Tell us a little about your academic and professional background – what led you to the field of clinical neuropsychology and in particular your focused research on modifiable risk factors for dementia and the importance of sleep in healthy brain ageing?
I always found brain behaviour relationships fascinating and was attracted to the diversity of training in psychology, including in the fundamentals of research. As a neuropsychologist in clinical practice, however, I was compelled to move away from long diagnostic assessments and focus instead on things we could do to improve cognition. Amongst the modifiable risk factors, these have primarily been in the areas of depression, cognitive training and sleep. The more I learn about sleep, the more critical it appears for optimal brain functioning. I enjoy leading a research program in this field as the work cuts across mechanistic studies, clinical trials, using digital tools and in research translation. I am particularly interested in understanding the role of brain glymphatics in driving Alzheimer’s and vascular pathology and in determining whether in people attending memory clinics we need to assess for and treat sleep disturbance more routinely.
You are the ADNeT Memory Clinics Co-Lead. For those unfamiliar with memory clinics, can you briefly explain the work that you and your team do and what do you hope to achieve with ADNeT memory clinics in the future?
In short, our team is working on ways to improve the access to and quality of services. We have done an enormous amount of work in mapping the services that exist across Australia, both public and private, and the specifics of those services. We have been able to map more than 150 services (86 of these are multidisciplinary, which is fantastic). We have found there is considerable heterogeneity in staffing, frequency, wait times, and services across the memory clinics including in the assessments utilised. Also, less than a third of clinics provide post-diagnostic supports, and this is often only one session. Most clinics are only funded to undertake assessments. Many only operating one day per week, even in busy metropolitan areas. Resources and funding for clinics need to be expanded!
Using a modified delphi process, we have undertaken vast stakeholder consultation and surveys to establish best practice for clinics and subsequently established the first ever National Memory and Cognition Clinic Guidelines. To support the knowledge and skill base of our network, we run a bimonthly webinar series which is always well attended. We have been working with government, politicians and health providers to advocate the need for expansion of memory clinics, review current funding and focus on improving post-diagnostic support. We are pleased that ADNeT memory clinics work has been incorporated into the National Dementia Action Plan.
In the future, we will seek funding for initiatives that provide services to regional and rural areas, to implement cognitive training into practice, and to work alongside ADNeT Clinical Quality Registry to establish a national accreditation program to support quality improvement in memory clinics. We will also be testing the impact of the new blood-based biomarkers for Alzheimer’s disease, and we will soon be scoping our preparedness for delivering the new monoclonal antibodies, in the event that they are approved in Australia (watch this space!).
You have recently been awarded the International Neuropsychological Society (INS) Mid-Career Award. How does it feel to be recognised by your peers for your impressive body of research?
It feels fantastic to have been recognised by this esteemed society. Australian neuropsychologists working across the lifespan and across many conditions have really been trailblazers in this field. I am fortunate to be amongst many amazing prior Australian awardees and to have so many neuropsychologists as friends – they definitely keep me grounded as to the rigours and challenges facing everyday clinical practice. I am especially grateful to my colleagues, also working in dementia, who nominated me.
A 2021 report from the Australian Institute of Health and Welfare showed that nearly half (48%) of adults reported at least 2 sleep-related problems. Given your work in sleep disturbance and its link to increased risk of cognitive decline, what advice would you give to those who do suffer from poor sleep quality?
I would suggest trialling some simple behavioural strategies such as regular wake times, light exposure, daily activity and management of anxiety and stress and if these don’t help, then a discussion with a GP is a good next step. There are multiple medications, mental health and lifestyle conditions that affect sleep and these are important to consider. There are also effective and safe strategies such as cognitive behaviour therapy for insomnia. I would avoid the use of benzodiazepines beyond short periods and perhaps consider melatonin instead if required. Investigation for sleep apnea is definitely worth considering, as effective treatments are available. Where there is dream enactment behaviour, investigation for rapid eye movement (REM) sleep behaviour disorder may also be warranted.
You also work in early intervention. From your research, what are the most important lifestyle interventions we can practice to off-set cognitive decline?
I would always recommend physical and cognitive activity for MCI, aligned with the American Academy of Neurology recommendations. While we now recognise 12-15 risk factors as being important, I would assess and make other suggestions using a personalised and goal-directed approach depending on the patient’s profile.
Outside of being a busy researcher and neuropsychologist, what are some of your interests and hobbies?
I thoroughly enjoy being a mum to two beautiful girls, aged 8 and 10, and love being involved in all their pursuits! On the rare occasion I have time to indulge myself, I love hiking, travelling, music, reading, sharing good food and wine with special friends and I have recently taken up painting (which I am terrible at!).
Further, how do you manage to find a good work/life balance? Any tips for women in STEM struggling to find this balance?
I don’t believe I have yet mastered the perfect balance! The expectation on researchers to work around the clock is unrealistic, and we need to be agile in response to unexpected deadlines and out of hours events. Over time I have needed to adjust my expectations with regard to what I can achieve; and having children has required and motivated me to do this! However, clinical research can be very flexible and rewarding with respect to new discoveries, meeting new people, working with those with lived experience and in seeing the real-world impact of what we do for patients, services and advancing science. So it’s fair to say that part of my work-life balance is derived from enjoying what I do.
For women, I suggest finding good mentors and colleagues, work alongside male and female champions of change, be confident, take opportunities for leadership or to extend yourself. Have integrity and be respectful to fellow colleagues, junior team members and students and support each other.
Finally why is this an important/rewarding area of research and how can we attract more researchers to work in the dementia field?
Working with older people is an utter joy. They have the most wonderful stories, wisdom and humour. Many are grateful for our time and even motivated to keep their brain healthy. For those of us working with those in the MCI or early dementia stages, this is a super exciting time, with the positive recent results of Lecanemab and Donanemab trials and the transformative advances in plasma diagnostics. Our colleagues at ADNeT have been crucial to many of these great leaps forward. Even at later dementia stages, Australian researchers are leading the way in so many fields that aim to optimise mood, social interactions and quality of life for people with dementia and their support persons.
As researchers, we work with great minds from so many disciplines and we have a lot of autonomy regarding who we work with and how we wish to work. We make great new discoveries, and we travel to unique global destinations to fill our cups with science, innovations and networking. Most of us have terrific colleagues, with whom we can seed and fertilise ideas and strategies and some of us (like me) are lucky enough to be supported by wonderful early career researchers, clinicians and people with lived experience. It is tough sometimes, and the weeks often blur into one, but we are a community, with novel and shared challenges that drive us and unite us, and together we are making a difference. To me, those are excellent reasons to have a conversation about being engaged in, or pursuing an academic career in dementia research!