Md Hamidul Huque

LEAD!- Leveraging Evidence into Action on Dementia

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.

Three workstreams

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.

CogDrisk- Cognitive health and Dementia Risk Assessment

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?

• The CogDrisk website provides latest evidence on dementia, dementia risk factors and risk reduction.

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.

• Recommendations provided are based on National and International Guidelines.
• The tool would also be used to identify individuals at high risk of developing dementia before they can be involved in clinical trials for dementia prevention.

The Personality and Total Health (PATH) Through Life Project 

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 5^th 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:

• To delineate the course of depression, anxiety, substance use and cognitive ability with increasing age across the adult life span
• To identify environmental risk, genetic risk and protective factors influencing individual differences in the course of these characteristics
• To investigate interrelationships over time between the three domains of: depression and anxiety, substance use, and cognitive ability and dementia
• To examine the mental health related impact of various personal, social and lifestyle transitions and events experienced by the different age cohorts, including infertility, fertility and pregnancy, changes in family structure, relationship formation and separation, menopause, and retirement.

Several design features of the PATH project contribute to its unique standing among population-based longitudinal cohort studies.

• Obtaining measures of genetic, biological (including MRI), psychosocial and lifestyle risk and protective factors for mental health and wellbeing
• Use of a narrow age cohort design with longitudinal follow ups as an optimal means of separating age and cohort effects
• Assessment of participants across the full adult lifespan, permitting investigation of developmentally significant, though under-studied periods such as midlife
• Recruitment and follow up of a young-old population, providing important pre-clinical data for studying the development of age-related changes in memory and cognition.

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.

The Driving, Ageing, Safety and Health (DASH) project

Older adults represent a growing sector of the driving population in Australia, and while driving can be important for maintaining social engagement in late life, age-related changes such as cognitive and visual impairment can impact on driving safety.

The Driving, Ageing, Safety and Health (DASH) project is designed to develop and validate screening measures for older drivers to support determinations of driving safety. The DASH project is a collaboration with Joanne Wood and the Queensland University of Technology.

Over 550 older drivers, across three groups, were followed for two years to evaluate how well laboratory assessments and an on-road test predict driving outcomes. The three groups included a) older drivers referred for assessment by GPs and Road Safety Authorities, b) older drivers with eye disease and c) older drivers drawn from the community.

Primary Aims:

• To validate a short screening battery for older drivers called the Multi-D based on the Multifactorial Model of Driving Safety, a theoretical model of the abilities involved in safe driving and knowledge of age-related changes in cognitive, visual and sensorimotor function
• To compare the Multi-D and existing screening approaches including Hazard Perception, Road Rules Knowledge, the Useful Field of View, and the Drivesafe tests to determine whether combining measures improves the accuracy of classification of safe and unsafe drivers.

Secondary Aims:

• To compare the efficacy of the Multi-D and other screening instruments in predicting prospective self-reported crash rates (derived from standardized monthly diaries) between three groups of older drivers
• To evaluate the screening instruments and assessments in relation to mobility outcomes (driving cessation, driving frequency, driving distance) over two years and longer pending further funding
• To collaborate with practitioners to develop clinical practice guidelines for using the Multi-D battery in the context of older driver assessment
• To inform the development and design of interventions to prevent injuries among older drivers.

Findings from this research project will enable health professionals and licensing authorities to assist in their decision-making regarding the fitness to drive of older adults.

DASH is funded by the National Health and Medical Research Council.

The Dementia Risk Factors and Assessment (DemRisk) program

The Dementia Risk Factors and Assessment (DemRisk) program involves over ten years of research performed by the Anstey group on the identification and assessment of risk factors for Dementia.

The DemRisk program includes:

• Systematic reviews and meta-analyses of dementia risk and protective factors
• Analysis of cohort studies to identify dementia risk and protective factors
• Development of evidence-based interventions for dementia risk reduction
• Development of innovative e-learning resources to support dementia risk reduction
• Development of risk assessment tools validated for assessing individual exposure to risk factors known to be associated with an increased risk of developing dementia
• Development of guidelines (e.g. physical activity guidelines) to reduce risk of cognitive decline and dementia in collaboration with other researchers and organisations including the World Health Organisation
• Training of early career researchers with a focus on identifying and targeting dementia risk

Read Professor Kaarin Anstey and Dr Ruth Peters’ recent invited commentary on second-hand smoke as an under-recognised risk factor for cognitive decline here. You can also watch Professor Anstey’s NeuRAtalk on ageing well to reduce your risk of dementia here.

NHMRC Centre of Research Excellence in Cognitive Health

The Centre of Research Excellence in Cognitive Health focuses on the integrally linked areas of optimising cognitive health and the prevention of cognitive decline.

The centre aims to:

• Build the evidence base in cognitive health promotion and prevention of cognitive decline, focussing on evaluating putative new risks and under researched areas
• Develop methods of transferring, translating and implementing established findings, through the development and evaluation of interventions
• Model population level impacts of cognitive impairment and risk modification to quantify potential economic benefits of risk reduction and to inform policy.

The CRE Cognitive Health led by Professor Kaarin Anstey is a collaboration between Chief and Associate Investigators from the Australian National University, University of Melbourne, University of New South Wales, Australian Catholic University, Baker IDI Heart and Diabetes Institute and University of Exeter.

For more information about the CRE Cognitive Health, please visit the centre website, including more information on research themes, news and events, and recent publications.

The CRE Cognitive Health is funded by the National Health and Medical Research Council.