The world now faces a crisis of ageing. Dementia sits firmly at the crux of this crisis. In the Australia alone over 400,000 people are now living with dementia and this figure is expected to more than double by 2050. Worldwide, in 2019 57 million people were living with dementia and it is anticipated 153 million will experience the disease in 2050. In the absence of any effective, disease modifying therapy we urgently need to find better ways of preventing dementia. Hypertension is the most prevalent risk factor for dementia, affecting more than 1 billion people worldwide, including 1 in 3 adults in Australia. We know that midlife hypertension increases risk of all cause dementia by around 60% and Alzheimer’s Dementia (AD) by 25%. However, in late life this association is not consistently observed, with most studies finding either no association or that higher Systolic Blood Pressure (SBP) or Diastolic Blood Pressure (DBP) is associated with lower risk of dementia. This lack of clarity is deeply problematic. It is precisely for the group that has the highest risk of hypertension (1 in 2 of those > 65) and the greatest risk of dementia (1 in 16 of those > 65) that optimal BP management for dementia prevention is unclear.

My research uses a consortium of longitudinal studies of aging including over 43,000 participants to explore the effects of blood pressure, blood pressure variability and antihypertensive medication on cognitive function and dementia risk. There is evidence that with increasing age the optimal blood pressure for cognition and dementia risk increases and that both very low and very high blood pressures will lead to poorer long-term outcome. We are also using the largest genetic database in the world, the UK Biobank, including over 500,000 participants to examine how the genetic risk for high or low blood pressure affects cognition.

I have a number of other collaborations including some work examining the long term cognitive effects of TBI on cognitive outcomes (with collaborators at Oxford and Exeter Universities) as well as examining key factors involved in human flourishing.