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Introduction by Jane Miller, Senior Director Alumni & Engagement, UNSW Sydney

Good afternoon ladies and gentlemen, and thank you for joining at this month's Learn@Lunch. Our bite sided lecture series with UNSW's leading academics. In this 70th anniversary year for the university. We are more committed than ever to bringing to our alumni and friends opportunities for lifelong learning. And it's great to see so many of you here today to hear from Professor Brodaty on this terribly important topic. I'd also like to thank particularly those in attendance from our Scientia Circle group. This programme, the supporters of this programme enable UNSW to advance knowledge through research and education by giving in their will. Just a couple of pieces of housekeeping, and then I'm going to introduce a very special guest who will be today's host.

In terms of housekeeping, just to let you know that today's session will be recorded and will be available as a podcast on the UNSW alumni website. Please turn your phones to silent. And if you need the bathrooms, they're out of this door to the right, and there are staff outside to help you. Now without further ado, I want to introduce you to our special guest host for today. This person was awarded an honorary doctorate in medicine from our university last year. She is passionate about the field of health and aged care and has been a very close supporter of Henry's work, and that's why she's here today. Please join me in welcoming Dr Ita Buttrose.

1.54 Dr Ita Buttrose AO OBE

Thank you very much Jane. And good afternoon everybody. I'm pleased to welcome you here, and thank you for joining us at this month's learning at lunch programme. And it's great to see such a huge crowd of people here, because I know you're going to have a very interesting time listening to Henry. I would like to acknowledge the Gadigal people of Eora Nation, the traditional custodians of the land. I pay my respect to their elders past and present. Now to our speaker. Professor Henry Brodaty is a Scientia professor of ageing and mental health and co-director of the Centre for Healthy Brain Ageing at UNSW. His research focuses on diagnosis, treatment, and prognosis of depression in later life. Including depression as a risk factor for Alzheimer's disease and a complication of dementia. His research aims to improve diagnosis, prevention, and treatment, and to benefit older people and their families.

Henry was the brains behind the Alzheimer's Association, Alzheimer's Australia which he started in 1982 at the Teacher's Federation in Sussex Street. And he went onto great things, he was the ideas man before behind dementia ... It's called Dementia Australia now, it used to be called Alzheimer's Australia. Behind the Dementia Australia Research Foundation. And he keeps involving me in his work, I never know where I'm going if Henry rings. But I'm very pleased to be the patron of his Maintain Your Brain programme, which you're going to hear about this afternoon. I think it's a really fascinating study, and one which will be of enormous benefit to everyone who works in the brain health area. I'm very proud to know Henry Brodaty, and to work with him on all these initiatives that we get involved in both past and present. Here's what I call a one only, a very special man who has made a difference. And who has dedicated a lifetime of leadership, clinical excellence and research to improve the quality of life for people living with dementia. Would you please welcome Scientia Professor Henry Brodaty.

4.17 Learn@Lunch presentation from Scientia Professor Henry Brodaty

Thank you, Ita. And you never know when I got to ring you what I going to ask you about for projects past and present, you didn't say future. I'm just warning you. Thanks for the introduction, and I'm thrilled to see such a huge crowd here. Very, very strong support, very strong interest. I guess some of you might be worried about your memory. Anyone? Okay. I was going to tell you a joke about memory, but I can't remember them. I thought I'd show you some cartoons first. This one says, hold on, I've got a suppository in my ear, where the hell is my hearing aid? And this one says, now am I going upstairs or have I just come down? Well see these, when people make a lot of jokes about things it's because they're worried about it. And that's one way we deal with things we worry about by using humour. A lot of people have had dementia, and you'll recognise all these people here, although my medical students don't.

And they all had dementia. I think Margaret Thatcher had vascular dementia, and Reagan was the first person to come out and talk about his Alzheimer's disease publicly. And that's his wife talking about the fact that she's really been his support. And as we know, dementia is not just one person's illness, it's a whole family and it's society too. And in Australia we've had our people with dementia who've gone public and talked about it. And you can see Hazel Hawke and Jeannie Little and Don Lane. And P.J. Lane, his son, is one of our ambassadors for the Centre for Healthy Brain Ageing or CHeBA. Can I just check, the back, can you hear me clearly, and see the slides clearly? Perfect. Let me just orientate you to this slide. This is age from zero to 100. These are girls, women, these are boys, men. Here are the numbers of children aged zero to 10, 10 to 20, right up to 100. The yellow bar is 65. This is where we were in 1971 when our population was 13 million.

Now, keep that image in mind and let's go by the decades, 1980, 1990, 2000, 2010, 2020, that's where we are now approximately, 2030, 2040, 2050. We've gone from the pyramid shape to a coffin shape of our population pyramid. Okay. We are an ageing society. There are a lot more people up here than children down here. We'll have two older people for every child. Back in 1970, it was two children for every older person. Our society is changing, and with change, with ageing, comes change in age related diseases.

This is the proportion of people with dementia, about 1% between 60 and 64, it doubles every five years. By the time we reach 100 there's about 50% of people who will have dementia. And as Ita said it's what people fear most. We do a survey of people aged over 65, what do they worry about most, is it climate change, is it the economy, is it who's going to win the election? No, it's about their health. And what do they worry most about the health? Their brains. It used to be cancer, now it's their brains. And that's why we got so many people here today. This is the brain at autopsy of a normal person, it weighs about 1.3 kilograms. As Woody Allen said, he said it was his second favourite organ. Well, it's my favourite organ. It's 1.3 kilograms of fat and protein sitting up there doing a lot of work. Use the 20% of our oxygen, 20% of our blood, it's an amazing piece of architecture of organisation. But in Alzheimer's disease at death, like a shrunken walnut, half the size of the brain of a person without dementia.

I'm going to talk about the secret to healthy brain ageing or how we can prevent dementia. I just want to clarify some terminology. What do I mean by dementia? Dementia is an umbrella term that encompasses over 100 different diseases, the most common form of which is Alzheimer's disease. Alzheimer's is a type of dementia, it's a different pathology in the brain. As we get older, the type of pathology in the brain that causes dementia becomes less distinct. It's not likely just to be Alzheimer's or just to be strokes, it's much more likely to be a mixture, of mixed dementia. Alzheimer's is the most common, vascular dementia, the second most common, and then there are many, many others. Sometimes I'll be talking about prevention of dementia because that's what the research has been looking at, and sometimes I'll be talking about prevention of Alzheimer's disease. Can we eliminate dementia or even Alzheimer's like we have smallpox from the planet? The answer is no. There are studies trying to develop antibodies to prevent Alzheimer's disease so far without success. But we can't prevent it, but maybe we can delay it. And even delaying it by a couple of years because it's largely a disease of late life, would reduce the numbers of people by 20%.

And if we could delay it by five years, it would half the rate of dementia, because it's a disease of late life. Ideally you want to delay it much and much later. A life course approach is a good way of thinking about prevention. And it may be the most effective preventions can happen really right at the beginning of life, perhaps even in utero. Of course the NHMRC only gives grants for five years, and we can't do a study to wait from birth right through to the end. We rely on population statistics, observational studies. And these things have been associated with decreased cognitive reserve. Let me move over this side. Less foetal development or maldevelopment. Smaller babies for gestational age, now that's how many weeks they are. Poor education, poor socioeconomic circumstances, poor nutrition, poor dietary history, and it's interesting, when loss of a parent before 11, I'm not sure how strong that is. But the important point is, this may be where we can do quite a lot, particularly in the education and nutrition area.

Because over two thirds of the world's population with dementia will pretty well soon be in developing countries. Half in just China and India alone. In Australia, Aboriginal population have up to five times the rate of dementia than the non-Indigenous population, and it comes out at an earlier age. And it's mainly Alzheimer's, and it may be these are the factors, nutrition, education, or early childhood, which make a difference. But here we are all adults. Some of us have been adults for quite a while, and it's too late for looking at those early childhood things. What can we do now? And there are five elements, looking after our heart, being physically active, being mentally active, healthy eating well, and being socially active. And I got to come through the information about that, the evidence for these. Let me start with the heart. We know that people who have a high blood pressure in midlife have more dementia in late life.

And some, but not all studies show, by treating blood pressure, we actually reduce the amount of cognitive decline. Cognition, by the way, is our thinking abilities such as memory, language, organisation. Cognitive is the adjective from that, and so sometimes I'll be using that term. Each year of treatment makes a difference. Once we're getting past the age of 75 or 82, vigorous treatment of blood pressure can be dangerous. We need to take that into consideration. In this study, the number of vascular risk factors increase the risk. What we have is the odds ratio, anything above one increases the odds.

If there's no risk factors, that's the baseline. But we see it goes up one and a half times, two and a half times, three and a half times, the more risk factors. The risk factors are listed there. A trial came out this year which said, how vigorously should we treat blood pressure? We've been taught that 140 or 90 is the maximum, and we should treat it at that level. And what these investigators did, they took over 9,000 people with high blood pressure and randomised them to two groups. Usual blood pressure treatment or more intensive treatment, having an aim of 120 rather than 140 as the maximum systolic.

And they found that the people who are at the more intensive group had over four years, had less cognitive impairment and less changes in the MRI brain scans indicative of vascular damage. It's important we all get our blood pressure checked, and if it's high, treat it. It's good for our heart, it's good for our brains. There's been quite a controversy about statins, such as I'd imagined more than half this audience will take a statin to control cholesterol or lipids. Hands up who takes a statin. Yeah. Yeah. Okay. And it might vary by sex and race, but it doesn't look like it's a risk or a protection. On the other hand, physical activity, this was a pot-bellied GP in Perth who decided that he wanted to get into physical activity. And that's his picture, and he's still doing it. Yeah. And it seems it does protect, it protects against the brain getting damaged. And the more the better. I don't want to give in the way of the picture. Getting puffed, getting sweaty, it's good.

A recommendation at least half an hour a day, five days a week. It says three days, but five days. Okay. At least 150 minutes a week. People say even an hour a day would be better than half an hour a day. Of course there're some people who have contraindications that you do need to take care. It decreases the rate of cognitive decline, decreases incident dementia, and most randomised controlled trials are showing not only fitness improves, but cognition improves. We can measure things like the size of various parts of the brain showing that improves. We can do experiments with mice, we can put them in cages. The mice can be in a cage where they've got nothing to do. And they can be in a cage where they have running wheels and various activities, which give them exercise. Then we can look at the mouse brains when they're sacrificed, and show a difference. We can even genetically, we not they can, genetically engineer mice to make Alzheimer's in their brains. And the Alzheimer engineered mice who didn't exercise have more pathology in their brain than the mice who did exercise.

The mice brains also have more of the good chemicals in the brain that make nerve cells grow, less inflammation in the brain, more nerve cells, new nerve cells. Is it too late? Never. Never too late to start, never too early, never too late. Do it gradually, and gradually increase it. What sort of exercise? Is not clear. But some research that we've been involved with at CHeBA is, resistance training seems to have some extra benefit. I know Ita is a recent convert to going to a gym and pushing weights and pulling pulleys, and it does show a difference. It's best to do different sorts of exercise, or maybe even better to combine physical, social, and mental exercises. Dancing is one such example. In this study they took a group of people over 70 who did not exercise and randomised them into two groups. Before the exercise, they looked at the MRI brain scans and the size of the hippocampus. The hippocampus is a small area here, and Professor Phil Waite is in the audience, a neuroanatomist, and she will know it very well.

And it's shown here in this yellow there. And people who have the exercise we see the size of the hippocampus on the left and the right increasing every year, and when the second MRI was taken. And the people who didn't exercise had the usual slow rate of shrinkage of the brain, which we all have. It's not just the brain, it's really important, it's not just the brain. Improves physical health, heart, improves our blood pressure, diabetes, the risk for diabetes or if you have diabetes, improves some types of cancer, or recurrence of cancer. Pardon me. And improves our bones and our muscles. It reduces mortality and morbidity, improves mental health, confidence, quality of life, it's just fantastic. Now I don't care who you are, you can't outsource this. You've got to do it. You can't take it as a pill, you've just got to do it. What about our brains? Mental exercise, the brain exercises, we are very big on this in CHeBA.

And we're working with University we've doing a number of studies. In a review of 20 randomised controlled trials, 70 showed improvements in memory. If you go to our CHeBA website, by the way, all these slides will be available. Memory improved in four out of six. What's unclear is does this continue? Does it generalise to our functional activities? And there is some evidence that it does. For people with normal, healthy older people, or for people with mild cognitive impairment, not dementia, but some memory problems or other cognitive problems. But with dementia it may be too late, unable to show benefits there. It's very good you're here at Learn@Lunch, because you're learning, you're getting brain food, but you're not getting lunch, which will be good for this waistline. Now, there's quite a lot of evidence that midlife obesity, but not late life. If you get to 75 with obesity, don't worry.

But before that, your basal metabolic index or BMI is a ratio of your weight over your height squared in metres. And 25 to 30 is overweight, and over 30 is obese, and over 35 is very obese. And you can see that the risk increases dramatically in people who are obese. But there is this late life paradox. Well, you may go and have some lunch afterwards. What should you eat? Can you eat your way to brain health? And most of the evidence comes from the Mediterranean diet, which is abundant plant foods. You can read that, and you can see it. But the important point is ... Pardon me. That your total fat should be less than a third of your calories, and saturated fats less than 8%. And the Mediterranean diet has been shown as a pyramid. And here we have a whole lot of fruit, vegetables, grains, lesser amounts of fish and seafood at least twice a week, lesser amounts of poultry, eggs, cheese, and yoghourt, and meats and sweets, just a little bit at the top.

It doesn't have to be the Mediterranean diet. You can do the equivalent diet in the eastern diet. I've just been to China and we talked about what the diet is there. And it's very interesting looking at centenarians. And there's been a study from the National Geographic, which looked at these blue zones where there's a high concentration of centenarians. And you can see these zones, which have been ... And why were they called blue zones? It's very curious. We had the guy who invented the term John Michel, and he said, well, he took a map, he had a blue pencil. He drew those areas where there were a lot of people who are centenarians, and then became now the blue zones. In Okinawa, which is one of those blue zone, they have a high concentration of centenarians and as you'd expect more women. And all of the centenarians, a third are functioning independently. And these are the factors that might influence their longevity. Diet, genetics, of course, and physical activity.

And their diet is, vegetables, tofu, miso soup, a little fish or meat, and this confusion inspired adage, Hara Hachi Bu, until your stomach is 80% full. I find it very hard actually to know when my ... I know when it's 100% full, but it's hard to know where to pull back. Yeah. What about just taking supplements. The supplement market, the whole complimentary medicine market is worth billions of dollars a year in Australia. People love taking vitamins, and most of it ends up in the sea, but it doesn't stop people. The evidence is pretty slim that they make any difference. While fish has been associated with better brain health, taking omega-3 supplements has not. Low vitamin D has been associated with poor cognition, but taking vitamin D has never been shown to be in improving. Caffeine, there've been a couple of very small studies saying it's good for your brain, which is nice to hear. Vitamin E, there was some evidence, and then other studies have negated that, and no evidence of Vitamin C. The general rule, is better if we eat the stuff than take it as a pill.

The Oxford Group, the OPTIMA group had been looking at experiments where taking high doses of folic acid or folate, vitamin B12 and vitamin B6, or pyridoxine. And have shown less brain shrinkage, better cognition, and particularly in people who have a high level of homocysteine. Homocysteine is an amino acid we all have in our blood, people sometimes think of it as the new cholesterol. And if you have a high homocysteine, we recommend you take this diet. But other people have not had positive results with use of the medication, use of these supplements. I've mentioned vitamin D, probably 50% of the Australian older population are D deficient. In nursing homes it's over 90%. But we don't have data that taking Vitamin D actually improves it. There was some evidence of anti-inflammatories, but the evidence is mixed, and it's not recommended. And curcumin which is in curry, there is some evidence, but it's not strong. There's good evidence that current smoking is a risk factor for Alzheimer's disease. Kaarin Anstey summarised this evidence, she's at the UNSW as well, it increases the risk for Alzheimer's.

The good news for the few of you who still smoke is if you stopped smoke that risk will drop suddenly, pretty quickly. Alcohol, we got pretty excited some time ago because we were told that small to moderate amounts of alcohol was actually good for our brain. And people got very excited, and there's this j shaped curve. Being abstinent had a high rate of dementia than people who are teetotal ... Sorry had a lower rate than people who are teetotal, and people who ... But this research again is very weak. It's not recommended you take up alcohol, but if you do drink alcohol in moderation, that's probably okay for your brain. Everyone agrees that heavy alcohol is bad for the brain, there's no question about that. Which alcohol? Perhaps the red wine has theoretical reasons for being better it has a lot of antioxidants and polyphenols. But there's not really been good data about that. What's been distressing lately is the association between alcohol and cancer. What might be good for your brain may not be so good for the rest of your body.

Here's a summary of natural therapies. And most of them have not shown any benefit, either too large stalls of ginkgo, studies of ginkgo, no benefit. Turmeric and curcumin, maybe. One study in men looking at this as a treatment for prostate cancer, also looked at cognition, found no benefit for vitamin E and selenium. The other stuff, I go into the chemist and there I see on the counter brain food or something like that, you can buy it, it's like $10 a packet. But what's in it? It's this brahmi, or one of these other compounds. Maybe it helps, who knows? There's no evidence to say that it does help. If you want to invest in that, that's your business. It doesn't do any harm as far as I know.

There're also very vigorous claims on the internet, things like taking coconut oil or not eating grains, grain brain, or eating a ketogenic diet. There are doctors now who've done the course and charge quite a lot of money to get on this special diet to actually improve your brain. Who knows? There's no evidence. There are some things that are promising. David Sinclair, who's at Harvard and at UNSW has personally who found resveratrol, discovered that it acts on the brain to stop ... Effects on the body to try and stop ageing, it works well in mice. And there are newer compounds that he's developing. We wait and see.

Now here is a surprise, there was a large review that came out towards the end of 2017, and reviewed all the studies to do with this. And one of the things I discovered, and they report it and people now taking interest, is on hearing loss. Three studies found the relative risk was increased by 55%, 167%, or 132% for people with hearing loss. Why? The mechanisms I don't understand yet. And people are now doing studies to see whether wearing hearing aids makes a difference. These were pretty long follow-ups, up to 17 years. This is an area of quite intense activity since that came out. Why are they particularly interested in social isolation? Clearly no one here is socially isolated. But social isolation has been linked to poorer cognition and more dementia. We had an honours student two years ago, Ross Penninkilampi, this is the summary of his findings. That people who had less frequent social contact, less social participation, more feelings of loneliness, had an increased risk of dementia.

He reviewed the world literature on this, and it was about a 57% increase in risk. And good social engagement reduced the risk by 22%. HRT. The early epidemiological study suggested women who took hormone replacement therapy, got some protection. And then the women's health initiative study came out showing that hormone replacement therapy for women aged 65 increased the risk of dementia. In fact, this lot is very confusing, we get these stories in the media every month. Something is a risk factor or a protective factor or there's a breakthrough. It's very hard to evaluate until you drill down and look at the actual science. And the conclusion now, looking at women who take HRT at menopause, not at 65 that it's not harmful. In women who've had their ovaries out say in their 30s or 40s and take HRT, it may be beneficial. But taking HRT at 65 there may be an issue. It may be a more nuanced approach to HRT.

Sleep, they say sleep is good for the brain, they're right. Now about one in two older people has insomnia. About one in two older people have sleep disordered breathing like sleep apnea. We know that when we go into slow wave sleep, it clears some of the toxic protein called amyloid beta protein that builds up in the brain. We know that when people have sleep disordered breathing, particularly sleep apnea, their cognition is worse. They fall asleep during the day, and I'm pleased to see, I can't see anybody asleep here today, it's good. Okay. What we don't know is whether correcting insomnia or sleep disorder breathing prevents or delays the cognitive impairment associated with it. And what are the complications of the epidemiological research that we do, is we don't know what comes first. Because Alzheimer's disease is a build-up of a toxic protein in the brain over 20 or 30 years. And we know that from studies with people who get the genetically autosomal dominant inherited form, which is rare, it's about 1% of all Alzheimer's. And they going to get the dementia, their Alzheimer's disease, about the same time as their parent.

They've got a one in two chance. And they already start seeing changes in their brain, which we can see by imaging 20 years before they're going to get the clinical symptoms. Putting all this together, and there's another effect to this too, I haven't got time to go into. But 30%, about a third of what's called the population attributable risk of Alzheimer's disease, the most common form of dementia can be accounted for, by seven and ... Sorry, seven environmental factors. And if we could reduce these by just 25% there'd be 3 million fewer cases in the world. And the environmental factors differ to which part of the world. In the countries like Australia, US, Europe, it's physical inactivity, in developing countries it's low education. These are the seven factors, and these are the percentages that they respectively contribute, and some of them overlap such as obesity, diabetes, and physical inactivity of course. And the ones in red are for USA or Europe and Australia and UK. The one in blue, the cognition with the hash sign is for developing countries where there's low and maybe for some of the aboriginal population.

Some good news. Yeah. Some good news. Maybe the rate of new cases of dementia is dropping. Yes, it's dropping, the rate not the numbers, I'll explain the difference. And there are studies now from many countries, Scandinavia, UK, Spain, US, almost all showing this trend. And it may be that living conditions have changed, people are getting more education, better nutrition, better healthcare, getting their blood pressure treated. And that's what's hypothesised is causing this drop in rate of new cases. But the numbers of cases are going up. What's happening is the ageing of the population is trumping the reduction in the rate of new cases. We have something like 430 or 40,000 people in Australia in dementia now, and that's set to reach a million people within 40 years. Now people often question these findings, how reliable are they? Because they're observational. We can't do a randomised control trial, say I want everyone on this side of the room for the next 10 years to eat diet A and everyone here eat died B, we just can't do that.

We have to actually do observational studies, either looking backwards or looking forward. There are some intervention studies, but they're generally looking at one thing like exercise or brain training using computer cognitive programmes. The question is, can intervention studies prove that adopting these recommendations make a difference? And this is the last part of the talk. Here are some of the studies that have been done or are being done now. The most famous is the first one, it's called the FINGER study. And it was named after the Finnish Geriatric Initiative to Prevent Cognitive Impairment. And it had five elements as you can see, diet, cognitive training, exercise, particularly progressive muscular resistance training. This is the weights and pulleys, and aerobic. Managing metabolic, like high sugar and high cholesterol, and vascular risk factors like blood pressure. And they brought people in groups together and so there was socialisation as well.

And what they found the two years we're benefits on a composite neuropsychological battery. An hour or two hours of testing, and they've got composite school and they were better. And looking at individual scores, executive function, planning organisation was better, speed of information processing was better. And complex memory, but not just all memory, was better as well. The five year analysis is underway now. They've found benefits for health, number of hospitalizations, et cetera in the people who are in the intervention versus the control.

This is another study focusing mainly on vascular factors. The nurses led this, looking after blood pressure, heart problems, and got some benefit in people who hadn't been treated before. The problem in this randomised controlled trial is the control treatment was so good they couldn't show a difference. Thank you. We’re interested in internet based interventions, because there are a lot of advantages. You can do it in your own home. We can reach the whole population. We could reach people in Aubrey, we can reach people in every part of Australia in, rural and remote areas. We can reach people who are housebound. It's scalable, it's relatively cheap, but it's not free. And there are two main trials I'm going to tell you about, or but this one very briefly from the Netherlands led by Richard Edo. And I'll tell you about that.

There were some disadvantages in our trial. We budgeted to build a platform to do this study for six months. It took us two years and three times the budget that we had budgeted for, it's very complicated. You could need a headquarters to run it and monitor it. Not everyone, but increasingly almost everyone is computer savvy, and the older old are the fastest growing sector of this area. And we don't yet have proof that they work. In the Netherlands study, HATICE, which was actually several countries in Europe, they developed an innovative interactive internet programme, mainly focusing on vascular components. The results are not yet out, they have been submitted, and I know but I'm not allowed to say just yet. But we think ours will be better, and this is Maintain Your Brain. And this is one of the tasks that I asked Ita to help with, and she's our patron for Maintain Your Brain. We have videos of people of Ita actually infusing our participants to be part of this study. What's the study?

It's four main modules, physical activity, diet and nutrition, brain training, and for people with depression or a history of depression, depression treatment. Everything is delivered online, everything. And people do lessons or modules. And the physical activity, there's three streams, there's balanced training, aerobic exercise, and strength training. And depending on the individual profile, the package is designed for them. And they do a module every quarter, 10 weeks of whatever modules they're eligible for. They can be eligible for up to four modules. 10 weeks of the module, then they have two weeks of doing assessments and a rest, and then they had the next module. And it's set to finish our first year, most of them will finish in July this year, some will finish in October. Here's the nutrition mainly based on the Mediterranean diet. And as they get programmes every week they get diet advice, they get new recipes, and it's they're coached on the Mediterranean diet week by week. And they fill in this pyramid as they achieve more and more.

Brain training is done on the computer, there're 30 exercises they do over a 10 weeks. And peace of mind is for depression anxiety, and that's a well-run programme out of St Vincent's Hospital. People have been randomised into two groups, get coaching where they get this very individualised coaching, or to get information based on their risk profile. But it's static, it's not a coaching thing, that's the control group. We contacted over 100,000 people from the 45 and up study, and 12,000 responded. And by the time we looked at eligibility and people had to complete various things online, we have randomised 6,200 people into the study. And the first year we'll finish in October, and after the first year people get monthly boosters of their modules for the next two years. And we hope to show at the end of three years less cognitive decline in the intervention group versus the information group.

We're going to try and get some more funding because we want to follow people up for eight years. Because we think we really show dementia difference in eight years. But if we can show ... If we had some more funding now, we could actually start looking at genetic markers because people are now talking about precision medicine. The link between our genetics and what might work best for us. I'm not mentioning drug studies, there are a number of drug studies, but in the last three months, two huge studies have failed. One using an antibody against the amyloid beta protein, it was Aducanumab, which was released with great fanfare two years ago. Nature published a study article on this. And the other one from Merck, which this week came out in The Lancet showing, not only it didn't work, but the placebo was better than the drug.

Now they ... I estimate, very back of the envelope, they spent over a billion dollars with a b on this study. Yeah. The policy implications, and here I'm finishing, Australia and the world is ageing. 30 years have failed to find a cure. How are we going to cope with the people now and the people in 40 years? We're already spending over $14 billion on dementia in Australia, and that's 1% of GDP and that's going to double in a generation. Prevention and delay, I think is our best bet right now. Can we prevent Alzheimer's? No. Can we delay it? Yes. And I've told you these figures. We want to delay it just about by a few years. We want to delay it till after we die, that's our aim. Audience, you can be the change, you can do all this.

You can do physical activity, you can manage your diet, you can manage your blood pressure. We're working with health services because we need to make this part of primary healthcare. The GPs take this on board, the governments take it on board and make it a general population policy. It's government's public responsibility, it's primary care responsibility, it's our responsibility. Here's a plug for CHeBA, invest in change, and help advance CHeBA's large scale, big data research. And you can do that by joining the dementia momentum, or going to CHeBA@UNSW, and if you Google that, you'll find us, and you'll find a copy of the talk. Thanks very much.

46.05 Q&A with audience

Dr Ita Buttrose:          Now we do have time for about 10 minutes of questions. If you'd like to ask, perhaps stand up and produce your voice. Here is a microphone, it's okay.

Speaker 4:                Hi. You mentioned about the association possible with hearing but undetermined the actual link, what about loss of smell?

Henry Brodaty:        That's been well known for a lot ... You're still on. That's been well known for ages, that people who have loss of smell have a higher rate of Alzheimer's disease. And our sense of smell is ... You saw the picture of the hippocampus, that little yellow part, is very close to that area in the brain. And our nose has nerve cells that come from the brain. It's the only place in the body where we have actually brain nerve cells exposed to the environment. People lose their sense of smell for many, many reasons, it increases the risk. Does it mean everyone who loses their sense of smell is going to get dementia? Absolutely not. Not everyone has diabetes, or not everyone has high blood pressure. These are risk factors, not causative factors. Yeah.

Ita Buttrose:             And another question? Yes.

Speaker 5:               Thank you for the insightful talk. You mentioned-

Henry Brodaty:         I like insightful. Thank you.

Ita Buttrose:              Speak ... Hold the microphone right up close to your mouth.

Speaker 5:                Is that better? Okay.

Ita Buttrose:              Yeah.

Speaker 5:                Great. You mentioned physical activity and that would have an impact on cellular metabolism rights and of course diet would play into that as well. There's a group of doctors who became famous for solving the helicobacter problem, Australian doctors who are now claiming to cure Alzheimer's with gut bacteria, and stool replacements. I'm wondering if you have any views on that?

Henry Brodaty:         It's an area that we've just started investigating. In fact, we have an application in for some funding to look at the poo of centenarians to the see what their microbiome shows. I'm not up on the literature on that, but of course I know the work of Barry Marshall and I'm the others with the helicobacter. But whether this is going to be ... There's a strong link site between the gut and the brain, and whether treating the microbiome in some way is going to improve the brain, I think it's early days. But there's a group at St George Hospital we're working with who have a microbiome centre there looking at that. Maybe in a few years time you could ask me again, I might have an answer for you, sorry.

Ita Buttrose:             There's one down here in the front, the lady was a green jumper.

Speaker 6:               Thank you Professor Brodaty. I respect enormously the amount of lectures you've given to different audiences and the work you do. I'd just like to us Professor Carolyn Ray at CHeBA is just doing research on early detection of Parkinson's. And I'm very aware that Parkinson's often takes a very long time to be confirmed, and I'm intrigued by the fact that the MRIs of the substantia nigra could be found to be giving an early indication of Parkinson's. And if that were detected, help could be given to those people. Would you like to comment on that for just a moment or two?

Henry Brodaty:         Well, that's ... Could you all hear the question? Yeah. That's been the great hope that if we could detect that pre clinically, that we could actually make treatment for it. Well as I said, the drug trials have been looking at that. Some of the drug trials I just had one slide on, looking at people who have the gene for Alzheimer's disease, which is autosomal dominant, means you have 50% chance of passing it on to children. Until those people are asymptomatic, but they know they're going to get Alzheimer's disease, usually by their 40s or 50s. And they're in this trial now with one of those antibodies that so far hasn't worked. Parkinson's is a different kettle of fish. There's different proteins, different parts of the brain, it is more amenable to drug treatment. People with late onset Parkinson's do get a dementia as the disease progresses.

                                There are imaging where you can actually look at the dopamine transporter and measure that using a PET or SPECT imaging. We don't have ready access to that in Australia because the company that makes the chemical, the ligand that links onto the transporter are not prepared to give us their ligand in Australia, I'm not sure what the commercial reasons are for that. But yes, that's an exciting area, but so far has not yet shown benefit. Thank you. She's not at CHeBA by the way, she's at UNSW but not part of ... She’s at NeuRA.

Ita Buttrose:             A question over here?

Speaker 7:               Yes. Thank you. And thank you for the very interesting talk. I'm an applied linguist and I'm interested in promoting lifelong learning in adults of languages. And I wondered whether the kind of cognitive tests and exercises that you have in your programme approximate language learning in any way.

Henry Brodaty:         Yes. I don't know if they approximate language learning, but now in fact we've got a study just underway now looking at people's use of language and looking with machine learning. Just analysing transcripts or actual audio scripts of people talking, and you notice a number of um's and uh's that I've been using in my talk, maybe they increase as my cognition drops. And you can look at the production of speech, not just what people are saying, as a way of monitoring cognition. Other people are actually monitoring how people use their keyboards and number of mistakes they make. And looking at the metadata from use of your iPhone or from your computer may actually be a measure of your cognition.

Ita Buttrose:             But you might just be a lousy typist, Henry.

Henry Brodaty:         But it's the change. If you get lousier that's the problem. Yeah. I got it. Yeah. We were talking before we started that using your thumbs, that if you're under 30 everyone, you ... does their messaging using two thumbs, everyone over 40 or 50. Yeah.

Ita Buttrose:             They will get arthritis. Who's down the back the one with the question? Right, way down the back row.

Speaker 9:               You mentioned resveratrol, you didn't dive into it too much, in ... If you look at it on what's over the counter and so forth, there are different dosages that you can buy. Would you care to comment?

Henry Brodaty:         No, I don't, sorry, I don't know enough about that. And I know that David Sinclair does have some recommendations about that, and he had his own mother on resveratrol for over 10 years, and reckon she lived longer because of it. But she didn't live forever of course and ... No, I don't know.

Ita Buttrose:             Doesn't it come from red wine? I thought it was the doctor's answer to having a drink.

Henry Brodaty:         My information is you need to drink a thousand litres a day to get as much as they get in one of those tablets.

Ita Buttrose:             Just there in the middle, please.

Speaker 10:             Thank you so much professor, and thank you for that website address there too because I won't have to remember it now. Following up on the question about language, I was wondering are there any studies showing the value of singing in choirs and learning new music and so on?

Henry Brodaty:         Yeah.

Speaker 10:             Thank you.

Henry Brodaty:         There's been a lot of studies of people with dementia singing showing that it improves their mood and improves their engagement and so forth. Singing I think, is a lovely exercise to do, it improves the breathing, and you get a lot of socialisation, and people who participate in choirs really love it. But I haven't seen any studies of singing as a protection against getting dementia, but I think it's good for you.

Ita Buttrose:             And another question?

Speaker 11:             It all right. I'm quite interested in the cognitive aspect of what you were talking about in your speech, you talked about the exercise and the diet. What's involved with the cognitive exercises on the computer? What sort of things are you getting people to do?

Henry Brodaty:         Okay. It's multi domain, we have different domains of cognition, memory, visual-spatial, planning, executive function, speed of information, processing language, and they try and cut across a lot of those things. It might be some of those simple concentration games where you have cards flipped over and you flip over two at a time, and you have to make pairs, and how long does it take you to get all the pairs in a packet. Or they may give you something where it's counter-intuitive. You see the number red written in blue writing and you have to click yes if it's compatible, or no if it's not compatible.

Henry Brodaty:         It may be visual memory, it may be looking at that executive function where you have to do different things at once, they may be numerics things that you have to do as well, generating words or unjumbling words, it's a variety of different things. And generally what they do is they give you exercises which you'll get about 85% accuracy. Then they move you to the next level and the next level. The market leader is Lumosity, it may not be the best package. We're working with a company from Germany called NeuroNation, in our study. And I think they're the principles underpinning all of those things. Yeah.

Ita Buttrose:             I'm afraid we've run out of time. Would you please thank Professor Brodaty for his most informative presentation. Thank you so much, Henry. The next Learn@Lunch will be on the 12th of June with Professor Pasi Sahlberg from the Gonski Institute. Be sure to note the date in your calendars or visit the UNSW alumni website just to subscribe to updates and download today's lecture recording. Thank you all very much for coming and enjoy the rest of your week. Thank you.

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