Speaking with Cognitive Neuroscientist - Dr Maree Farrow
Australian Hospital and Healthcare Bulletin speaks to Dr Maree Farrow, a cognitive neuroscientist and Research Fellow with Alzheimer’s Australia and the Dementia Collaborative Research Centre - Early Diagnosis and Prevention.
What can you tell us about any new clinical trials for Alzheimer’s drugs currently being conducted in Australia?
There are several clinical trials for potential new Alzheimer’s drugs currently underway in Australia. One exciting study is the IMAGINE trial, testing a drug called PBT2 developed by researchers in Melbourne.
This study aims to test the effectiveness of PBT2 in treating early Alzheimer’s disease. Findings from earlier small trials were very promising, so we hope to see some positive outcomes from this larger trial.
The study involves 12 months of treatment and brain imaging to measure PBT2’s effect on amyloid deposits in the brain (a pathological hallmark of Alzheimer’s disease). People aged 55 or older with either prodromal Alzheimer’s disease (early or mild cognitive impairment) or mild Alzheimer’s disease may be eligible to participate.
For more information contact the Imagine Clinical Trial Message Line on 1800 837 683
A new report commissioned by Alzheimer’s Australia forecasts that three million Australians will develop dementia between 2012 and 2050. With these latest findings, how important is an increased investment in dementia research?
Increased investment in dementia research is critical. Our current healthcare system and budget will not be able to cope with the growing numbers of people living with dementia. An investment in research now could potentially save billions of dollars in the coming decades.
Another report commissioned by Alzheimer’s Australia earlier this year found that funding for dementia research lags far behind that for research into other chronic diseases, especially cancer, cardiovascular disease and diabetes. This is despite the fact that dementia places a similar or even larger burden on the healthcare system.
“There are several clinical trials for potential new Alzheimer’s drugs currently underway in Australia. One exciting study is the IMAGINE trial, testing a drug called PBT2 developed by researchers in Melbourne.”
Without an increased investment in dementia research, finding a cure or at least better ways of treating dementia to reduce this burden will take much longer, with significant consequences for those 3 million people, their families and the healthcare system.
Your current research interests include dementia risk reduction, early diagnosis and intervention for dementia, and translating research evidence into clinical practice and community education, that’s a heavy schedule, what was the reason behind taking your research focus in this direction?
Dementia is a significant health issue for Australia. There are 300,000 Australians who have the condition and over 1 million Australians are involved in their care. Because our population is ageing, these numbers will grow exponentially in the coming decades.
There is no cure for dementia, so the best we can do at the moment is educate people about how they can reduce their risk, about the benefits of an early diagnosis, and about the interventions that we know help people with dementia and their carers. There is actually a great deal the experts know about these things, but awareness among the community and health professionals is low and so they are not routinely put into practice. That is why a large part of the work Alzheimer’s Australia undertakes involves raising awareness and advocating for improved policy and practice.
To do this we need to be involved in building the evidence base that shows what works, hence my research focus and our involvement in the Dementia Collaborative Research Centres.
The release of your evidence paper with Elodie O’Connor, collated increasing evidence that suggests lifestyle and medical factors, particularly in midlife, can impact one’s risk of developing neurological conditions such as dementia. Can you outline for our readers what these were?
There is now a solid body of evidence that several health and lifestyle factors are associated with the risk of developing dementia. These can be summarised into the 3 key messages of Alzheimer’s Australia’s Your Brain Matters program – you need to look after your brain, body and heart.
“We are currently evaluating programs that allow users to determine which areas of their lifestyle they need to improve to have better brain health and a lower dementia risk.”
Matters program – you need to look after your brain, body and heart.
Keeping your brain active helps build connections between neurons, efficient brain networks and better cognitive function. People who are more mentally active and people who are more socially active are consistently found to have a lower risk of developing dementia.
Keeping your body fit and healthy is also important for brain health. Regular physical exercise is associated with healthier brains and lower dementia risk. A healthy diet low in saturated fat and high in vegetables and fruits may also help reduce risk. We now know there is a very strong link between heart health and brain health.
Having high blood pressure, high cholesterol, diabetes or obesity in midlife is associated with increased risk of developing dementia later in life. Detecting and treating these conditions is therefore recommended for dementia risk reduction. Smoking also increases dementia risk. More information is available at the Your Brain Matters website yourbrainmatters.org.au.
Ita Buttrose, the National President of Alzheimer’s Australia, says pharmaceutical companies must continue to do research into medications to modify or stop the progression of dementia, why would pharmaceutical companies be slow in doing this?
Pharmaceutical companies have in fact invested billions of dollars into research and clinical trials of potential new drug therapies for dementia, especially Alzheimer’s disease. The problem is, this work has so far proved largely unsuccessful.
Drugs that showed promise in early research failed to show benefits for people with Alzheimer’s in large clinical trials. So there has been some concern that pharmaceutical companies may be unwilling to keep investing in this area. However, we now know that Alzheimer’s disease builds up in the brain for many years before dementia symptoms arise. So giving a drug that stops Alzheimer’s to someone who already has dementia, may in fact be intervening too late.
The focus of clinical trials is now shifting to people at the earliest stages of disease, and in fact recent findings from a trial of a drug called solanezumab showed that while there was no benefit overall when all participants were included, there was a benefit for those with mild Alzheimer’s disease. So early intervention with these drugs may be critical for them to work.
It is essential that pharmaceutical companies and others continue to invest in drug research. We have to find more effective treatments for a devastating condition that will affect millions of people.
Dementia is not just an old age disease and can occur in people as young as 30, public awareness of this has been slow, is that because this is something new? Or do the media and practitioners simply prefer to not focus on early onset? What kind of diagnosis and support is there for those with early onset Dementia?
The term younger onset dementia is preferred, rather than early onset, because early onset gets confused with early stage dementia. When dementia is diagnosed in someone younger than 65, we call this younger onset dementia.
It is an arbitrary cut-off really, but it relates to the fact that dementia is actually very rare in people younger than 65. It can occur as young as 30, but there have only ever been a few cases of this. It is estimated there are currently around 23,000 Australians with younger onset dementia, and most of these people would be diagnosed in their 50s or early 60s.
Younger onset dementia is not new, but it is much better recognised now so we see more people being diagnosed with it. Because it is rare, doctors may be more likely to think of other potential causes of the dementia symptoms, and may misdiagnose the person as having depression or another condition, and it can take a long time before an accurate diagnosis is reached.
“Whether it is research into potential new treatments or ways to reduce risk, Australian researchers are struggling to recruit enough participants for their studies. These studies simply cannot succeed without people who are willing to volunteer.”
An accurate diagnosis is important for the person to receive the most appropriate treatment, so people should ask for a referral to a specialist or memory clinic where a thorough assessment can be made.
People with younger onset dementia may need support that takes into account the special circumstances of their younger age. They may still be working and looking after children for example. Support is available through Alzheimer’s Australia who have staff specialising in the needs of people with younger onset dementia and their families and run support groups for people to learn from each other’s experiences.
Awareness of dementia risk factors and the potential for risk reduction in the Australian community is low. What is your research doing to encourage behavioural change?
Awareness that we can all do something to reduce our risk of dementia is low in the Australian community. We found in a review of surveys that only about half of adult Australians believe dementia risk reduction is possible, while another third are unsure. So the first step is to educate people and raise awareness. But just telling people about it isn’t enough.
We are also developing and investigating tools that aim to make it easier for people to actually take up the brain health messages we’re providing. We’re using e-health tools, utilising the internet, smartphone and other technologies, to make these resources accessible to as many people as possible.
We are currently evaluating programs that allow users to determine which areas of their lifestyle they need to improve to have better brain health and a lower dementia risk. The program then provides users with tips and resources in those areas to help them make changes and track their progress.
It is still very much up to individuals to make healthier choices, but we hope these e-health tools will provide them with knowledge and strategies to make this easier. If people would like to participate in this research, they can visit the study website at brainhealthstudy.org.au for
What are the greatest challenges you face in achieving your research goals?
There are two major challenges facing dementia research, including my own work. The first is a lack of funding, as we’ve already talked about. The second is a lack of people willing to participate in research trials.
Whether it is research into potential new treatments or ways to reduce risk, Australian researchers are struggling to recruit enough participants for their studies. These studies simply cannot succeed without people who are willing to volunteer.
Tell us about the National Dementia Research Forum 2013, taking place in Brisbane, Queensland on September 21 and 22, who from the health industry should get involved and why?
The National Dementia Research Forum is an annual conference hosted and organised by the Dementia Collaborative Research Centres. In 2013, it is the turn of the Dementia Collaborative Research Centre – Carers and Consumers, based at Queensland University of Technology, to host the forum.
The theme is A life worth living: enhancing quality of life for people with dementia and carers. The conference will explore quality of life and its links with quality of care for people with dementia, their family and carers, from early symptoms to end of life. The
work of researchers in the field of care provision will be highlighted, but many other aspects of dementia research will also be included.
Anyone working in the health industry with an interest in how the latest knowledge impacts on dementia policy and practice could gain from attending. Visit dementiaresearch.org.au for regular updates on the conference.
An international report has found that one quarter of people with dementia, and one in ten carers, have admitted to hiding their diagnosis from others because of the stigma attached to the condition. What can we do to combat this stigma?
Unfortunately, stigma remains a huge issue for people with dementia and their carers. While awareness and understanding of the condition are improving, the nature of dementia means that there are still misperceptions and fear among many in the community.
Dementia affects the way someone thinks and behaves. We know this is caused by brain disease, but this is invisible and so it can be hard for many to understand and accept that the person cannot help the changes they experience. Some people see dementia as going
crazy or losing your mind, adding to the stigma.
The key to combating this stigma is education. We all need to talk about dementia more and make sure people understand that it is caused by brain disease, that it can strike anybody, and is nothing to be ashamed of. Just as if someone has a broken leg, they can’t
walk properly, if someone has a damaged brain, they can’t think and behave normally. Alzheimer’s Australia works very hard to promote the facts about dementia and reduce the stigma, enlisting the help of the media, health professionals and others.
You can find out more about our campaigns at fightdementia.org.au.
Dr Maree Farrow
Dr Maree Farrow is a Research Fellow with Alzheimer’s Australia Vic and the Dementia Collaborative Research Centre – Early Diagnosis
and Prevention, and a Visiting Fellow at the Centre for Research on Ageing, Health and Wellbeing at the Australian National University.
She completed her PhD in cognitive neuroscience at the Brain Sciences Institute, Swinburne University of Technology, and has
over 15 years research experience in this field. Her research has involved studies of cognitive function in development, ageing and brain disorders.
Dr Farrow’s current interests include risk reduction and early intervention for dementia and translating research evidence into practice. She has developed a range of resources and e-health tools for community and health professional education about dementia and
reducing the risk, including a comprehensive website for Your Brain Matters, Alzheimer’s Australia’s dementia risk reduction program.
Her most recent publication, Targeting brain, body and heart for cognitive health and dementia risk reduction, outlines the current evidence for health and lifestyle strategies for brain health. She helped develop BrainyApp, the world’s first dementia risk reduction app, downloaded by around 230,000 people internationally, and winner of a 2012 Victorian Public Healthcare Award for healthcare innovation.
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