Researcher in focus: Professor Clive Ballard

Ahead of his arrival, we spoke to Professor Ballard about his aims for the Medical School, the misunderstood areas of dementia, and what the major targets are for dementia research.

What attracted you to join us as at the University of Exeter?

The focus and the ambition of the university, the trajectory of development and the way the university has moved forward is great. Also the Medical School strategy areas mapped with things I am personally passionate about.

What is your research background?

The work I have been doing is quite broad, Ranging from prevention of dementia, biological mechanism and drug discovery through to the needs of people with more severe dementia living in care homes and the overuse and harms of anti-psychotic medication in these individuals.

When I started this work focussing on antipsychotic medication, in the late 1990s, about one in two people with dementia in care homes were prescribed these drugs, Research I’ve led and been involved in has played a key role in showing the harms and limited benefits of those medications, leading to a 50 per cent reduction in their use.

Some of my recently published research has shown that better training of care staff can half the use of anti-psychotic medication, improve quality of life, and reduce mortality.

I’ve also conducted more traditional pharmacological interventions. For example, I’ve played a key role in the development of a novel anti-psychotic pimvasnserin, which doesn’t have the side effects of other medications in patients with psychosis related to Parkinson’s. This has led to the licensing of the medication in the US, which is a brand new classification and is hopefully a step forward in treating psychiatric symptoms in people with Parkinson’s disease without the adverse effects of previous therapies.

Another thing our group has been working on recently is an online study called PROTECT, led by my colleague Dr Anne Corbett who is also joining us in Exeter. We have around 20,000 participants who are providing psychological assessments, donating DNA samples, and taking part in clinical trials.

Using large online studies we can engage with the community to understand research priorities. It’s a two-way stream: one way is doing the research; the other is using the volunteers as a broader patient public involvement group.

How do you feel about the progress made with research into dementia?

Psychosocial care has improved tremendously, diagnosis has improved a lot, and we understand a lot more about the biology of the disease.

The disappointing thing is that it hasn’t yet translated into substantially effective therapies; particularly, pharmacological therapies.

What are the major targets for dementia research moving forward?

The areas of real weaknesses are around moving the biological understanding into specific targets for treatment, moving that forward to the identification of specific therapies, and then manned studies of these therapies. It’s that bit where the chain goes from basic biological understanding to the final phase clinical study. The two end bits are okay but the bits in between need to be more joined up.

There needs to be more mechanisms to create links between academia and biotech and for there to be clearer funding routes for biotech companies wanting to develop products.

“The lesson here is about not being too hooked on a hypothesis. Sometimes the more interesting things come from the results you weren’t expecting.” Professor Clive Ballard, University of Exeter Medical School

What are your ambitions for the development of dementia research at the University of Exeter?

I want to see all areas of research developed – not just dementia.

For the dementia research, though, I would like us to become one of the country’s leading centres in certain areas. There is already a lot of strength around non-pharmacological intervention studies and cohort studies, with work from researchers like Professor Linda Clare, we can build upon that.

A very neglected area of research is severe dementia; care home research is another really important area; it’s something I have spent a lot of my career focussing on – quality of life, overuse of medications.

There are also opportunities for higher quality biomedical research. There is lab based work already happening – the genetics and epigenetics work is really strong – this is something we can build on.

There’s also a real opportunity to conduct more clinical trials and get involved in larger cohort studies.

I also like the idea of precision medicine. For example, we know patients with diabetes have an increased risk of dementia; we also know some of the things leading to dementia in those individuals might be related to insulin signalling problems. There are opportunities to bring together areas of expertise in a way that allows more precise treatment for an individual.

What are the least known / most misunderstood aspects of dementia in the public sphere?

People are very frightened of it, which is understandable, part of that fear is the feeling that nothing can be done. Some of what can be done is about symptomatic drugs and therapies we already have; a lot of it is to do with proper support, proper information, and other things which enable people to optimise their quality of life.

We don’t necessarily get those messages out very well. Peoples’ understanding of it is often: ‘There’s no cure, therefore it’s all hopeless’. That’s an important misunderstanding because it stops people going to the doctors for early diagnosis and treatment.

How did you get into the field of dementia research?

It was kind of coincidental, actually; at medical school I always wanted a career in Psychiatry, but not really with older people. My first trainee post was in old age psychiatry and the way people were treated and cared for was so awful. I just thought ‘there has to be a better way of doing this’.

You would have a ward full of people who were over-medicated and had Parkinson’s symptoms because of drugs’ side-effects. There were no proper Occupational Therapy assessments, and when we went out to do care home visits the homes were desperate environments.

One which sticks in my mind had 200 residents and was a converted school; the main sitting area was a school sports hall, the chairs were in a circle with a big TV in the middle and I thought: ‘You can’t treat people like that!’
A lot of other areas of research at the time needed a lot of high-tech things to make a difference. It felt like this was about such basic things – proper medical care and proper social care. That is what grabbed me initially.

What were the ‘eureka’ moments in your career that shaped the direction which you have taken?

Going back to the area of anti-psychotics, it wasn’t what I set out to do. What I set out to do was to look at the impact of psychiatric symptoms on the quality of life of people with dementia. When I analysed the data it showed that the drugs people were being prescribed were having a far worse impact than the symptoms.

The lesson here, and one of the things I get nervous about, is about researchers are too hooked on their own hypothesis. Sometimes the more interesting things come from the results you weren’t expecting.