Dr Moyra Mortby is a Psychologist specialised in neuropsychiatric symptoms in dementia and pre-clinical stages of dementia and is an NHMRC-ARC Dementia Research Development Fellow. She was awarded her PhD with Laudatio Magna Cum Laude from the University of Zurich, Switzerland for her research on apathy and depression in Mild Cognitive Impairment and Alzheimer’s disease, and completed her MSc in Research Methods in Psychology and BSc in Criminology and Psychology both at Keele University, UK.
Her research program focuses on neuropsychiatric symptoms in dementia and pre-clinical stages of dementia, neuroimaging and epidemiology. 2015 International Society to Advance Alzheimer’s Research and Treatment (ISTAART) and the Neuropsychiatric Syndromes (NPS) in Neurodegenerative diseases Professional Interest Area (PIA) New Investigator Award.
Her research program is structured around 4 key areas which aim to: 1) improve our understanding of dementia, its risk factors and trajectories; 2) better understand the impact of neuropsychiatric symptoms on dementia trajectories, quality of life and the provision of formal and informal care; 3) validate the concept of Mild Behavioural Impairment as a pre-clinical stage of dementia; and 4) develop and evaluate interventions to reduce neuropsychiatric symptoms associated with dementia, improve quality of life for people living with dementia and those providing care and develop useful support mechanisms.
Currently, there is no effective treatment for dementia, highlighting the urgent need to preventing more cases through evidence-based strategies for risk reduction. As there is an overlap between the risk factors for dementia and other preventable non-communicable diseases including stroke, diabetes, and heart disease, it is important to build upon proven risk-reduction strategies.
What is LEAD?
LEAD! is a project funded by the NHMRC Boosting Dementia Research Grant led by Professor Kaarin Anstey. It involves an international collaboration between leading academics, clinicians, consumers, and community members. Organisations involved include the Department of Health, WHO, Dementia Australia, Alzheimer’s Disease International, Diabetes Australia, and Heart Foundation.
The project aims to translate dementia research and implement evidence-based strategies for dementia risk reduction to individuals, communities, and healthcare centres.
The project has three concurrent workstreams over five years: Development, Implementation, and Evaluation and adoption.
The Development stream, led by Professor Kaarin Anstey and Associate Professor Peters, focuses on building a new tool for predicting dementia and other non-communicable diseases including stroke, diabetes or myocardial infarction. The tool will be available to the public, researchers and clinicians. It will save clinical assessment time, accurately predict multiple outcomes and will be more acceptable in comparison to using individual tools for each disease outcome.
The Implementation stream led by Professor Nicola Lautenschalger’s team at the University of Melbourne, will develop strategies to support the implementation of dementia risk reduction evidence by engaging with consumers, clinicians, policy makers, and the public. The stream will develop strategies for incorporating the new risk assessment tool into various technological platforms (e.g., websites or apps).
The Evaluation and adoption stream, led by Professor Anstey and in collaboration with Professor Louisa Jorm and Dr Heidi Welberry at UNSW, focuses on measuring trajectories of Australian’s national risk factor profiles for multiple chronic diseases. Collaboration with key stakeholders including the WHO will help build an evaluation framework and methodology for implementing evidence on dementia risk reduction based on WHO guidelines at national level and in the global context.
Evidence related to dementia risk factors continues to increase with advancement in study methodology and more research being published in the field of dementia prevention. WHO guidelines for risk reduction of cognitive decline and dementia has published the latest evidence on the risk factors in mid and late life. There is a need of a new risk assessment tool that can be used both in population and clinical settings which would incorporate the latest evidence for the risk factors of dementia.
What is CogDrisk?
The CogDrisk project led by Professor Kaarin Anstey at NeuRA. The project aims to develop and validate a new risk assessment tool for assessing individual exposure to risk factors known to be associated with an increased risk of developing dementia. The tool will be developed from risk estimates selected from latest systematic reviews and meta-analyses. External validation of the tool will be carried out using five high standard international cohorts for discrimination and accuracy of predicting dementia cases.
Who will use the CogDrisk?
The assessment tool will be available online to the public, researchers and clinicians. Individuals aged 18 years and above can take the assessment to assess their risk of developing dementia, get a risk profile, and recommendations to reduce their risk of developing dementia. A risk score along with recommendations to reduce their dementia risk will be provided to individuals aged 60 years and above.
What are the benefits of the CogDrisk?
Those who are interested to take the assessment (anyone over the age of 18 years) can do so at a time convenient to them and can redo the assessment later to see if they changed their risk of developing dementia.
The Personality and Total Health (PATH) Through Life Project is co-hosted by the Australian National University and the University of New South Wales and has been led by Professor Anstey since 2006. It is a large on-going population-based longitudinal cohort study comprising approximately 7500 participants. The study includes three cohorts including a younger (aged 20–24 at baseline), midlife (aged 40–44 at baseline) and older (aged 60–64 at baseline) adults randomly sampled from the electoral roll of the ACT and the nearby city of Queanbeyan. Additional waves of data collection have occurred in 4-year increments, with the 5th wave of data collection underway. The study involves many national and international collaborations.
The broad aims of the PATH study relate to clinical outcomes that constitute the major burden of disease within the Australian community.
Primary PATH Objectives:
Several design features of the PATH project contribute to its unique standing among population-based longitudinal cohort studies.
This project has been funded primarily by the National Health and Medical Research Council. Wave 5 40s and 60s follow-ups (led by Professor Kaarin Anstey) are funded by the ARC Centre of Excellence in Population Ageing Research.
For more information, please visit the study website at www.pathstudy.org.au. PATH participants can also contact the research team by phone on 1300 917 295.
It is estimated that 1.2 million Australians are currently caring for someone with dementia. Caring for somebody with dementia can become more complicated by the presence of behavioural problems (e.g. depression, anxiety, apathy, aggression) in the person with dementia. These behavioural problems can contribute significantly to carer burden and distress. This study aims to improve our understanding of how interactions between the carer and the care-recipient affect behavioural problems in dementia. A better understanding of these interactions will help us develop programmes which can be used to assist the carer and those suffering from dementia to minimise the negative impact of problem behaviours in dementia.
Rates of behavioural and psychological symptoms of dementia (BPSD) amongst people living in residential aged care facilities (RACF) are high. Over 90% of Australian aged care residents exhibit clinically significant BPSD. Physical aggression, agitation and disinhibition, especially when severe, are difficult to manage and can put patients, carers and other residents at risk. Management of BPSD has recently become a focus of attention for the Australian Government, especially in relation to inappropriate overprescribing of antipsychotics. The discrepancy between international and national recommendations and the continued over-prescription of medication to manage BPSD must be addressed. Australia urgently needs better programs to support RACF to implement non-pharmacological, cost-effective management programs.
IRIS CARTER Research Assistant
JENCIE CASTLES Research Assistant
DR NIKKI-ANNE WILSON
Postdoctoral Research Fellow in Cognitive Health and Knowledge Translation
: 02 9399 1126
This Special Issue provides a systematic examination of the neuropsychiatric symptoms (NPS) and non-cognitive prodromes of dementia, with an eye toward validating the construct of mild behavioral impairment (MBI).
The World Alzheimer Report 2016 estimated that 47 million people are living with dementia worldwide (Alzheimer's Disease International, 2016). In the inaugural World Health Organization Ministerial Conference on Global Action against Dementia, six of the top ten research priorities were focused on prevention, identification, and reduction of dementia risk, and on delivery and quality of care for people with dementia and their carers (Shah et al., 2016). While the Lancet Neurology Commission has suggested that even minor advances to delay progression or ameliorate symptoms might have substantial financial and societal benefits (Winblad et al., 2016), advances have been slow.
This study presents the first population-based prevalence estimates for MBI using the recently published ISTAART-AA diagnostic criteria. Findings indicate relatively high prevalence of MBI in pre-dementia clinical states and amongst cognitively healthy older adults. Findings were gender-specific, with MBI affecting more men than women. Knowing the estimates of these symptoms in the population is essential for understanding and differentiating the very early development of clinical disorders.