Straight Talk with Mark Bouris
Brain Expert: Why Dementia Is Australia's Number One Killer (Project 100)
24 May 2026
Chapter 1: What is the main topic discussed in this episode?
Professor Matthew Kiernan, welcome to Project 100 again, mate. And we'll probably run this on Straight Talk as well, if you don't mind, because I think there's a lot of people who are in the Straight Talk audience who would like to hear what Project 100 has got to say about this. So I appreciate your time.
No, thanks very much, Mark. And I really appreciate what you're doing for the community to raise awareness of brain health, mental health. It's a huge topic. I mean, I was shocked when I became aware that
The broad umbrella of dementia today is the number one cause of death in Australia. And so therefore it's overtaken heart or coronary attacks or heart attacks or, yeah, heart failure. First question to you is, is that just simply a result of us living longer and therefore if we got through cancer and heart problems that eventually our brain's going to get us?
Is that just that reason or are you seeing younger people getting it now?
Well, I think it's a combination of both of those factors. But really, you know, as a doctor, when I was a junior doctor, cardiovascular health was the key focus. And, you know, there was bypass surgery and people having heart attacks and it was the number one. And so understandably, you know, politicians in the community put a focus on trying to understand the condition and treat it.
And I think that's really the gold standard to understand that heart health and heart disease, you have to look after vascular health, stop smoking, understand the risk factors, cholesterol, blood pressure, blood sugar levels. And it was with that understanding and then some therapies coming through. And I think everyone would accept that the statin evolution has changed cardiovascular health.
And then a biomarker, so understanding that we can treat against cholesterol. And gradually you started to see cardiovascular deaths going down. In my field in neurology, stroke was always going up every single year, higher and higher and higher. And then eventually they did an epidemiological study and they saw that stroke was dropping. And the neurologists didn't actually believe it.
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Chapter 2: Why is dementia Australia's number one cause of death?
Like, how could this be the case? They repeated the study, and sure enough, stroke was actually dropping. And it's because we've learned from the vascular health approaches from, you know, cardiologists and heart physicians, and the same thing has happened.
So while that's been happening, and then obviously all the great advances in cancer because of molecular biology, understanding genetics, the whole human genome, all of these things are getting well understood, and no one has really focused on, inverted commas, dementia.
And I suppose as a community, we've often thought that it's an elderly people's condition, and we didn't really care about it, and okay, if we end up a bit demented in a nursing home, that's the cost of living. But really what's happened alarmingly is it's really come to the fore. And we're seeing there's a huge amount of dementia and neurodegeneration.
And in fact, this geographical region, the Western Pacific, carries three-fifths, so 60% of the world burden. What? Yeah. And it's going to be a massive cost. We're talking about the budget. What is that? Well, I think it's an unusual sort of racial mix, but we've got obviously a lot of Asian populations. We've got South Pacific Islanders. Obviously, we've got the Anglos from Western Europe.
But it's a huge population, firstly, and they're prone to vascular, particularly related neuro problems, dementia, vascular dementia in particular. And also, I suppose, there's a lot of underdeveloped regions. So if we think about our neighboring countries, we've been very lucky, and Australia's lucky, and there's Japan and Korea. But then it's mixed with great poverty, Thailand, Myanmar, Burma,
Thailand, Indonesia, all at huge populations. So the focus globally is to try and fix up the Western Pacific and then take some of the learnings from the Western Pacific and do refinements, particularly in Western Europe and North America. So as a neurologist, obviously I'm a bit prejudiced. I'm glad there's a focus on brain health because it's really going to be an evolution.
And in fact, the reason I did get into neurology was, you know, George Bush Sr. saying that the 90s were the decade of the brain. And the brain has been left behind a little bit. And now we're starting to understand these conditions. And we're going to be like the cardiologists of the 90s. We're going to understand risk factors. We're going to be titrating blood biomarkers.
We've got effective therapies. And it's going to be totally transformational. The joke about neurologists were they're really good at making a diagnosis, but they don't do any treatment. So you go to the neurologist to get your diagnosis and prepare your will. That was that.
Yeah.
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Chapter 3: What are the modifiable risk factors for dementia?
The other sort of big centers around Australia would be the Florey in Melbourne. There's the Queensland Brain Institute in Brisbane. And there's the Perrin Institute in Perth. But I think they're the biggest entities. Sounds like the biggest one in Sydney, though.
Yeah.
Yeah. And does government support it? Well, of course, the government does support it, but times are tough. And I suppose Neura was established on grant funding. So National Health and Medical Research Council, so NHMRC and ARC, Australian Research Council, have been very, very successful in grants. Did you have to apply for those grants?
And at present now, the success rate for grants is about 8% to 10%. And the funding has really taken a battering, and I was actually pleased in the budget to see an extra $508 million coming towards medical research.
And that had been driven by a campaign through medical research institutes, but also great advocates like Monique Ryan, who'd been pushing forward to try and get the MRFF amount fully released. But now with, you know, lowering government grants support, researchers have to reach out more to the community. And what are the best, what are the most successful ways?
Well, the most successful way to fund your research program is have an industry partner. And industry, you know, they need to make money. For example? Well, any pharma company. So examples that we're working with very closely include Roche Diagnostics based in Switzerland, Eli Lilly or Lilly Pharma United States. They're key, Teva, are key partners for us to drive our research programs.
But the beauty about having an industry partner is you're more likely to have what we call impact and translation. So in other words, your discoveries are going to make it out to the patient, to the clinic, And that's why the health district and the university are engaged, because they want to see better health outcomes. So you're much more likely to get that if you have an industry partner.
Now, the other key way that Neura has been surviving has been the support of the community. And we've been very lucky to have, you know, fantastic philanthropic support. And there have been individuals who funded whole programs and, you know, developments of the building. Margaret Ainsworth is responsible for the main building at Neura.
But I think we're starting to see that the community is investing in research with the desire to have better health outcomes. And it's really ā it's great to see.
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Chapter 4: How does vascular health impact cognitive decline?
But that was because we studied neurology on the basis of a deficit, like a stroke or an injury. In fact, okay, a lot of the neurology understanding came from major wars. So particularly World War I, bullet wounds in the back of the head, people would understand that's the cerebellum. And so it was looking at deficits. And one of the great neurologists is a guy called Charles Miller Fisher.
And he said, you learn neurology stroke by stroke. So you see a patient with a stroke, you see what part of the brain is affected, and then you see what the manifestation is that, and then that's your understanding. But now we see the brain more as a network. So all of these parts of the brain are communicating through these nerve fibers.
And when the blood supply is affected, they start not working as well as they should. So the speed of the signal getting through is less. Sometimes they die. So little parts and little holes start developing, small strokes, micro strokes at a very molecular level. So you wouldn't see it if you had the brain in front of you, but if you put it under a microscope, you'd see it.
And you probably can't detect it either while someone's alive. Unless there's a certain amount happening, like a volume. It's a volume effect. So we start to see it with MRI scans, but by that stage, it's more often than not more severe. More problem. So right at the beginning, and that's the trouble. We don't know when this begins.
So it could be beginning 20 or 30 years before the patient manifests any symptoms.
And what causes this blood supply problem? Like, in other words, I presume what we're talking about is a reduction in blood supply.
Reduction in blood supply. And it's really been driven, the understanding through vascular research, so cardiovascular health, so understanding that the wall of the blood vessel gets thicker, the sort of the lumen or the hole in the middle gets smaller, less blood gets out there. Sometimes the vessel actually breaks apart a little bit. A bit of ooze and blood and proteins escape into the brain.
That's the process. And that happens in general areas. Interestingly, one of the key problems that you see is people start falling over. And everyone thinks, oh, falls are normal. No, if you have a fall, that's abnormal. I mean, obviously, if you have a fall, you're running and you trip on a gutter, that's understood.
But if you're walking around the house and you fall over, you're on the street and you fall over, that's abnormal.
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Chapter 5: What groundbreaking treatments are available for Alzheimer's disease?
Retreating from what? Social interaction? Social engagement. Oh, really? And so social engagement is another critical factor that was identified by the Lancet Commission. So the more that you're engaged in a profession, a work, an environment, a community, a sports environment, a rugby league club, the better off people go. And if you're isolated, the brain doesn't like isolation.
So, these are all modifiable risk factors. And then how could you sort of cut off a few of them? Well, firstly, like if you like exercise, are you involved in a community approach or is it a particular exercise that you like doing, aerobic type of exercise, but also resistance training? And these, again, are modifiable risk factors for dementia.
Another part of that that's only really come out in the last few years is an understanding we call frailty. So you might have said, oh, someone looks a bit frail. That doesn't really mean anything. But frailty is, it's a two-way process between the body and all of the body organs and the brain. So when the brain stops working, the organs don't work as well.
But if the organs don't work as well, the brain stops working in converse. So you don't let yourself get frail. How can you prevent yourself from becoming frail? Well, resistance training, high-protein diet, aerobic training, stay engaged with the community. These are the things that are going to help brain health.
I remember Mark Penny, Professor Mark Penny, once told me about, because I was talking to him about his dad, Ron, who died from dementia. And Ron was like a genius, skinny, fit, walked up the stairs to a level of whatever it was every day at St. Vincent's. And I said to Mark... are you worried about your genetic predisposition perhaps? And would you bother getting a genetic test for dementia?
And he said, no. And I said, why? And he said to me, the reason why, he said, is because even if I find out, the solution right now, I don't have any symptoms, but the solution right now would be to do high intensity exercise. And he said, so I'm also doing it anyway, whether I get a diagnosis or not.
Therefore, I don't need the diagnosis because getting the diagnosis can cause a lot of anxiety and people do retract socially and all sorts of things. He said, I'm better off probably not knowing. But doing the very thing that they would recommend me do Anyway, and so how does high-intensity exercise assist in that regard?
Well, I think obviously he was a visionary. But yeah, when you exercise, for instance, blood vessels dilate. So the blood vessels dilate, more blood flow starts going through. In your brain, you mean? In your brain and all over your body, but in your muscles. So it's just reflecting what's going on.
But a number of conditions are also associated with other metabolic changes in the brain and the body in a general sense. So insulin resistance, metabolic health, mitochondrial function. So all the cellular approaches, inflammation, inflammation in the brain, inflammation in the organs of the body.
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Chapter 6: What role does sleep play in brain health?
And by the way, medical technology will get us there now because they can fix the heart, they can replace the heart, they can fix kidneys, they can fix just about everything, except this thing. And if they said, if you were to rate your standard of living, one thing is you probably don't want to be confronted with is
Your kids having to bathe you and not be recognized by you or your kids having to put you in a nursing home because you turn a little bit violent because you've got dementia. That would be probably the lowest standard of living I can imagine. I'd say a lot of people would agree with that. Yeah. That's the fear. Absolutely. It's a massive fear.
Yeah. And it's well-founded. I think that the essence of being a human is our brain function, our executive function, the fact that we're having this conversation now. So when that is affected in any way, it has massive implications and it's very hard for individuals and families to cope with that.
So if I could just, I just had a thought then, Matthew, if I could just go back to something. When we're talking about high-intensity exercise, you can do that when you're 40, 50, 60, some people maybe 70, but it largely depends on your mobility and a lot of other stuff, you know, energy levels, et cetera. But when you're 80...
Does high intensity then mean ā I mean, how do we measure high intensity? Is it about my heart ā as a percentage of maximum heart rate or is it ā and therefore, you know, take 120 to minus 80 and it gives me 140, I mean, and I go try to get 85% of that or ā Or is it, what is it? What is high intensity exercise?
Well, that is exactly it. But I suppose when you're 80 or 90, are you going to suddenly do a high intensity exercise for the first time and do it as well as a 20 year old? No. So you're going to be doing it in your 20s, 30s, 40s, 50s, 60s, 70s and 80s. And in fact, by doing that, it makes it more likely that you are going to be able to do it in your 80s, 90s and 100s.
I see a lot of people who come in who were in fantastic health in their 80s and 90s. So that's the message. You don't have to be in bad health. You don't have to have, you know, disability. But that hasn't come out of nowhere. Yeah. So it's like doing homework all day, every day for the course of your life.
Yes. And to that extent, and this shows a lot about this, is that they've got to take control. Individuals, but they're not going to take control unless someone makes them aware. and sort of gives them a bit of an indication of the type of lifestyle. That's lifestyle stuff. Change your lifestyle. Don't drink as much. Don't drink at all if you can help it. No cigarettes at all.
Eat the right foods. Don't put on too much weight. Exercise properly. Sleep is really important. I do want to talk to you about something, this APOE thing. Chris Hemsworth did his show on whatever the streaming platform was. He talked to Peter Atiyah. Peter Atiyah did a blood test on one of the most athletic-looking people I've ever seen on television, and I dare say he therefore is athletic.
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Chapter 7: How are blood biomarkers being developed for early detection of dementia?
But of course, an N equals one, i.e. yourself, it's not an exact science. Yeah. So, and as I understand it, it's something like...
People who pass away with perhaps Alzheimer's disease or some form of dementia, probably heart attacks too, but 10 times more of those people have the genotype E4.
we're both they got both parents it's a 10-time factor so in other words it's correlation it's not a causation but let's say and look he looks great i mean and obviously he's adjusted his lifestyle and by the way i don't mind telling everyone i'm the three four so i got e4 from one of my parents um don't know which one but one of them um and uh i don't know who to blame someone mom or dad it doesn't really matter because they both passed away but um
Point being is that there's a, I don't know, six-time, I don't know, ten-time chance, like some other statistical greater chance of having a brain disorder or even a heart disorder. Because E4 actually affects your heart too. Like it's bad for your heart. As you always say, if it's not good for your heart, it's not good for your brain. E4 does that too and also has an effect on your kidneys.
It's a kidney issue too, by the way, because it's the same deal. Absolutely the same deal. Yeah, because your kidneys can get, the arterioles can get, the ones coming out of the kidney can get damaged.
Yes, and hardened.
Yeah, hardened. And then they don't filter as well. And so, you know, you start getting early kidney disease.
That's exactly right.
So it's a big deal. Yeah. And we should be getting tested for this sort of stuff more often. So E4, just to explain a little bit more, if you don't mind, because one of the things that, as I understand it, Matthew, is that And amyloid accumulation and tau come about as a result of other processes that happened before that, way before those things started getting produced. And there is...
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