Simon Bell

Although dementia disproportionately impacts global disease burden, people with dementia are usually not included in key clinical trials to provide evidence of medication efficacy and safety. With the ‘Four Continents For Dementia’ (4C4D) initiative, we aim to provide new evidence to inform prescribing for people with dementia.

We have shown that people with dementia have similar responses to different dual blood pressure treatments compared to people without dementia. Our results give reassurance to prescribers when choosing the effective treatment combinations to prevent cardiovascular events and improve survival in people with dementia. We also found that people with diabetes and dementia will equally benefit from newer, so called SGLT2 inhibitor medications or “gliflozins” for type 2 diabetes, which have previously shown to reduce the risk of heart disease and hospital visits due to heart failure. We have now demonstrated that similar benefits occur in people with dementia. However, other newer diabetes medications, so called DPP4 inhibitors or “gliptins” are no necessary advantageous in preventing cardiovascular events than older diabetes medications, but they may be better in improving survival.

When studying preferences of prescribers, carers and people living with dementia for ceasing a blood pressure medication, people living with dementia considered important that pill burden was lower after the cessation. However, carers of people living with dementia and prescribers would not cease blood pressure medication to lower pill burden. Overall, out study highlighted that all three groups valued different attributes when considering whether or not to cease blood pressure medication. This emphasises the importance of shared decision-making within the deprescribing process.

Lee H, Baek YH, Kim JH, Liao TC, Lau WCY, Man KKC, Qin X, Wood S, Ilomäki J, Bell JS, Lai EC, Leung MTY, Chan AYL, Chui CSL, Wong ICK, Shin JY. Trends of polypharmacy among older people in Asia, Australia and the United Kingdom: a multinational population-based study. Age Ageing. 2023;52:afad014.

Geethadevi GM, Peel R, Bell JS, Cross AJ, Hancock S, Ilomaki J, Tang T, Attia J, George J. Validity of three risk prediction models for dementia or cognitive impairment in Australia. Age Ageing. 2022 51:afac307.

Wood SJ, Bell JS, Magliano DJ, Shaw JE, Cesari M, Ilomäki J. Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors vs. Dipeptidyl Peptidase-4 Inhibitors in Frail People With Diabetes Who Were Recently Hospitalized. Front Pharmacol. 2022 Jul 12;13:886834.

Wood SJ, Bell JS, Magliano DJ, Fanning L, Cesari M, Keen CS, Ilomäki J. Impact of Age, Frailty, and Dementia on Prescribing for Type 2 Diabetes at Hospital Discharge 2012-2016. J Frailty Aging. 2021;10:343-49.2

López-Rubio C, Koponen M, Lampela P, Taipale H, Tanskanen A, Bell JS, Tolppanen AM, Hartikainen S. Changes in the use of diabetes drugs among community-dwelling people with Alzheimer's disease. BMC Geriatr. 2021;21:701.

Picton L, Bell JS, George J, Korhonen MJ, Ilomäki J. The changing pattern of statin use in people with dementia: A population-based study. J Clin Lipidol. 2021;15:192-201.

Fanning Lau WCY, Mongkhon P, Man KKC, Bell JS, Ilomäki J, Dārziņš P, Lau KK, Wei L, Wong ICK.. Safety and Effectiveness of Direct Oral Anticoagulants vs Warfarin in People With Atrial Fibrillation and Dementia. J Am Med Dir Assoc. 2020;21:1058-64.e6.

Ilomäki J, Bell JS, Chan AYL, Tolppanen AM, Luo H, Wei L, Lai EC, Shin JY, De Paoli G, Pajouheshnia R, Ho FK, Reynolds L, Lau KK, Crystal S, Lau WCY, Man KKC, Brauer R, Chan EW, Shen CY, Kim JH, Lum TYS, Hartikainen S, Koponen M, Rooke E, Bazelier M, Klungel O, Setoguchi S, Pell JP, Cook S, Wong ICK. Application of Healthcare 'Big Data' in CNS Drug Research: The Example of the Neurological and mental health Global Epidemiology Network (NeuroGEN). CNS Drugs. 2020;22:1-17.

Ilomäki J, Lai ECC, Bell JS. Using clinical registries, administrative data and electronic medical records to improve medication safety and effectiveness in dementia. Curr Opin Psychiatry. 2020;33:163-9.

At the time of award, Professor Bell was a NHMRC Dementia Leadership Fellow, Centre for Medicine Use and Safety, Monash University; Adjunct Professor of Geriatric Pharmacotherapy, Faculty of Health Sciences, University of Eastern Finland; Adjunct Associate Professor, School of Public Health and Preventive Medicine, Monash University and Adjunct Associate Professor, School of Pharmacy and Medical Sciences, University of South Australia.