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The path to prevention: targeting vascular risk factors to prevent cognitive impairment

Professor Amy Brodtmann, Institution: Florey Institute of Neuroscience and Mental Health

2020 Future Leader Fellowship

Years funded: 2021-2024


More than half the total dementia burden in Australians is due to the combined effect of vascular risk factors. Yet despite the greatest risk of dementia being in vascular populations, this population is ignored or excluded from most current dementia studies. Those at highest risk of late-life dementia include people with stroke and atrial fibrillation (AF), and people who are inactive. Indeed, physical inactivity may be the individual risk factor contributing most to total dementia burden. While it is known that exercise is one of the only known neuroprotective behaviours, we don’t fully understand the biology to optimise its effects.

My research findings have challenged orthodoxies, offering a paradigm shift in understanding neurodegeneration by positing that vascular risk factors are the major determinants of late-life dementia. The proposed projects for my Heart Foundation Future Leader Fellowship Level 2 application build on this research. In my research program over the next 4 years, I want to focus on identifying modifiable mechanisms with a view to prevention of cognitive impairment. Given the strong association between stroke and atrial fibrillation (AF), I wish to understand the relationship between AF and cognitive decline in elderly Australians (ASPREE-AF study). My work has shown that people following stroke have accelerated rates of brain shrinkage, or atrophy. I want to examine whether exercise stops your brain from shrinking after stroke with the Post-Ischaemic Stroke Cardiovascular Exercise Study (PISCES).

I can foresee at time when we can assign a dementia risk profile to a patient in clinic – whether they be seen for heart failure or diabetes management or stroke – and prescribe a multi-modal regimen of drug and lifestyle therapies to reduce dementia risk. This vision sits squarely within the Heart Foundation mission to foster healthy brain aging and develop interventions to reduce dementia risk.

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