical findings of this work would find its way into a variety of professional and public forums. However, many of the issues that we discussed at greatest length had to do with the opportunities for and challenges of conducting longitudinal research in this special population. Those issues touched upon matters of science -e.g., sampling, recruitment, retention, analysis, participant confidentiality -as well as local benefit -e.g., community participation, feedback, and programmatic application. The lessons learned about these matters seemed much less likely to be published. Most professional journals, today, are interested only in what they consider to be the "meat" or substance of a study; the "doing" of research often is considered outside of this domain. Ironically, with respect to longitudinal work in particular, thoughtful reflection on the latter is precisely what is now needed. Thus, Walker et al.'s offer to author a manuscript along these lines, employing their current experience as the central speaking point, was fortuitous: an offer I quickly accepted.In the pages that follow, then, the reader is treated to a sophisticated presentation of research methods employed in a longitudinal fashion and comments by other investigators who have shared similar struggles. The result is a wonderful discussion of ideas, approaches, and priorities that is sure to instruct all of us. This exchange adds in important ways to the dialogue surrounding the potential and the pitfalls of studying the human condition over time.

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