Long-term research across the population: looking to the future Fiona Matthews

Background Population research has given us enormous understanding Many studies are now quite old Is the current population the same?

Challenges Population changes Changing technologies Changing attitudes Cost and benefit

Population change

Population Pyramids: Age Structure by Sex Figure. Age Structure 1891 Figure. Predicted Age Structure 2031

Scale of the increase within the older population Graph from National Service Framework for Older People Source: Nick Steel

Challenges for Ageing Societies Change in population age structure will influence prevalence and incidence of age- related conditions Increase in all chronic disease closely associated with age (e.g., stroke, heart disease) Dementia is such a condition

Population change Larger older population Larger oldest old population But have older people changed too? Have chronic diseases increased as fast as population?

Changing technologies MRI imaging New diagnostic coding –Mild cognitive impairment –Changing boundaries of definitions Blood tests Computer screening tests

Changing attitudes Response rates have been falling –What’s in it for me? –My life is too busy. –I’m still working. Research may need to change Too many asks will hurt us all Co-ordination of resources

Cost and benefit Population studies are expensive New technologies too expensive for large studies But diagnoses must match clinical understanding Do not need to replicate all previous work

The future underway in Cambridge MRC CFAS II ( –Understand cohort changes –Keeps a core from before to address change –Will look to understand treatments too Cam-CAN ( –Population cohort of all ages –Combined with detailed imaging

MRC CFAS II 2,500 individuals in Cambridgeshire, Newcastle, Nottingham, Gwynedd and Neath/Port Talbot First wave finished in Cambrideshire and Nottingham, nearly in Newcastle Study just started in Wales Two waves funded look for prevalence and incidence

Cam-CAN About 3,000 individuals age 18+ from Cambridge City, currently underway Recruit 100 per decile (18-88 years) for detailed imaging Focus of the imaging on healthy cognitive ageing Complete population represented Can build on new studies into the population