Brain Awareness Week: The Future of Dementia Research
Dementia, now more than ever, is in the public spotlight. This Brain Awareness Week we meet some of the researchers from around the University of Oxford hoping to change the analysis, progression and outcome of the disease.
We speak to Vanessa, Ruby, Ivan, Laura and Sarah who are all based in the Department of Psychiatry and contribute to Dementias Platform UK alongside other important research and clinical roles. DPUK is funded by the Medical Research Council to facilitate and accelerate the discovery of new ways to understand, diagnose, and treat dementia.
Here they speak to us about their work, motivations and hopes for the future of dementia research.
Dr Vanessa Raymont
“My father died in 2017 with dementia, and I think that reinforced for me on a very personal level, the importance of trying to treat and support people with these conditions and maybe even stop them occurring in the first place.”
I got interested in the brain and psychiatry as a medical student in Birmingham and although I always thought I’d go into general practice, I subsequently trained in psychiatry in London and then did a master’s degree in cognitive neuropsychology. That’s when I really began to enjoy understanding more about how the brain works, as well as how it’s affected by head injuries and what happens to cognition in later life after such injuries.
When I finished my masters, I knew I wanted to do more research, so I then spent eight years in the US where I spent time at the National Institute of Health working on an incredible study of veterans with head injuries from the Vietnam conflict, as well as doing some dementia and imaging research. When I came back to the UK, I wanted to continue working within the fields of head injury and cognitive impairment. I do some brain injury work, but my main focus is now in memory research. My father died in 2017 with dementia, and I think that reinforced for me on a very personal level, the importance of trying to treat and support people with these conditions and maybe even stop them occurring in the first place.
I think I was very lucky in that my father encouraged a curiosity and my interest in science from very early on. We were always talking and arguing about something! That led me to focus on sciences at A level and his own determination as an immigrant led me to feel like I could do anything I put my mind to — he was a great mentor!
I have gradually moved into working in research focused on the prevention of dementia and we are getting close to preventing, or at least reducing the risk, of developing these diseases. As a clinician that has worked in memory clinics for 25 years, I am also excited that we are starting to adapt memory clinic services so that we can identify people at risk of developing dementia more accurately and these changes are very much being led by research. In Oxford I’m part of the of the UK-wide Deep and Frequent Phenotyping Study, a project within Dementias Platform UK, which is taking assessment of risk for dementias to a whole new level of detail. It includes things like wearables technology which will be used to assess movement, activity and memory via a smartwatch and a smartphone app. We are also creating a ‘brain health clinic’ and I think within the next few years, there will be a significant change and we will start being able to provide ‘risk assessments’ and individual programmes to reduce the risk of developing dementia or delaying its onset, which is amazing.
Dr Ruby Tsang
“I was particularly interested in studying late-life depression as it is one of the major modifiable risk factors for dementia, and understanding the pathways that lead to late-life depression may provide some insight into how we may reduce rates of late-life depression, which may in turn reduce rates of dementia.”
After completing a PhD in Psychiatry at the University of New South Wales in Australia, I moved to the UK to take up a postdoctoral position at the University of Oxford. My PhD research examined genetic, environmental and epigenetic influences on late-life depression using data from Australian cohorts. I was particularly interested in studying late-life depression as it is one of the major modifiable risk factors for dementia, and understanding the pathways that lead to late-life depression may provide some insight into how we may reduce rates of late-life depression, which may in turn reduce rates of dementia.
My current work with Dementias Platform UK builds on my previous research by exploring biological and environmental mechanisms that may be associated with cognitive and mental health outcomes in mid- to late life. One area of interest is vascular ageing. As people age, the walls of their arteries generally increase in stiffness and thickness, and we are interested in finding out whether arterial stiffness and thickness are related to cognition and depression, as well as how other factors may moderate these associations.
There is also growing evidence to suggest that exposures during sensitive periods of brain development may leave long-lasting structural and functional changes in the brain, leaving people more vulnerable to cognitive impairment and mental health issues later in life, so the other projects that I am working on at present take on a life course approach. We are examining if early-life factors such as exposure to childhood adversity or early pubertal timing would predict subsequent cognitive and mental health outcomes.
Since we do not have any disease-modifying treatment for dementia to date, it is essential that we focus on the prevention of dementia through targeting modifiable risk factors. With larger, longitudinal and multi-modal datasets that have now become available through collaborations like Dementias Platform UK, we hope that we can have a much better understanding of the contributions of various risk factors and risk factor combinations to dementia risk, particularly in different subgroups of the population. It is expected that these findings will be able to inform clinical practice and policy, resulting in better screening, as well as earlier diagnosis and intervention.
Dr Ivan Koychev
“My interest in the neurosciences I suspect dates back to my school years when I would spend time on my father’s inpatient psychiatric ward while waiting for him to finish work (creative solutions to childcare in 1990s post-communist Bulgaria were very much the norm).”
I am an academic psychiatrist working half the time in the NHS (seeing patients with the major mental health disorders: dementia, schizophrenia, depression, bipolar disorder) and the other half in research. My research focuses on a question that becomes ever closer to my heart as friends, family and ultimately I age: what are the earliest signs of dementia that we can identify and treat? We know that the process starts up to 25 years before first symptoms and while this is genuinely worrying (universally popular party chat I have found out) it also may represent a window of opportunity for stopping the disease in its tracks.
A critical challenge therefore is to find the right test to find out who it is that has the earliest signs of the condition. An issue that is intuitively true is that tests we have developed to diagnose dementia are not what is needed in its preclinical (or early) stages: head scans don’t show much shrinkage, memory tests are too easy. Other tests are more meaningful but either too expensive or too unpleasant (or both!) to be unleashed on the unsuspecting healthy public.
My research therefore looks to address this gap in tools to diagnose preclinical dementia by harnessing the opportunity provided by novel digital (smartphone apps) and wearable (fitbit-like wristbands) technologies to define minor changes in the function of a healthy adult that may indicate they are in the very initial stages of the process that 20 years later would lead to dementia. One method is a smartphone app that allows us to test your memory up to 10–15 days after you learn a task. Difficulty remembering information you learnt 7 days ago may be particularly good at indicating future dementia risk and smartphones allow us to collect this previously inaccessible data cheaply. You can try it for yourself through a project we are running with Alzheimer’s Society: https://www.alzheimers.org.uk/research/play-your-part/gamechanger.
Wearable technology allows us to get a sense of how much activity you get, how stable your gait is and whether you get a good night’s sleep. The hypothesis is that changes to these indicators of daily ‘function’ are much better suited to picking up the earliest indicators of change. The final step is to compare these novel measures with established dementia tests that we get access to through Dementias Platform UK — a digital platform bringing together more than 40 long-term health studies for the use of dementia researchers.
My interest in the neurosciences I suspect dates back to my school years when I would spend time on my father’s inpatient psychiatric ward while waiting for him to finish work (creative solutions to childcare in 1990s post-communist Bulgaria were very much the norm). I remember being struck by how very unusual behaviours could suddenly appear and then dissipate in people who were otherwise functioning well in society. This made me wonder what causes changes to behaviour that are beyond one’s control leading me to study medicine, at the Medical University of Sofia, and then a neuroscience PhD at the University of Manchester.
Going forward my vision for dementia is one where we increasingly focus on identifying and treating causes of the illness before they cause lasting damage. I believe that with the improvements in methodology based on cheap and already widespread technology such as digital and wearable devices this is now closer than previously possible.
Dr Sarah Bauermeister
“When I left school I was drawn towards studying a sports science degree in my home country of South Africa where I had grown up running barefoot before my coach bought me shoes.”
Two of my notable characteristics as a young child were that I was fascinated by the human body, spending pocket money on anatomy books, and I loved research, often writing my own mini-projects on any topic I had recently read about. When I left school I was drawn towards studying a sports science degree in my home country of South Africa where I had grown up running barefoot before my coach bought me shoes. I completed a 4th honours year majoring in applied physiology and sports psychology, planning to return to the UK to pursue a research PhD in sports psychology at the University of Exeter.
This all suddenly changed when I experienced losing two close family members to cerebrovascular incidents, and a family friend was diagnosed with early onset dementia within the year. Placing studying on hold, I returned to the UK and I took a major career break to have a family and teach my own children. Later, as a mature student, I engaged with studying again 15 years after graduating from my first degree. I decided there was no time to lose if I was still to be a researcher, this time focused on the ageing brain and cognition, I had some catching up to do. After ten years of further studying I completed a BSc Hons in psychology, an MSc in cognitive psychology and a PhD in cognitive ageing with brain imaging.
In my career, I have been fortunate to lecture across my subject areas and research cognition in frail and older adults. During my journey of academic discovery, I have travelled from sports scientist to cognitive neuropsychologist and I am excited about using my skills and experience for dementia and mental health-related research.
I am now a senior researcher at the Department of Psychiatry, University of Oxford, working for Professor John Gallacher, Director of Dementias Platform UK (DPUK). I research and supervise across multiple projects as a multidisciplinary and psychometric analyst for the European Prevention of Alzheimer’s Disease (EPAD) study and DPUK. I am also senior data manager for DPUK’s Data Portal, a data repository platform for over 2 million participants across 45+ population and disease-specific cohorts.
As a psychometric analyst, using large cohort data, one of the areas in which I conduct analyses is childhood adversity. This encompasses adverse experiences during childhood such as sexual, physical and emotional abuse, deprivation, and family dysfunction. Experiencing adversity within childhood alters the life of a child to such an extent that it has been linked to a change in biological processes which lead to adverse biomedical health outcomes in adulthood, as well as ongoing poor adult mental health, lower adult life satisfaction and dementia.
Moreover, poorer adult mental health has a subsequent deleterious effect on cognition, cognitive decline and dementia in older age. My current research explores the effect (prediction) of childhood adversity on a cascade of adult biomedical and cognitive outcomes including dementia, across four population cohorts in the DPUK Data Portal.
Dr Laura Winchester
“Currently dementia is diagnosed in late stages and being able to detect the disease before it advances will allow us to develop different treatments; by using real world data we hope to understand what social, environmental or health variables could increase or decrease the risk of dementia.”
I am a senior postdoctoral researcher in the Translational Neuroscience Bioinformatics team based in the Department of Psychiatry at Oxford University. This gives me the opportunity to work on a wide range of neurological related disorders and data types; the main focus of my research is Alzheimer’s Disease and dementia where I work to understand causes and find predictive markers.
Alzheimer’s disease is seen in patients as a decline in memory or cognitive function but is a physical disease which causes degeneration of brain tissue and nerve connections. I analyse patient cohorts of genetic data and protein expression to search for potential markers or disease related genes which might provide an earlier indicator of disease. Currently dementia is diagnosed in late stages and being able to detect the disease before it advances will allow us to develop different treatments; by using real world data we hope to understand what social, environmental or health variables could increase or decrease the risk of dementia.
Risk factors from other diseases, for example cardiovascular, could have an effect both directly on heart health and an impact on cognitive decline seen in dementia; understanding these factors could give us other approaches to Alzheimer’s treatment. As a team, we analyse real world data to understand mood disorders, in particular depression. In the MRC Mental Health Data Pathfinder project we link datasets and different data types together and apply machine learning techniques to extract data, such as Natural Language Processing on text clinical records or neural networks on brain images. We can then run innovative analysis methods on these multimodal sets for in depth disease investigation.
My original degree was in Genetics which I followed with a doctorate in Clinical Medicine. I began working at the laboratory bench so I had to learn programming myself from textbooks and willing computer scientists. Now, the focus on data analysis has allowed me the flexibility to move between diseases ranging from breast cancer to neurosciences. Although changing direction has needed a lot of extra reading, it gave me opportunities to work in the rapidly advancing field of data science in dementia.
Understanding interactions and factors that cause disease will be an important milestone for the next stages of Alzheimer’s research. Accessible big datasets, such as UK Biobank with 500,000 participants, and linked resources, such as the Dementias Platform UK Data Portal, let researchers ask questions about the effects of different factors which are not possible to detect in smaller datasets. For the future, I hope we can identify new disease biomarkers for patient diagnosis using blood tests to complement the expensive imaging scans. New genetic markers provide information about the way the disease works as well as yielding targets for drug development, giving opportunities for advanced treatments to improve and save lives.
Further information:
Play the Alzheimer’s Game Changer app and play your part in dementia research.
Thank you to Vanessa, Ruby, Ivan, Sarah, Laura and Dementias Platform UK. Find out more about DPUK and the Department of Psychiatry.
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