The launch of a new strategic roadmap for dementia research is a reminder of the increasing social and economic challenges associated with Australia’s ageing population.
The $200 million Boosting Dementia Research initiative in the 2014-15 budget was a signpost of an enhanced awareness within government that research is needed address this issue. To date, the program has provided 133 grants to dementia projects. As part of the Medical Research Future Fund, there is now also 10-year Dementia, Ageing and Aged Care Mission to accelerate the development of disease-modifying therapies.
The NHMRC National Institute for Dementia Research (NNIDR) Strategic Roadmap for Dementia Research and Translation was put in place in 2016, and then revised in 2017, to provide a guiding framework for Australia's dementia research effort. The now released 2019 iteration is a response to a 2018 review of the roadmap recommending substantial changes to ensure that the strategy reflects the emerging developments in the area.
Prevention is a key objective of the now released paper, but the opportunities for intervention will vary across the different types of dementia, which encompasses a broad spectrum (more than 100 different forms) of neurodegenerative health issues. While lifestyle factors clearly play an important part, it is becoming clear that the various expressions of dementia are triggered by a complex interplay of genetics and environmental exposures.
There is a clear need to better understand these factors, and potential interventions.
Critically, the 2018 review found that early diagnosis needs to be the foundation to all aspects of dementia research, and it urged to prioritise the development of new personalised, less invasive diagnostic approaches. The challenge here is that due the complexity of dementia there is no single one-fits-all approach to address this. In addition, the onset of symptoms is often slow, and at present diagnosis can take up to seven years.
The 2019 roadmap recognises that more rapid and accessible diagnosis will require engagement across the entire health system, including partnerships with industry to develop better screening tools. It also provides a greater focus on basing prevention, diagnosis, and intervention on the molecular and cellular mechanisms underlying the health issues.
There is now a plethora of powerful research tools that dementia researchers have at their disposal, such as gene editing, stem cell models, and whole genome analysis. This provides opportunities to intensify the research into the separate and shared characteristics of neurodegenerative diseases, and the fundamental underlying biological pathways.
The expectation is that this will provide a basis to identify new ways to intervene in the disease process, and pioneer new therapeutic interventions.
But the roadmap also details the need to extend the focus beyond developing clinical measures, and to direct attention to the support structures that are dealing with patients on the ground. This includes a better understanding of the needs of unpaid carers, who play a crucial role within Australia's support system, and the widespread adoption of new evidence.
A notable emphasis of the revised roadmap is on the challenge faced by the Indigenous population. Aboriginal and Torres Strait Islanders experience a much higher rate and an earlier onset of dementia than the broader Australian community.
A dedicated strategy paper deals with this issue, and details a strengths-based and healing centred approach to address five priority areas (health literacy; prevention, risk reduction and diagnosis; access to services and supports; culturally informed services and workforce; and end of life care).