Kaarin J. Anstey

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UNSW Sydney | UNSW · School of Psychology

Effective, scalable dementia prevention interventions are needed to address modifiable risk factors given global burden of dementia and challenges in developing disease-modifying treatments. A single-blind randomized controlled trial assessed an online multidomain lifestyle intervention to prevent cognitive decline over 3 years. Participants were d...

With recent technical advances, many cognitive and sensory tasks have been adapted for smartphone testing. This study aimed to assess the criterion validity of a subset of self-administered, open-source app-based cognitive and sensory tasks by comparing test performance to lab-based alternatives. An in-person baseline was completed by 43 participan...

Background and Objectives Cognitive, visual, and physical performance are associated with driving safety. However, there are few comprehensive models that empirically evaluate how such factors together impact driving safety in older adults. The present study used structural equation modeling (SEM) to evaluate Anstey’s original Multifactorial Model...

People living with dementia have a range of functional, physical, cognitive, and behaviour needs. Reablement (and/or ‘rehabilitation’) is an important multidisciplinary approach, such as using occupational therapy and exercise, to address each person’s needs. People with dementia in Australia are being referred to community aged care teams for ever...

Background Lifestyle modifications incorporating a healthy diet, physical activity, brain training and health monitoring have proven effective in preventing dementia and related cognitive decline (REF). The Australian‐Multidomain Lifestyle Intervention to reduce dementia risk (AU‐ARROW) is an ongoing 2‐yearintervention, which is the Australian cont...

Background The Maintain Your Brain (MYB) randomised controlled trial (RCT) aimed to prevent cognitive decline and dementia through a multidomain risk‐reduction intervention delivered digitally. The intervention targeted four modifiable risk areas (physical inactivity, poor diet, cognitive inactivity, and depression and/or anxiety). MYB ran for thre...

Background High‐income countries (HICs) are over‐represented in current global dementia incidence rates, skewing estimates. Variance in diagnostic methods between HICs and low‐ and middle‐income countries (LMICs) is speculated to contribute to the regional differences in rates. Cohort Studies of Memory in an International Consortium (COSMIC) offers...

SIGNIFICANCE In an aging population, the number of people living with neurodegenerative disease is projected to increase. It is vital to develop reliable, noninvasive biomarkers to detect disease onset and monitor progression, and there is a growing body of research into the ocular surface as a potential source of such biomarkers. BACKGROUND This...

Background Mild Behavioral Impairment (MBI) and functional ability are two non‐cognitive markers of dementia. To date, little is known about the impact of functional ability on the clinical manifestation of MBI. Using data from the Australian population‐based PATH Through Life Study we examined the impact of functional ability on MBI. We hypothesiz...

Background: A brain healthy lifestyle, consisting of good cardiometabolic health and being cognitively and socially active in midlife, is associated with a lower risk of cognitive decline years later. However, it is unclear whether lifestyle changes over time also affect the risk for mild cognitive impairment (MCI)/dementia, and rate of cognitive...

Subjective views of aging have been associated with positive health-promoting behaviours and well-being. While age-related changes are considered fundamental to views of aging, the role of declining hearing function in shaping these age views remains a largely unexplored area. Within the scope of this study, we hypothesized that poor hearing functi...

Subjective age (SA), measured as how old you feel, is associated with positive health and developmental outcomes. Despite the increased use of multi-dimensional items, there is great heterogeneity in how it is implemented. SA measures often use different scoring methods which may impact subsequent analyses and interpretations. To understand the dai...

Older drivers are an at-risk population when on-road. Normal ageing processes, such as declines in visual, sensorimotor and cognitive processes, impact driving skills and contribute to the increasing crash rate. Advanced Driver-Assistance Systems (ADAS) may provide a solution to keep older drivers safe on the road. This study investigated what tech...

Abstract Background Fall injuries resulting from trips are a major health concern. Virtual reality (VR) offers an effective way of training obstacle avoidance while walking due to its ability to provide safe and meaningful real-time feedback during rehabilitation. This proof-of-concept study examined the benefit of providing physical feedback durin...

Objectives This study examined the association between childhood adversity and late-life cognitive outcomes among older Puerto Rican adults. Methods Data were from the PREHCO study, a population-based cohort of 3,713 older Puerto Rican adults (mean age 72.5 years; 60% female). Adverse childhood experiences (ACEs) were categorised into four factors...

Introduction Cumulative blood pressure metrics may provide greater precision for measuring temporal risk exposure, especially in later life where data are mixed regarding associations of high blood pressure (BP) on cognitive function. We examined the relationship between greater cumulative exposure to high BP in later life and several domains of co...

INTRODUCTION It is unclear how midlife depression and anxiety affect dementia risk. We examined this in a Norwegian cohort followed for 30 years. METHODS Dementia status at age 70+ in the fourth wave of the Trøndelag Health Study (HUNT4, 2017–2019, N = 9745) was linked with anxiety and depression from HUNT1 (1984–1985), HUNT2 (1995–1997), HUNT3 (2...

Objectives: Deterioration in vision is an important dementia risk factor yet few studies have examined objectively measured changes in visual acuity over time. Visual decline may also reduce social engagement, highlighting the need to examine visual changes in concert with broader social function. Method: The relationship between change in visua...

Background Current estimates of dementia and Alzheimer's disease incidence and prevalence are required to understand the health needs of the elderly. Objective We used two Australia cohort studies, administrative datasets, and data linkage techniques to estimate dementia rates in Australia. Methods The study used Australian Longitudinal Study on...

Background We aimed to develop risk tools for dementia, stroke, myocardial infarction (MI), and diabetes, for adults aged ≥ 65 years using shared risk factors. Methods Data were obtained from 10 population-based cohorts (N = 41,755) with median follow-up time (years) for dementia, stroke, MI, and diabetes of 6.2, 7.0, 6.8, and 7.4, respectively. D...

Around 55 million people worldwide live with dementia, and more are expected due to population ageing. We aimed to investigate associations between healthy diet and mild cognitive impairment and dementia in 1753 older adults aged 60–64 from the PATH (Personality and Total Health Through Life Cohort) study. Healthy diet was defined by the Mediterran...

Background and Objectives Sex and gender are important topics of increasing interest in aging and dementia research. Few studies have jointly examined sex (as a biological attribute) and gender (as a sociocultural and behavioral characteristic) within a single study. We explored a novel data mining approach to include both sex and gender as potenti...

Objectives: This systematic review aimed to synthesise the evidence on potential differences in financial, social, health and safety-related decision-making between younger and older adults. Methods: Trial, experimental, and prospective studies including older (60+) and younger adults that reported on quantitative decision-making outcome measures (...

Objectives Interpersonal relevancy appraisals are a dynamic and understudied aspect of human social cognition. Despite their importance, there are no existing measures. This study developed and validated a new measure of self-perceived interpersonal threat, opportunity, and invisibility appraisals among a life-course sample of adults. We also explo...

Importance Poststroke cognitive impairment is common, but the cognitive trajectory following a first stroke, relative to prestroke cognitive function, remains unclear. Objective To map the trajectory of cognitive function before any stroke and after stroke in global cognition and in 4 cognitive domains, as well as to compare the cognitive trajecto...

Introduction Promising evidence is emerging for the procognitive, anti-inflammatory and neuroprotective properties of dietary flavonoids, particularly anthocyanins that provide red, purple and blue plant pigments. Methods and analysis The ‘Food for Thought’ study is a multicentre, 6-month randomised, parallel 3-arm clinical trial. Its primary aim...

In the Western Pacific Region, the prevalence of dementia is expected to increase, however, the diversity of the region is expected to present unique challenges. The region has varying levels of preparedness, with a limited number of countries having a specific national dementia plan and awareness campaigns. Diversity of risk and healthcare service...

Introduction Dietary nitrate is potentially beneficial for cardiovascular, cerebrovascular, and nervous systems due to its role as a nitric oxide (NO) precursor. Increased nitrate intake improves cardiovascular health and therefore could protect against dementia, given the cardiovascular-dementia link. Objective To investigate the association betw...

Introduction The growing population of older drivers presents challenges for road safety attributed to age-related declines and increased crash fatality rates. However, enabling older people to maintain their health and independence through continued safe driving is important. This study focuses on the urgent need for cost-effective interventions t...

Background and objectives: Previous randomized controlled trials and longitudinal studies have indicated that ongoing antihypertensive use in late life reduces all-cause dementia risk, but the specific impact on Alzheimer dementia (AD) and non-AD risk remains unclear. This study investigates whether previous hypertension or antihypertensive use mo...

OBJECTIVE: This study aimed to investigate the relationship between childhood adversity and cognitive impairment in older adults. METHODS: We analysed data from 1568 participants aged 72-79 (M = 75.1, SD = 1.5, % male = 52.6%) from Wave 4 of the Personality and Total Health (PATH) Through Life Project. The outcome variable was the presence of mild...

Sex and gender—biological and social constructs—significantly impact the prevalence of protective and risk factors, influencing the burden of Alzheimer's disease (AD; amyloid beta and tau) and other pathologies (e.g., cerebrovascular disease) which ultimately shape cognitive trajectories. Understanding the interplay of these factors is central to u...

Evidence-based dementia risk assessment is required to inform individual and policy-level dementia risk reduction interventions. We developed the CogDrisk Short Form (CogDrisk-SF) to assess dementia risk factors, for situations where time and resources are limited. To evaluate concurrent validity with the original CogDrisk, we conducted an online s...

Objectives This study aims to identify the relationship between psychosocial factors and unmet needs among community-dwelling older adults who have received or who expect to receive formal home-based aged care services. Methods A subsample of the national Survey of Disability, Ageing and Carers was used to examine the prevalence of having any unme...

Background More than 57 million people have dementia worldwide. Evidence indicates a change in dementia prevalence and incidence in high-income countries, which is likely to be due to improved life-course population health. Identifying key modifiable risk factors for dementia is essential for informing risk reduction and prevention strategies. We...

Background: Emerging observational evidence supports a role for higher fruit and vegetable intake in protecting against the development of depression. However, there is a scarcity of research in older adults or in low- to middle-income countries (LMICs). Methods: Participants were 7,801 community-based adults (mean age 68.6 ± 8.0 years, 55.8% fema...

Depression is the largest global contributor to non-fatal disease burden(1). A growing body of evidence suggests that dietary behaviours, such as higher fruit and vegetable intake, may be protective against the risk of depression(2). However, this evidence is primarily from high-income countries, despite over 80% of the burden of depression being e...

Introduction: Recent evidence suggests that the influence of verbal intelligence and education on the onset of subjective cognitive decline may be modulated by gender, where education contributes less to cognitive resilience in women than in men. This study aims to examine gender differences in the association between cognitive resilience (CR) and...

Background Digital dementia risk reduction interventions are cost-effective and scalable. However, it is unknown how they are perceived by people already experiencing cognitive concerns or decline. Objective To understand the current use, interest, and preferences for online learning courses and interest in learning about factors influencing brain...

INTRODUCTION The Finnish Geriatric Intervention Study (FINGER) led to the global dementia risk reduction initiative: World‐Wide FINGERS (WW‐FINGERS). As part of WW‐FINGERS, the Australian AU‐ARROW study mirrors aspects of FINGER, as well as US‐POINTER. METHOD AU‐ARROW is a randomized, single‐blind, multisite, 2‐year clinical trial ( n = 600; aged...

INTRODUCTION White matter hyperintensities (WMHs) are an important imaging marker for cerebral small vessel diseases, but their risk factors and cognitive associations have not been well documented in populations of different ethnicities and/or from different geographical regions. METHODS We investigated how WMHs were associated with vascular risk...

Objectives To explore the prevalence of frailty, association between frailty and mortality, and transitions between frailty states in urban- and regional-living First Nations Australians. Study design Secondary analysis of longitudinal data from the Koori Growing Old Well Study. First Nations Australians aged 60 years or more from five non-remote...

Background and purpose The complex aetiology of Alzheimer's disease suggests prevention potential. Risk scores have potential as risk stratification tools and surrogate outcomes in multimodal interventions targeting specific at‐risk populations. The Australian National University Alzheimer's Disease Risk Index (ANU‐ADRI) was tested in relation to c...

Background: Findings on the associations between anxiety and cognitive decline are mixed and often confounded. Objective: We studied whether anxiety symptoms were associated with the risk of cognitive decline after adequate adjustment of confounding factors. Methods: Our study consists of 2,551 community-dwelling older adults recruited between the...

Objective:There is increasing focus on effective preventative interventions applicable at the population scale such as through technology and web-based approaches. We aimed to reduce cognitive decline with ageing using an online package of interventions delivered intensively for 12 months followed by monthly boosters for 24 months. Methods:Invitati...

Objective:Older adults have low levels of mental health literacy relating to anxiety which may contribute to delaying or not seeking help. Lifestyle interventions, including physical activity (PA), have increasing evidence supporting their effectiveness in reducing anxiety. The COVID-19 pandemic also highlighted the potential for technology to faci...

Introduction Concerns about falling (CaF) are common in older people and have been associated with avoidance of activities of daily life. Exercise designed to prevent falls can reduce CaF, but the effects are usually short-lived. Cognitive behavioural therapy (CBT) can reduce CaF for longer but is not readily available in the community and unlikely...

A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the “LIfestyle for BRAin health” (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for...

Background Physical inactivity significantly increases dementia risk (DR). For middle‐aged and older adults with co‐occurring cognitive concerns/impairment and mental health symptoms, DR increases further. Clinical trials indicate lower adherence to PA interventions for dementia risk reduction in such high risk‐group, and interventions tailored to...

Background ‘Cognitive reserve’ (CR) refers to a model of active protection against cognitive decline conferred by the adaptability of one’s cognitive processes. Research on life‐course accumulation of reserve and impact of factors like gender is limited. We examined long‐term effects of CR on episodic memory in two population‐based cohorts. Method...

Background Gender differences in dementia and dementia‐related neuropsychiatric symptoms are well described. Similarly, the Apolipoprotein E (APOE) ε4 allele is a well‐known predictor of Alzheimer’s disease. However, their impact on the clinical manifestation of Mild Behavioral Impairment (MBI) remains unclear. Using data from the Australian popula...

Background Efforts to prevent cognitive decline with aging have had mixed results with successful interventions delivered in person. While online approaches are more scalable and feasible to deliver at a population level, no multimodal online intervention has yet been demonstrated efficacy. We aimed to reduce cognitive decline with ageing using an...

Background Physical inactivity significantly contributes to chronic disease burden, including increasing dementia risk. Physical activity (PA) can benefit cognitive health for groups at high‐risk of dementia, such as people experiencing cognitive concerns (including mild cognitive impairment and subjective cognitive decline), and mental health symp...

Background Social engagement has been linked to higher cognitive function in later life and it is a well evidenced protective factor against dementia and cognitive decline. However, far less is understood about how the type, quality and quantity of social engagement differentially affects cognitive health outcomes in older adults. Methods The samp...

Advanced Driver-Assistance Systems (ADAS) are in-vehicle technologies that promise to improve driver safety and may help support older drivers to drive safer for longer, however there is little research examining acceptance and use of ADAS among older adults. This study investigated age and gender differences in attitudes to ADAS and use of ADAS. W...

Objective The aim of this study was to examine the association between childhood adversity and mental health and cognition in older adults. Methods The sample included older Australian adults from the Personality and Total Health (PATH) Through Life Project (N = 2551). Childhood adversity was measured using a 17-item scale of domestic adversities...

Introduction Middle-aged multidomain risk reduction interventions targeting modifiable risk factors for dementia may delay or prevent a third of dementia cases in later life. We describe the protocol of a cluster randomised controlled trial (cRCT), HAPPI MIND (Holistic Approach in Primary care for PreventIng Memory Impairment aNd Dementia). HAPPI M...

Introduction Digital health interventions are cost-effective and easily accessible, but there is currently a lack of effective online options for dementia prevention especially for people at risk due to mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Methods and analysis MyCOACH (COnnected Advice for Cognitive Health) is a t...

Recent decades have seen exponential growth in research on modifiable risk factors for dementia across the lifespan which has considerably advanced our understanding of brain health. Not all modifiable risk factors are equal, however, in the ease with which they can be addressed. Some individuals and populations face significant barriers to engagin...

Introduction Current efforts to reduce dementia focus on prevention and risk reduction by targeting modifiable risk factors. As dementia and cardiometabolic non-communicable diseases (NCDs) share risk factors, a single risk-estimating tool for dementia and multiple NCDs could be cost-effective and facilitate concurrent assessments as compared with...

Importance The utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested. Objectives To assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and rac...

INTRODUCTION: White matter hyperintensities (WMH) are an important imaging marker for cerebral small vessel diseases, but their risk factors and cognitive associations have not been well-documented in populations of different ethnicities and/or from different geographical regions. METHOD: Magnetic resonance imaging data of five population-based coh...

INTRODUCTION Few studies have explored dementia risk according to sex and gender including for transgender and non‐binary adults. This study evaluated dementia risk factors and risk scores among cisgender, transgender, and non‐binary adults. METHODS Observational data were drawn from the 2019 Behavioral Risk Factor Surveillance System. A matched‐c...

In this cross-sectional study, we examined the extent to which features of the neighbourhood natural, built, and socio-economic environments were related to cognitive age in adults (N = 3418, Mage = 61 years) in Australia. Machine learning estimated an individual's cognitive age from assessments of processing speed, verbal memory, premorbid intelli...

There is a clear need to identify older drivers at increased crash risk, without additional burden on the individual or licensing system. Brief off-road screening tools have been used to identify unsafe drivers and drivers at risk of losing their license. The aim of the current study was to evaluate and compare driver screening tools in predicting...

We absolutely agree that the language used is important, and that the language of risk is very often geared towards a biomedical paradigm, in which an individual is at risk, and actions taken by them (and their healthcare provider) may or may not avoid the translation of risk into disease. We agree that this represents an insufficient perspective f...

High dementia prevalence and associated disability have necessitated a focus on the identification of potentially modifiable risk factors. One such example is type 2 diabetes; however, there are not enough large population-based studies that can provide an accurate estimate of the strength of the association. Therefore, we investigated prospective...