Md Hamidul Huque

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.

Better Drive Program

Current road safety policy for at-risk older drivers involves ‘fitness to drive’ assessment and either license restriction or revocation. However, research indicates that there is no clear evidence that mandatory testing lowers crash rates amongst older drivers, and that driving cessation in older adults is associated with increased rates of depression, social isolation, and general health decline.

The Better Drive program includes a series of studies evaluating interventions to improve driver skill. Two trials have been completed to date.

Trial 1 used a two-arm randomised controlled trial (RCT) approach to investigate the efficacy of individually tailored driving refresher lessons against a group-based refresher course on on-road driving performance, safety and crash risk in older adults. Findings indicate that although classroom based road rules workshops for seniors can lead to improvements in on-road driving skill, the inclusion of tailored driving instruction can significantly enhance safety and reduce crash-causing on-road errors relative to classroom based workshops alone.

Trial 2 used a two group (training, no-contact control) non-randomised design to examine the transfer of computerised speed of processing (SOP) training gains to cognitive measures that are known predictors of driving safety in older adults. Findings indicate that SOP training effects can be achieved with self-administered, online training at home, with some transfer to other known cognitive predictors of driving safety. However, differential effects of training may be observed for tasks requiring goal-directed search strategies rather than diffuse attention.

A third trial is currently underway. This trial uses a three-arm randomised controlled trial approach to assess the effectiveness of computerised cognitive training and tailored on-road skills training on driver safety in older adults. Data collection for this trial will be completed in 2019.

The Better Drive program has been funded by the NRMA Road Safety Trust.

The Body-Brain-Life Project

A growing number of modifiable risk and preventative factors for dementia have been identified. Primary care offers a natural setting for the identification of those who may be at particular risk and who may subsequently benefit most from risk reduction interventions.

The Body, Brain, Life – General Practice (BBL-GP) project – a continuation of the original Body Brain Life study – evaluates the efficacy of lifestyle management programs for reducing risk profiles for dementia in adults recruited from primary care. The project compares three different interventions: a BBL-GP intervention designed to reduce the risk of cognitive decline, a Lifestyle Modification Program (LMP) designed to enhance general wellbeing and improve lifestyle to reduce risk of chronic disease, and an Active Control condition. A total of 120 adults participated in the trial.

The BBL-GP intervention group completed eight online e-learning modules designed to improve dementia literacy, knowledge of risk factors, physical activity, nutrition, health, cognitive activity, social activity and mood. This group also received tailored face-to-face physical activity and nutrition sessions. Participants in the LMP group participated in group sessions on basic nutrition, meal planning, physical activity, health conditions, motivation and goals, medications and sleep. The Active Control group received weekly emails with links to information regarding lifestyle risk factors and disease management.

Primary Outcome:

• Dementia risk as measured by the ANU-Alzheimer’s Disease Risk Index (ANU-ADRI)

Secondary Outcomes:

• Cognitive function
• Physical activity
• Depressive symptoms
• Diet quality
• Sleep quality

Outcomes were assessed immediately following the intervention, 18-weeks post-intervention, and 36-weeks post-intervention. The final follow-up at 62-weeks post-intervention is due to be completed in mid-2018. A cost evaluation of the two interventions will also be completed.

Read more about the BBL-GP protocol here.

The BBL-GP project is funded by the National Health and Medical Research Council Centre of Research Excellence in Cognitive Health.

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.

International Research Network on Dementia Prevention

Globally, dementia cases are increasing at a rate of 21 per cent annually, and most of these are occurring in low to middle-income countries. With no cure for neurodegeneration or the diseases that cause dementia, there is an urgent need to link both knowledge translation and researchers more closely together in a global effort to tackle prevention more effectively.

Founded in 2017, the International Research Network on Dementia Prevention (IRNDP) is a multinational network bringing together researchers who are working to reduce the risk of dementia across the world.

IRNDP aims to:

• Increase dementia risk reduction messaging worldwide
• Develop targeted research to answer questions about the detailed impact of known and emerging risk factors in preventing dementia
• Welcome membership from researchers in both high and low or middle income countries
• Collaborate and work closely with public health stakeholders, policy makers and those who have a diagnosis of dementia and carers.

The goals of the IRNDP have particular relevance in low- to middle-income (LMIC) countries as exposure to lifestyle and clinical risk factors becomes more common as LMIC economies grow.

While there are many current overlapping public health, patient, research, policy and practice initiatives aimed at prevention or treatment of dementia, IRNDP is the first single collaborative network of researchers to focus attention on prevention that is truly global.

For further information, visit the IRNDP website, including news and updates, an evidence hub on cohort studies, an evidence synthesis on clinical trials, and information on how to join the network.

IRNDP is chaired by Professor Kaarin Anstey and is a project of the Dementia Centre for Research Collaboration funded by the NHMRC National Institute for Dementia Research (NNIDR).

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.

NHMRC Dementia Centre for Research Collaboration

The NHMRC Dementia Centre for Research Collaboration (DCRC) was established in 2006 under the Australian Government’s Dementia Initiative.  DCRC projects are diverse and map onto the priorities of the NHMRC National Network for Dementia Research (NNIDR). A key focus is applied research on topics meaningful to people with dementia and their family carers.

There are three DCRC hubs located at UNSW, NeuRA and QUT, respectively. The three-hub framework aims to grow partnerships and strengthen ties with consumers and service providers, Dementia Training Australia and Dementia Support Australia in order to progress prevention, assessment, care and translation of knowledge into everyday practice, as well as building the next generation of dementia researchers.

The primary focus of the DCRC NeuRA hub is risk reduction and prevention including individual, community and population-based interventions targeting lifestyle risk factors for dementia.

The flagship project of the DCRC NeuRA hub is the International Research Network on Dementia Prevention (IRNDP). Founded in 2017, the IRNDP is a multinational network bringing together researchers who are working to reduce the risk of dementia across the world. For more information on the network, visit the IRNDP website, including news and updates, an evidence hub on cohort studies, an evidence synthesis on clinical trials, and information on how to join.

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

ARC Centre of Excellence in Population Ageing Research

The ARC Centre of Excellence in Population Ageing Research (CEPAR) is a unique collaboration bringing together academia, government and industry to address one of the major social challenges of the twenty first century. Based at the University of New South Wales with nodes at the Australian National University, The University of Melbourne, The University of Sydney and The University of Western Australia, CEPAR is producing world-class research on population ageing. CEPAR includes cross-disciplinary experts drawn from actuarial science, demography, economics, epidemiology, psychology and sociology. The Centre’s diverse research program which will deliver comprehensive outcomes with the potential to secure Australia’s future as a well-informed nation with world-best policy and practice for an ageing demographic.

Professor Anstey and Professor Mike Keane lead the CEPAR research stream concerned with decision making, expectations and cognitive ageing.

This research stream aims to:

• Develop a comprehensive model of ageing and decision making including identification of typologies of decision makers
• Develop multidisciplinary paradigms and predictive models of decision making and ageing
• Develop and evaluate interventions to increase positive expectations about ageing
• Develop life-cycle models that incorporate investments in health and housing as well as cognitive limitations in ageing.

For more information on CEPAR visit the centre website.

CEPAR has been funded primarily by the Australian Research Council, with generous support from the collaborating universities and partner organisations.