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Landmark women: Kaarin Anstey

Kaarin Anstey, Director, Centre for Research on Ageing Health and Wellbeing and the Dementia Collaborative Research Centre, 11 April 2014

CARISSA FLANAGAN: Hello everyone and welcome once again to Landmark Women. We have an amazing crowd again this month and we did last month. I am starting to worry I won’t be able to fit you all in the lounge. I don’t know how to solve that problem. But it is so wonderful to see so many people supporting the program and the amazing speakers that come to talk to us about their incredible lives. I would like to introduce you to Monica Lindemann who will introduce you to Professor Anstey. Monica is the head of Development at the National Museum of Australia and my boss, so be nice to her.

MONICA LINDEMANN: Good morning, ladies and gentlemen. This topic captured a lot of people’s interest when Professor Anstey was announced as the speaker. A lot of my colleagues thought ‘I really must get along to that’ because dementia and Alzheimer’s is something that is touching a lot of people in our community. I am absolutely delighted to introduce to you Professor Kaarin Anstey. I will just read some of her wonderful achievements. She is currently the Director of the Centre for Research on Ageing Health and Wellbeing and Director of the Dementia Collaborative Research Centre at the Australian National University. Her research interests include cognitive and brain ageing, chronic disease and mental health, prevention of cognitive decline and dementia, life span approaches to mental well-being and the impact of cognitive decline on productive ageing.

She currently leads the ‘Path through life’ project, which is an epidemiological study focussing on identifying risk and protective factors that influence mental health, cognitive decline and brain ageing from early to late adulthood. Some - and I say a very few - of her awards and honours include being selected as one of Canberra’s 100 women of influence in 2013 as a centenary event. In 2010, she was the adviser to the Governor-General on priorities in aged care. In 2008, she was invited to participate in the Australia 2020 future summit convened by Prime Minister Kevin Rudd. In 2005, she was awarded the Margret Baltes Award in social and behavioural sciences from the American Gerontological Society. At a personal level, Professor Anstey has lived in Canberra for about 13 years, moving here in 2001. She is married and has three children, amongst her many achievements. Please join me in welcoming Kaarin to the stage.

KAARIN ANSTEY: Thank you very much for that introduction. It’s a great pleasure to be here and quite an honour to be a speaker in this series on Landmark Women. I thought I would begin the talk today with some of my biographical details and some of my personal life story before I move into talking to you about my research areas and dementia, which I know is a topic that has attracted many people here today and is of great interest to all of us.

Just a bit about me, I was born in 1965, so I am 49. I had three brothers. I was educated in the public system in Sydney. I went to the University of Sydney and first of all studied philosophy and religious studies. During that time I also had some very boring jobs that motivated me to continue my education, because I decided that I did not want to end up a clerk pushing paper all day. I also worked as a proof reader for a record company and in the art department of a record company doing a lot of layout and decided that I wanted to do something more with ideas and research.

I went on and the first position after my degree in the humanities was in publishing. I also worked as a technical writer and a professional writer for Westpac Banking. I also worked as a freelance writer. I must say those experiences as a writer have stood me in good stead throughout my career. In fact, probably what I do most, if you looked at my list of time, is write. As an academic you write all the time. I also write for the media. I write for the Medibank Private magazine. I have written for the *New York Times* and I write documents for public policy. Writing is extremely important in terms of communicating. I think as a scientist being able to communicate what we do is absolutely essential. Often these early experiences that you have when you are sorting out your career and working out what you want to do end up contributing to where you end up in ways that you don’t expect them to.

But when I was working in publishing, I actually thought, ‘I don’t want to be publishing other people’s books. I would really like to be writing the books myself and doing research myself.’ I realised that studying psychology would give me the research skills that I needed to do that so I went back and studied psychology. I did my psychology honours at the University of Sydney and then I got a job which really determined the direction I would take in my career. That was a job as a research assistant in the Eastern suburbs of Sydney on a project looking at falls and fractures in older women. For this project I had to knock on the doors of every house in suburbs such as Coogee and Clovelly. I don’t know if members of the audience know that part of the Sydney, the little old terraces and in the apartment blocks. I had to find women aged 70 and older and see if they would participate in our study. Then I would get to interview these women, often over long cups of tea and homemade cake. I would hear about their lives and I would invite them into our laboratory for some physical assessments. This job, which I had for about a year, turned out to be extremely influential. Until then I had never even thought about ageing. I had never thought about it as an area of study or really considered ageing.

What the job showed me was the diversity of the women and their experiences, and I found it absolutelyy fascinating. It really is what started me on the journey that I have followed up until today. What was most interesting to me was the fact that I could interview three or four women, who were say aged 80, within a week and they were all completely different. Some were still extremely physically active, some were non-active, just socially, personality-wise in terms of their relationships - everything. They were so different.

I realised that chronological age was no indication of how well somebody was functioning and that we needed a better way of talking about ageing and a better way of assessing people’s individual capabilities. I went on to do my psychology honours on this very topic looking at bio markers of ageing. I then got another job that was also extremely influential in determining where I have ended up today. That was working with Professor Henry Brodaty, who is a leading dementia expert. He is the person that established Alzheimer’s Australia and set up the first memory clinic in Australia. I worked for him for a year studying dementia, working on research projects related to dementia, and that is what sparked my interest in dementia. All of those early experiences contributed different elements.

I then went to the University of Queensland and did my PhD in cognitive ageing, again looking at that issue of functional age, again with older women. I assessed 300 older women for my PhD and again found that it was how they were functioning that was more important than their actual chronological age in determining their cognitive abilities. Whilst I was finishing my PhD, I had my first child. I had moved up to Queensland with my husband and had our first child Jasper there. I was then going to do a post-doc in Adelaide with Professor Mary Luszcz, who has turned out to be a wonderful career mentor to me throughout my career. Another influence that is extremely important that many of us have experienced are these mentors that we meet throughout our journey.

However, my brother became quite ill. We decided that, rather than moving back to Adelaide, I would try to transfer the post-doctoral fellowship to Sydney so I could be near my brother as we were unsure what was going to happen with him over the next few years. I conducted my post-doctoral research at a medical research institute near the Prince of Wales Hospital in Sydney, again looking at these issues of ageing and what makes people age well.

Whilst I was in Sydney I had another child Felix, and that is when I really hit the issues that women face in science. I had two children; I was on a post-doc salary; and my childcare bill was almost as much as I was earning. I had no future prospects in my career because with a research career in Australia you are on a fellowship that ends and then you have to get another fellowship that also will end. The government had cut I think it was 14 per cent from the higher education budget in 1997, which was the year I completed my PhD, and they had axed a number of tenured academic positions so there were very few academic positions being advertised.

So I was in a career with at that particular time very few openings. I think I went through what most professional women go through, that real crisis and questioning about: ‘What should I do? am I absolutely crazy trying to do this with two children? I am not making any money. It’s killing me. It’s such hard work. I am trying to compete with men that don’t have children. I am in a very competitive environment.’ I went through a lot of self-doubt. I actually decided during my second lot of maternity leave that I would leave science because it was too hard. The scheme that I was on with the NHMRC had no maternity leave provision, and this was in 2000, so I applied to a special committee that they had because there was no policy on maternity leave. I took maternity leave on my own fellowship. By the time I had got back to work after six months, I got a letter from them finally saying that I was allowed to take some maternity leave - this is six months after the baby had been born.

Then what happened was I won quite a prestigious award in science in my area, and Professor Tony Jorm from the ANU wanted to recruit me here. I had been through that process where I nearly gave up. I had put my name down with some private companies to go and work in the private sector which would pay a lot better and offered better job security but I had thought I will give it a bit longer. The family moved to Canberra. So I took the position at the ANU, which was another contract, and we kept going.

My brother ended up dying. He had MS. He died in 2002. That was also another experience that has influenced my career and trajectory. MS is a neuro-degenerative disease. I study dementia, which is a neuro-degenerative disease, and there are similarities. I must say MS affects the body a lot more than dementia. There is a lot more disability leading up to the end stages, and any experience like that obviously influences people quite significantly. I did often wonder, and still sometimes wonder, why I didn’t end up going into MS research because I had such a personal reason to go in that direction. I was so far into my career in cognitive ageing and dementia at that point that I wanted to consolidate and stay in that area, but there are a number of similarities between the two.

I think with early onset Alzheimer’s, which often impacts people in their 30s - there are about 24,000 [sic] Australians with early onset Alzheimer’s at the moment - they go through similar processes. With watching my brother’s illness, he had to have a lot of care which impacted on the family. There are a lot of similarities in caring for someone with a disease such as dementia. He had respite care. We had to arrange that. It is quite unique, arranging respite care for someone who is young compared to someone who is old, given most of the facilities are designed for older people including things like the music that is played - lots of tiny things that you start to see from a young person’s perspective. I think that that experience as consumer myself has really enriched me as a person and, in terms of my work in dementia, I can see the perspective of carers and consumers by drawing on that particular experience.

In Canberra we had our third child Eloise. The ANU has been a fantastic place to work for me and for my career. I haven’t had any more of those moments of wondering whether I had made the right decision and whether I should throw it all in. The ANU is a fantastic place: it’s a beautiful physical environment; it has a fabulous intellectual culture; it’s very international; it’s a place where there is a lot of excellence; you work with good people; and it is a very inspiring place. There is a lot of intellectual depth in all the different areas in the ANU. It has been an absolutely fantastic period of time for me to be able to spend here and as a national university I am very proud to be part of that. I haven’t got the ANU template on (my powerpoint presentation) today ..

In 2010, I had the opportunity to take over the directorship of the Dementia Collaborative Research Centre at the ANU and that centre focuses on early diagnosis and prevention. That is an externally funded centre, funded by the National Health and Medical Research Council so it is not a permanent fixture. Again, it is one of those soft money things that could go. The ANU also established a permanent centre in its structure focussing on ageing in 2012, and I am now a director of that. That is the Centre for Research on Ageing Health and Wellbeing. That is the bio .

As an academic and I am sure other academics would probably agree with me, although I haven’t actually talked to them about this, I have my fundamental questions that motivate me, and in fact they haven’t changed throughout my whole career. One of the interesting things about preparing this talk was actually realising that I have the same questions now that I had when I started. i.e. when I had that first research assistant position. These questions are: Why do people age so differently and how can we measure ‘ageing’ or ‘age’? I still find that absolutely fascinating.

What causes normal cognitive ageing? So we all have a decline in our memory and our thinking as we get older, unfortunately. Why does that happen and what could we do to slow it down or even reverse it? As I have learnt more about ageing from a demographic perspective, I have realised that the demographic change that we are in the midst of at the moment with population ageing, combined with what I know about cognitive ageing, has a major impact and I will explain that to you as I proceed through the talk. That has led me to my current research which is: How can we prevent or delay dementia? That is really where my passion lies at the moment.

This is just a bit of light relief from my talk showing you some pictures of older women who all look completely different - just to make the point that we all age extremely differently. The differences between us actually become greater as we get older.

I would also like to point out the picture in the bottom right-hand corner which I expect many of you have seen. It’s used internationally as a sign to indicate elderly people. Whilst it’s a very useful sign, there are some things about it which are quite interesting. I think it encapsulates what we call an ageist stereotype, unfortunately. It depicts older people as stooped over, dependent on a walking stick, the woman behind the man sort of leaning on the man. It communicates very clearly and well, which we need, but often these types of stereotypes are embedded and internalised by us and create negative expectations about what it is like to grow old. That is something which we are doing research on at the ANU and which other groups internationally are doing research on. I think that is something we all need to address as a society. It impacts on everything, whether we are looking at dementia or looking at healthy ageing.

There is research now showing that people who have more negative stereotypes about ageing don’t do as well after a heart attack. They are less likely to be physically active. In some situations, they don’t even live as long. So there are negative stereotypes - I carry them in myself. I often catch myself saying or thinking something that is an ageist stereotype, because as a culture we have a very negative view of ageing. I wanted to highlight that that is a side stream of research that we are conducting.

In some of the work we have done looking at psychological ageing, which is going back to my early research in my post-doc where I was interested in people ageing differently. I have focused most of my career on physical ageing, but in this work we looked at psychological ageing and we did find that people who had a lower sense of control over their own life didn’t live as long. [graph shown] This is in the Australian longitudinal study of ageing based at Flinders University where we followed people for eight to 12 years and found people who on a questionnaire said they less control over what happened to them actually didn’t live as long. I will try to explain this graph. This (axis) is the days that people survive. This (line) is the people who had low control.

Similarly we looked at morale, and people who in the first assessment rated their morale as low also didn’t live as long in the study. The people who had the highest morale, were most hopeful and positive about life, actually lived the longest. So as well as a lot of the physical and health characteristics that I focus on most of the time and will tell you more about, it is true that psychological characteristics have a huge impact on how we age and our health.

I want to move on to cognition because that has been the main focus of my research. Cognition is quite a fascinating area. When I say ‘cognition’, I am talking about thinking skills - so your memory, your verbal ability, your knowledge of words, your processing speed, how quickly you can compare bits of information, how quickly you can select out important things in your environment or important facts. These are a few tests (of cognition) [slide shown]. This one on the top left-hand corner is a test of your reasoning ability. It’s a fairly typical IQ type of test. This is a test of processing speed on the bottom left. In this test [on the right] you have to pick out the word from the non-word, which is a test of your word knowledge. As psychologists we have lots of tests. We quite like all these different tests of cognition that we give to people. These are our measures that we use to look at cognition. We have some more practical everyday types of tests as well.

In normal ageing - all of us here are ageing - there is a normal decline in cognitive ability. It is normal for your memory to decline with ageing and that is apart from dementia, which is a disease. So there is this normative change. The most common complaint we get in ageing is the tip of the tongue phenomenon, knowing the word but you can’t remember it. I get that. That is normal from about the 40s onwards and everybody just about gets it. It usually resolves within 24 hours. There is sometimes a particular name that you really have trouble with - I have that.

What I have been really interested in is what causes this normal cognitive decline. In 2012 we did a national survey, the Australian diabetes and obesity and lifestyle study, which is a national study of Australia looking at the diabetes and obesity that I am involved with. [slide shown] These are the memory scores plotted by age across Australia and they just gradually go down with age. This is a 16-item word list that people did. So that is normal. That is what happens in the population.

You can see that, if people live longer, they are going to run into significant cognitive problems eventually if they are declining. [slide shown] This is processing speed in the same study, and this is typical as well where we find the verbal ability actually improves with age. We tend to find older adults are better at verbal skills, so doing crosswords, and have a much bigger vocabulary. We regularly find in our laboratory that older adults do much better at all the verbal type of tests, because that (ability) accumulates over your life course. And similarly professionally - that is probably why judges tend to be older - you develop a body of knowledge. If you are quite healthy that (verbal ability) is not affected by ageing, so you actually improve in your profession and professional knowledge over time.

We have normal cognitive ageing. This is the next fact which is really important to understand in terms of understanding the dementia epidemic. I want to talk to you next here about life expectancy and what has happened to us, say since I was born or over the last 150 years. This is UK data but it is almost exactly the same for Australia, except Australians live longer than the Brits. We have a couple of years extra in our life expectancy.

If you take 1965, that is the year I was born, males lived until about 67, which is what we now have for the age pension. If you think about pension age, I don’t know what the pension age was then but it was probably still in the 60s. It wasn’t such an issue financing the older population. And for women the life expectancy at that time was in the early 70s. This is only in 1965. It is not that long ago. Then if you go up to 2000, this is again in the UK so Australian numbers are actually a bit higher, the life expectancy at birth of men was 74.8 and of women was 80. That was only in 2000 and it has continued to go up. This is a global phenomenon that has happened across the world in developing countries and developed countries that life expectancy has risen dramatically over the last 100 years. That has some major impacts. It explains why dementia has become such a problem.

When you see my next few slides we will put it all together. [slide shown] This is Australian data and is the growth of different age groups over time, and the group that is going to increase the most in Australia is the 85-plus age group. Because we have population ageing we are going to see the biggest growth in the oldest cohorts and the composition of the Australian population will change, as will other countries.

I am going to move now on to dementia and spend most of the rest of the talk on dementia and explain why dementia impacts on population ageing. Who gets dementia? Anybody and everybody gets dementia. There have been presidents, film stars, it doesn’t matter whether you are rich or poor, it doesn’t matter what country you live in - dementia can strike anybody. It is very common and widespread.

I will just give you a bit of a definition. Dementia is actually an umbrella term that describes the symptoms (of progressive neurocognitive disorders) and there are a number of different causes of dementia. The issue with dementia is that it’s the progressive and irreversible decline in your cognitive abilities, so those thinking skills ( we looked at earlier). It can be caused by Alzheimer’s (disease). Alzheimer’s causes 60 per cent of dementia. It can be caused by vascular disease, so small strokes. But it could be caused by Parkinson’s, by HIV or by other viruses or conditions - alcohol dementia, for example. Dementia is acquired so it is not something you start off with. It persists and it involves multiple impairments not just memory. If you just had memory impairment you would have amnesia, but dementia requires more than one area of intellectual functioning to be impaired to get the formal diagnosis.

So what is the prevalence? This is where if we think back to population demographics when life expectancy was much lower, the prevalence of dementia in the late 1960s is actually very low, it is less than one per cent of the population. So when men lived until on average their late 60s, it wasn’t an issue. Dementia really becomes prevalent up in the 80s and 90s. That is why we have the epidemic now, because the people are living so long. So we are moving into an era where we still don’t know a lot about living into the 80s, 90s and over 100. We haven’t done enough research. It is quite a new phenomenon as a society to have so many people living to these ages. In history we have never experienced this before. It presents a lot of opportunities as well.

You can see the prevalence in this slide. This is averaged across multiple studies. The reason we have lots of lines is that different countries look at the frequency of dementia and use different methods. So researchers look at all different studies and try to draw an average across studies. So they are always just estimates. We can never be 100 per cent sure because we are trying to use all the data to make a generalization eg., ‘It looks like about 25 per cent of people in their 80s have dementia.’ If you look worldwide, the burden of dementia is actually higher in low and middle income countries than in high income countries. So dementia is a huge problem in developing countries. It is not just in wealthy countries and, because of the huge populations in some of those countries, the sheer numbers of people with dementia are going to be enormous.

These statistics are published by an international organisation - Alzheimer’s Disease International just to give you a view of the economics of dementia. Annually dementia costs $600 billion, which is greater than the economy of Wal-Mart or Exxon Mobil. Dementia is also an economic industry. There is so much money in care and in drugs for dementia that it’s a force. It is not just a disease; it is actually an economic force now internationally. 

Back to local statistics from Alzheimer’s Australia, there are more than 320,000 Australians living with dementia. This will increase to 400,000 in less than ten years. If we don’t have a major breakthrough - so we still have no cure for dementia and it doesn’t look like there is going to be one soon - we expect there will be nearly 900,000 Australians with dementia by 2050, and there are about 24,000 Australians living with younger onset dementia. So that is dementia that starts before the age of 60.

Another way of looking at the figures - there are different ways; you know what statistics are like – is that three in ten people over the age of 85 have dementia or one in ten people over 60. It depends which way you want to divide the pie up or talk about the numbers. At the moment there is an estimated 1.2 million Australians involved in caring for someone with dementia, which means either you or someone you know is caring for someone with dementia. That is how common it is. Often the symptoms are noticed quite a long while before a diagnosis. There is often that period of uncertainty, which I am sure many of you have experienced as well.

More on the personal journey of dementia before I talk about my own research, I think it is useful sometimes to try to imagine the experience of having dementia by looking at the way others have shared their own experience. I find these sorts of documentations of experience very inspiring for my own research. This is a painter William Utermohlen who had Alzheimer’s disease. These are some paintings that he did before he was ill. His wife was an art historian so she has actually documented his journey with Alzheimer’s.

When William Utermohlen was diagnosed in the mid-1990s, he decided he would paint his journey with Alzheimer’s and he did self-portraits all the way through. This is him when he was a young man, a self-portrait. There are many books written by people caring for someone with dementia and there is quite a lot of art by people with dementia. But this actually depicts his own experience, so it is quite personal. For him he found it was an experience of fear and isolation. His wife interprets this painting to depict that, and he himself said that his work was about anxiety. So for him as an artist, the experience of having Alzheimer’s disease was one of anxiety.

This shows you the progression trying to paint himself. There are quotes where he talks about knowing what he wanted to paint but not being able to do it or looking at a painting and knowing there was something wrong with it but not being able to work out what it was. He had incredible insight into the progression of his own disease and was able to express that in a way and share that with us. There’s a lot more of his paintings and you can find out about him online on various websites. It really gives you an insight that you can’t get any other way through just looking at his expression of his own journey. I find this extremely valuable and inspirational in terms of motivating me in my work, as do others.

Moving on to the research that I am doing now at the ANU - the values that you have come from your family and life experiences and choices that you have made yourself. With research I have always wanted to do something that was going to make difference. Clearly dementia is an area that needs a lot of research. My background in cognition and ageing is perfectly suited to research in that area so that is where I am focussing.

I have done a lot of work on is identifying risk factors, measuring the risk factors and bringing these findings to the people and to policy makers. That is another very important component for me as a scientist. We are also developing some interventions to help people reduce their risk of Alzheimer’s disease. I also conduct research into driving because I want to optimise mobility for older adults, keep them driving for as long as possible.

One of the things that I have been doing is sifting through the literature to identify risk and protective factors for Alzheimer’s disease. That has been going since about 2005. We have published in peer review journals the findings on the different risk factors for Alzheimer’s disease, and through that work we have actually developed a questionnaire which you can do yourself online. We have published the questionnaire and now we have developed a website so that anybody can go online and assess themselves and work out ways they can improve their risk profile. The motivation for this risk assessment tool was to get something that didn’t involve a medical test. So you don’t have to have a blood test; you don’t have to have a brain scan; you don’t have to be genotyped. This is specifically designed as a public health instrument that will be free, because not everybody can afford to go to expensive medical clinics and have expensive testing done and get access to high level interventions.

The other reason we did this because prevention has to start early. You need to know your risk factors when you are in mid-life or even early adulthood. It looks like with brain ageing and Alzheimer’s that the pathology actually accumulates over decades. So you can feel well in your 40s and 50s but your brain can be accumulating Alzheimer’s pathology. That is what we know now. We need to look at prevention much younger. Again, people aren’t going to be going to their doctor and asking about Alzheimer’s in their 40s, so we have tried to design some tools and instruments that can be used by people who are younger, who are perfectly healthy, to educate them on how to reduce their risk of dementia.

This is the self-assessment tool [http://anuadri.anu.edu.au/]. I am now going to tell you about the content of that tool and what the risk and protective factors are. That is the URL if anybody is interested in going and assessing themselves. You just type that in and you can then do the questionnaire. It will take you about ten minutes. There is an option of having a PDF emailed to you of your results that you could take to your GP or just keep for yourself. You don’t have to, you can just read the results that pop up for you online. It will say things like ‘you are doing well but you could benefit from being more socially engaged,’ for example. It will give you very practical advice.

I am going to go through the risk and protective factors for you. Risk factors for Alzheimer’s - these are only the ones for which there is very good evidence. A number of risk and protective factors are being researched right now. Our instrument only includes things that we are fairly sure about. Obviously being older increases your risk, being female increases your risk - you can’t do anything about those two things. Having had a head injury, again, you can’t do anything about it now but we can as a society implement policies to reduce head injury in sport. Being a smoker will increase your risk.

Not drinking is actually associated with increased risk of Alzheimer’s disease and dementia. It doesn’t mean that we recommend everyone go out and start drinking because we still don’t understand the mechanism and often people are not drinking for another health reasons. It’s a complicated one. There are some anti-inflammatory properties with alcohol, cardiovascular benefits, and animal models have shown that there are benefits of alcohol in low levels of consumption. It does come out over and over again in the literature that light alcohol consumption (is protective against dementia). The NHMRC guidelines are no more than two drinks a day, so light drinking seems to be protective.

Diabetes increases your risk; depression increases your risk – so obviously treat those disorders if you have them. High cholesterol in midlife increases the risk of late life dementia but if you have high cholesterol in late life it doesn’t seem to increase the risk. We don’t understand why. Low social engagement is a risk. The research that we have done has shown that people who have four or more types of social engagements per week seem to be protected. It’s a subjective type of thing, social engagement. Some people perceive social engagement differently from others. That can be with family and friends or it can be online, some type of social engagement.

Pesticide exposure increases the risk. This has been shown in people who have occupations that expose them to pesticide - crop sprayers and people like that. We don’t know about domestic pesticide use. There hasn’t been enough research done on it.

Having a high body mass index, so being overweight or obese in midlife increases your risk of late life dementia. To be overweight you have to have a body mass index of over 25. We have also found that being very underweight increases the risk, but very few people are underweight because the technical definition of underweight is a BMI of less than 18.5 which is extremely rare. We have looked at it in our big (Australian) studies and once you hit 40 there is virtually nobody who is that slim unless they are very, very ill.

In late life, being overweight doesn’t seem to increase the risk of dementia. We don’t understand why. There is something called the obesity paradox. Once you are in your 70s and 80s, being overweight doesn’t seem to carry the same risk as it does for when you are younger. So if you are overweight at my age, it increases the risk of dementia when you are older. But if you are overweight when you are older, it doesn’t seem to carry as much risk – and we still don’t know why.

Protective factors: the best thing that you can do is be physically active. In the past we thought that, when your brain finished developing say in your early 20s, that was it and you had a fixed number of brain cells.

I was taught that there is a lot of research showing education is protective. I am really all for lifelong learning but particularly keeping kids in school. The biggest thing we could do to reduce international rates of dementia would be to increase the level of education in developing countries.

I thought I would show you this picture quickly because I think many of you may have heard people say things like, ‘Healthy heart, healthy brain.’ Alzheimer’s Australia in all of their public awareness campaigns – that I have contributed to quite a lot - talk about the link between cardiovascular risk factors and brain health. If you look after your heart, you look after your brain. People go ‘Yeah, that’s right. I agree with that.’ But I think if you look at this picture you understand why. The brain is actually full of blood vessels. So if you look after the vascular health in your body, you are looking after your brain. So this picture basically says it all..

Some of the intervention work that we have done - we have just finished a randomised control trial of online risk reduction for Alzheimer’s disease, trying to find a low cost way of getting people to change their behaviour to reduce their risk, and this is in middle aged adults in their 50s.

We have all different components in the trial. We look at nutrition, social engagement, depression. (inaudible) It’s three or four servings of fish per week which is protective. For stroke it’s even less. It’s one or two servings of fish a week that will reduce your risk of stroke quite significantly. It’s very easy to increase your fish intake.

Evidence around what people can do to optimise their brain and cognition not just in old age but through adulthood.

I have nearly finished but I wanted to tell you a bit about public policy. As I said, there is no point just doing research and having it sit in academic journals. What I have tried to do with the research is get it out there, go and talk to people, advise, be in advisory roles. We do a lot of advisory work for Alzheimer’s Australia. I have been the chair of the medical and scientific panel. I am now on the board of directors of Alzheimer’s Australia and advise on their public awareness campaign. I have been on the Ministerial Advisory Council on Ageing in the ACT here and advising on the Older Persons Assembly that we are having this year. There are other roles that someone in my situation can take. You are often invited to contribute or to advise on committees and panels.

I have advised the Human Rights Commissioner about older drivers trying to provide some evidence about what we actually know from science. It’s a very emotive area and these people need to know what the science says. I have also advised the NRMA and their policies on older drivers.

Dementia is a huge problem. We are looking at trying to prevent or delay dementia. We can save an enormous amount of suffering and also a lot of money by even delaying dementia for five years to optimise how well people function over their adult life course so that reduces the decline. What we talk about is cognitive capital. So in this room if we looked at the cognitive capacities of everybody here, we could call that our cognitive capital that we have, and in ageing we are losing that cognitive capital. William Utermohlen had artistic capital that he lost through Alzheimer’s disease.

What we want to do as an ageing population is retain as much of that capital, of those skills and abilities, that older adults have or that all of us have as we age. That’s a much more positive way of looking at it. We want to prevent dementia on the one hand, but we also want to increase or grow our cognitive capital and maintain that as long as possible. What we want to do, and this is my Research Centre at the ANU, is find ways that people can age well in whatever circumstance you find yourself in. If you have dementia, how can you age as well as possible? If you have a disability, how can we discover through science how people can age as well as possible? And that’s all. Thank you. [applause]

MONICA LINDEMANN: Thank you very much, Kaarin, for a wonderful presentation. It was lovely to have your personal story woven in with such interesting, practical information. We do have some time for questions.

QUESTION: Thank you for an excellent talk. With dementia patients, there is clearly a lot of confusion and different ways that the patients react, but some are quite volatile and can be aggressive, whereas others seem to be very calm and accepting. Is there research into why different people react in different ways?

KAARIN ANSTEY: Yes. With dementia it depends which part of the brain is affected by pathology. Some can affect your personality. There is a lot of distress and problems with communicating. Often we find someone with dementia is actually in pain and what’s seen as difficult behaviour is actually the fact the person either has a broken bone or some sort of other health problem. There is a lot of research into that area - we call them behavioural and psychological problems, BPSDs. So, yes, there is a lot of concern and work in that field.

QUESTION: Your drivers with dementia, are you saying that people can drive for longer with dementia?

KAARIN ANSTEY: Good question. I do a lot of research into normal ageing and driving, so we are trying to optimise how well normal aged people can drive. With dementia, everybody with dementia will have to give up driving. Depending on the type of dementia, in the early stages a lot of people can still drive, but there will be a time when they will have to give up driving. In the early stages of dementia, people can actually be quite well a lot of the time and often in the late afternoon they get very tired and their concentration is affected then.

QUESTION: I am just wondering when you are going to write a book about ageing. There are so many books written about ‘here is your baby, this is what you do’ or ‘you are expecting a baby, this is what you do’. The child is growing up, there’s the teenager and all this sort of stuff. But when you get to 60 you go to the doctor and say, ‘Look, there is something strange happening to me here.’ ‘Oh yes, well that’s to be expected, you are getting old.’ And now at 85 I have had 25 years of this. I am finding it very difficult to really understand what’s going on with my body and my mind. I thank you very much for explaining about Alzheimer’s and I certainly will switch on to that page on the net. I am also wondering if you are associated with what’s going on with the Aspree program at Monash.

KAARIN ANSTEY: I am very much aware of Aspree but I am not involved in the Aspree project. As for writing a book, I have thought of writing a book. I just need to find six months in my schedule to do it. I have a collaborator in Denmark who would quite like to do that, but it’s the time to do it that’s the problem. I agree. I think it would be very useful.

QUESTION: This may not be quite the subject of your talk, but what is it that generally kills people with Alzheimer’s?

KAARIN ANSTEY: That kills them - probably like most things it ends up being a complication of the disease. There are problems with feeding and swallowing, just general bodily breakdown, the flu, heart disease.

QUESTION: Thank you very much for a great talk. My mother had Alzheimer’s and my father had Parkinson’s, and I found the process of being with them in the last years of their lives not just painful, often wonderful, but also fascinating. It was absolutely fascinating to see the processes that they went through and that they were not giving up at all right at the end. The day before my father died, when the rest of us were on our stumps, he was saying ‘I am not ready to give up yet.’ The question I wanted to ask you is: Is Australia worse at ageism than other countries? My perception is that we are a profoundly ageist culture and that other countries are aware that in age we have wisdom, experience, all sorts of wonderful things that younger people have too, but here ageism is barely even mentioned as an issue.

KAARIN ANSTEY: Yes, we are incredibly ageist. But a lot of countries are very ageist. There are countries that are less ageist than us. They even have different language, different words for older people, and older people are valued for their wisdom and knowledge. Yes, I think it’s a real problem. I know that the Human Rights Commissioner is very aware of it too. There is a growing awareness of ageism. The fact that we have an age discrimination commissioner in Australia is a big development here. I agree - I think we are an incredibly ageist country. We are not the most ageist but we are up there, I would say, with idolising youth and undervaluing what older people have to offer. But also I think there is a fear of ageing. What you said about dementia and the fact that you found it fascinating, we have a fear of illness, disability, death and disease - all of those things. We are very removed from it in our culture. If you spend time with someone with a neuro-degenerative disease or who is very ill and interact a lot with them, that all disappears. They are just a person. All those stereotypes and assumptions that their life is worse less than anybody else’s just go.

QUESTION: My question is about dementia and social isolation. I looked at a website the other day from the ABS on the demographics in Australia and something like 25 per cent of houses are a one person, so it seems like it’s on the rise. Are there any creative moves afoot here or around the world looking at more social ways of looking after people with dementia? I am thinking of housing and care, because sometimes the prospect of a nursing home doesn’t look all that great. I have read about countries like Holland for example that are looking at more group housing.

KAARIN ANSTEY: This isn’t my area of expertise, but there definitely are some wonderful innovations in housing for people with dementia in Europe. I agree that the way we have designed our buildings, the built environment, is very isolating in Australia. We don’t think in terms of community living. It is always just your family that you live with, not with other people. That’s going to become an increasing problem with an ageing population, and for people with dementia here. But I think there are some forward thinkers. There are architects that specialise in this area. There have been innovations internationally. When there are new developments and new suburbs, it’s really about getting in at the town planning stage. Again, it’s a bit like ageism, a lot of this is changing our thinking about what is possible and what is acceptable in terms of housing and living situations for people.

QUESTION: I want to follow up on the ageism question because I think we need to be very clear about whether we are looking at ageism or sexism. I am particularly thinking of doctors - medicos, GPs and all sorts of specialists – who are among the worst offenders. For them I think it’s more often sexism than ageism. I come in and out of a doctor’s surgery and I think would they do that to a man? No. I have been dyeing my hair silver for a bit over ten years now so I have been thinking about this for about 10 or 15 years. I am very keen to know if you have any plans or program already in place for getting the message across to medicos.

KAARIN ANSTEY: Unfortunately no, I don’t have any specific programs to address sexism or ageism. I deal with both myself. I think sexism is just as bad as ageism. I think we were chatting about this before the session this morning saying how little has changed for women. Professionally I often end up being the only woman on a committee or a board or whatever. I guess for older women you have both sexism and ageism together. Older men have their own issues as well so I think you have to be careful there.

I guess it’s about tolerance. Again, I think these need to be addressed at a public policy level and by public figures, people that have influence in trying to set up a different expectation and different stereotypes. It is not something that is a quick fix. They are issues we have been grappling with forever. Once you start talking about women’s issues, people perceive there is all this change and then often if you start looking at the statistics, actually they haven’t changed as much as we think they have.

QUESTION: Kaarin, first of all, I picked up a book called *101 ways to prevent Alzheimer’s* and a friend asked me if I could remember where I put it. As one at the moment in retirement in my 70s, I am public officer for the Tuggeranong Community Council covering also community and health and as an ex-nurse etc and setting up and running care for the aged, etc. I have been very interested in the UK team that looked at first of all octogenarians in Georgia and then Japan and then of course the little island in Greece where they discovered there were even more and they went to look at why. The team were quite exhausted because they couldn’t keep up to them actually. They are very interesting. That was very good to look at. Also the work of Phillip Day, who is a UK medical journalist and researcher working with Nobel Peace prizers, PhD students, and he states, ‘The first thing you do when you wake up in the morning is to have a very large glass of water, because the brain actually drains water through the night,’ and it gets it straight back to your brain. And some ordinary types of food, and particularly the hearts of celery and sage are marvellous for memory. So you don’t have to look at pharmaceutical drugs, there is a lot out there that let food be your medicine. That’s the sort of thing that I take up with our Tuggeranong community, and of course there are 17 suburbs with some 98,000 people. It’s very interesting to look at alternatives. Thank you very much. You are doing some wonderful work.

KAARIN ANSTEY: Thank you.

MONICA LINDEMANN: Thank you once again, Kaarin. That was a wonderful presentation. Firstly, thank Kaarin and thank yourselves for ticking off your engagement and your cognitive activities for this week. Morning tea is ready in the lounge, I believe, so please let’s make our way there.

Date published: 2 June 2014