There is an old adage that ‘an ounce of prevention is worth a pound of cure’, and this is what drives Dr Hiroko Dodge’s research philosophy in dementia and cognitive health.
Hiroko jointly directs Biostatistics and Data Core at two Alzheimer’s Disease centres in the US (Oregon Health & Science University (OHSU) and University of Michigan (UM) Alzheimer’s Disease Centre) and is Associate Professor of Neurology. Her background as a statistician and her wide-ranging research interests which include the epidemiology of dementia, clinical trial methods, longitudinal data analyses and healthy vs. pathological ageing, underpin the science behind behavioural and clinical interventions.
“Based on epidemiological studies, we know potential protective factors against dementia include controlling vascular disease risk factors during mid-life, enhancing social engagement and cognitive stimulating activities, and having a healthy diet. But modifying people’s lifestyles is difficult, and any behavioural intervention, including social engagement, exercise, meditation and healthy diet needs to be sustained,” she said.
“We all know that merely telling people to follow a healthy lifestyle does not necessarily work for all. I believe it is time to invest more on implementing sustainable behavioural interventions at a community level,” she said.
There are currently few community-based prevention protocols which are sustainable on a large scale. Hiroko believes that society needs to build an environment where intervention approaches can be almost effortlessly sustained by many people.
“The approaches will differ between developed and developing countries, and by cultural settings and this will also require creative solutions and additional resources,” she said.
So, what does this mean for Hiroko’s next research steps in dementia prevention?
“I think there are two important steps. The first is to detect early signals of cognitive decline while people are living in their communities through ecologically valid methods like unobtrusively monitored in-home activities or highly frequent digital data collection,” she said.
“The second is to modify people’s environment so that behavioural interventions can be implemented and sustained by many people within their own communities.”
An example of this kind of creative behavioural intervention on a sustainable scale is evidenced by her previous National Institute on Aging (NIA) funded randomised controlled clinical trial which examined whether stimulation through social interactions using modern communication technologies could improve cognitive function.
The trial found some improvements in certain domains of cognitive function such that Hiroko is now expanding the trial to include socially isolated elderly people with normal cognition and mild cognitive decline (MCI).
Hiroko’s other major area of interest is in improving clinical trial methods, which ties in closely with her work as a statistician.
“Highly frequently observed functional outcomes, for example, could provide more precise and individualised trajectories and could lead to more sensitive trial outcomes to be used in preclinical trials.”
Hiroko is a founding member of IRNDP and a member of the leadership committee.