Associate Professor Ruth Peters

Blood pressure, retinal microvascular abnormalities, and dementia: considering the socioeconomic pos

High blood pressure is related to the development of cerebral small vessel disease, retinal microvascular abnormalities, eye diseases (e.g. cataract and glaucoma), reduced visual acuity, and dementia. Cerebral small vessel disease, retinal microvascular abnormalities, eye diseases and vision are also related to the risk of dementia. Moreover, socioeconomic inequalities are related to blood pressure and dementia and may consequently shape the associations between blood pressure and risk of cerebral small vessel disease, retinal microvascular abnormalities, eye diseases and dementia. 

To date, there is no study investigating the indirect effects of cerebral small vessel disease, retinal microvascular abnormalities, eye diseases and vision impairment on dementia or cognitive decline and no study evaluating the influence of different socioeconomic indicators on these associations.  

Understanding Frailty

Frailty is a term that is often used in clinical or research settings to describe someone who has less ability to recover from disease or illness, someone who has less reserve and is more vulnerable. 

Frailty can occur at any age but it gets more common as we get older. Being frail also makes us more likely to need additional care such as care at home or hospital care. But the good news is that frailty can be modified, it can be stabilised or even reversed.  

Our team has several projects that are investigating frailty, from understanding the best ways to measure and approach frailty in community settings to testing ways that we might be able to reduce it. Our current projects are shown below:  

The INTERgenerAtional Clinical Trial In at risk Older adults and preschool childreN (INTERACTION) (ACTRN12622000368730).  

In the INTERACTION trial led by Associate Professor Ruth Peters, we are collecting data to help us understand whether an intergenerational program (that is bringing older adults and pre-schoolers together to complete purposeful structured activities) helps to reduce frailty in the older adults. We are also measuring what happens to the children as we think it will help them with things like school readiness.  

Associated people: Ruth Peters, Ebony Lewis, Mae Lim, Christine Zammit, Nicole Ee, Gail Kenning.  

Understanding frailty in Indigenous populations  

In this study led by Ebony Lewis, we are mapping the rates of frailty in Indigenous adults, looking at what proportion of people have frailty, what proportion are developing frailty over time and what that means for future engagement and care.  

Project 1 – Views that older First Nations people hold about frailty  

To understand the views that older Aboriginal and Torres Strait Islander people in Sydney hold about frailty and any needs and suggestions around frailty and ageing to support health and wellbeing as people age 

Project 2 – Incidence and prevalence of frailty in First Nations Peoples in New South Wales  

To describe the frailty profile of older Aboriginal and Torres Strait people using data from a population-based cohort in NSW 

Associated people: Ebony Lewis, Dr Kylie Radford, Dr Nicole Mealing, A/Prof Ruth Peters.  

Frailty and high blood pressure 

 In this study led by Associate Professor Ruth Peters, we are looking at whether frailty mediates the impact of blood pressure-lowering medication. This is important since both high blood pressure and frailty become more common as we get older.  

Early life risk factors for cognitive decline

In the last 30 years we have learned an enormous amount about the risk factors for dementia and cognitive decline and whether they have their biggest impact in mid and/or late life. Now we are starting to extend our understanding to earlier adult life and even childhood. To do this we are synthesizing the academic evidence using systematic review and meta-analysis techniques to deliver an overview of the current evidence at younger ages. We have recently published an article bringing together the available data on the impact of high blood pressure in childhood and early adulthood on cognitive function and are now looking at other modifiable risk factors that might be present in earlier life. This is important because the more we can understand about when and how the risk factors for poorer cognitive function have their impact, the better we can target our risk reduction strategies.  

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 INTERgenerAtional Clinical Trial In at risk Older adults and preschool childreN (INTERACTION) (A

There is increasing evidence to show that intergenerational interaction is beneficial for older adults and children alike. Higher levels of social engagement in older adults have been associated with better physical and cognitive function and wellbeing. Time spent with older adults has been linked to enhanced social and personal skills in children. However, familial intergenerational interaction is falling despite rising numbers of community-based older adults. In Australia alone approximately 15% of the total population are aged 65 and over, up from 5% in the 1920s and estimated to increase to 22% (8.8 million) in the next 30-40 years. Employment and economic factors drive greater geographical mobility of working age adults, resulting in increased separation from older family members with 40% of Australians aged 75-84 and 51% of those 85 and over living alone. Recent television series in Australia and the United Kingdom, have raised awareness and enthusiasm for intergenerational activities as an opportunity that could be realised within communities. However, while intergenerational programs are gaining in popularity globally, evidence for best practice in this area remains scarce. 

In the INTERACTION trial led by Associate Professor Ruth Peters, we are collecting data to help us understand whether an intergenerational program (that is bringing older adults and pre-schoolers together to complete purposeful structured activities) helps to reduce frailty in the older adults. We are also measuring what happens to the children as we think it will help them with things like school readiness.  

Our INTERACTION trial builds on our previous pilot work in the Intergenerational Integration Initiative (3i) project. In our previous work we answered three questions: We systematically reviewed the scientific evidence for community-based intergenerational programs and found that this was lacking. We asked the public and local community members what they thought about intergenerational programs and found that people are supportive and perceive such programs to be helpful. Finally, we ran a successful small pilot program in a Sydney community to test whether such programs were feasible. Our published work on the 3i project can be found here https://pubmed.ncbi.nlm.nih.gov/33567363/, and here https://www.mdpi.com/2076-0760/10/10/374  

Interested in volunteering?

Eye biomarkers for cognitive impairment

This project is funded by the UNSW Ageing Futures Institute.  The aim of this project is to use fundus photography as a tool to identify those with greater risk of developing cognitive decline with a view to early intervention and risk reduction.  We will investigate the relationship between retinopathies and changes in brain structure.  A systematic review approach will be used to summarize current evidence on the epidemiology of co-existent eye diseases and dementia/cognitive impairment.

The Life-Course Blood Pressure Cognition (LCBP-COG) study

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 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.

World Heath Organisation (WHO) Guidelines for the reducing the risk of cognitive decline and dementi

Systematic review of reviews were conducted to synthesize the available evidence for interventions for risk factors associated with cognitive declines and dementia. This research was used to inform WHO guideline development.

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.

The Dementia rIsk REduCTion (DIRECT) collaboration

We know that having high blood pressure increases the chance that we will develop dementia and cognitive decline as we grow older but we are still trying to understand whether using blood pressure-lowering treatments (antihypertensives) can help to prevent this. To explore the relationship between blood pressure, blood pressure lowering and cognition we will combine global data from the highest quality placebo-controlled trials of antihypertensive drugs. Working across three institutions, The George Institute for Global Health https://www.georgeinstitute.org.au/, Neuroscience Research Australia and Imperial College London https://www.imperial.ac.uk/  this project will deliver knowledge and targeted clinical recommendations for antihypertensive use to support reduction of dementia risk.