This article was originally published in the print edition of Retirement Magazine Vol. 3

Superannuation funds spend an enormous amount of time and energy thinking about money: how to protect it, how to grow it and how to turn a lifetime of compulsory savings into a stream of income that lasts as long as the member does. That is what they do by design and by law, and by and large they do it reasonably well.

But Professor Matthew Kiernan, chief executive and institute director of Neuroscience Research Australia (NeuRA), says funds might be missing the bigger picture. The best possible retirement is not solely a problem that can be solved mathematically or with clever financial engineering; it is also a brain health problem.

Declining brain health and function is now the number one cause of death in Australia, Kiernan says. It cruelly robs individuals of quality of life and is a major contributor to shortened longevity.

“The problem is people are dying, or, worse than that, they’re living, but their quality of life is just shot,” Kiernan says.

“There’s no enjoyment, or you can’t even recognise your own children. The children are saying, ‘I go and see my parents and they don’t even know who I am’. It’s heartbreaking.

“So, we don’t necessarily think about turning things around to having huge life expectancy… but the fields that I’m working in, brain health and mental health, have typically been associated with shortened longevity.”

The most common form of dementia is vascular, closely linked to the same lifestyle factors that drive heart disease and stroke. The others – Alzheimer’s disease, Parkinson’s dementia, frontotemporal dementia, Lewy body dementia – are each driven by distinct protein abnormalities accumulating in the brain. 

“Alzheimer’s disease is amyloid and tau protein build-up in the brain. Parkinson’s dementia is alpha-synuclein. Frontotemporal dementia is TDP-43. These are different proteins that build up in the brain,” Kiernan says.

What dementia actually does to the body is often misunderstood, and it’s a lot more than someone just losing their memory, or no longer being able to recognise their kids, as might be widely believed. The brain is the “master controller” of every bodily function. As the disease progresses, it stops doing that job. 

“It controls your heart rate, it controls your diaphragm, it controls your bowels,” Kiernan says.

“What happens is you become progressively frail, and your organs don’t work as well because the master controller has been turned off or is turning off. You’re not sleeping properly, and the proteins that should be cleared from your brain every night are building up.” 

Death, in most cases, comes not from the cognitive decline itself but from aspiration pneumonia or infection – the brain no longer able to control the body’s basic functions.

Matter over mind

Our understanding of heart disease and cardiac health led to a sharp decline in deaths attributable to those causes.

“We understand the importance of cholesterol. Statins have been invented. Lower your blood sugar level, look after your blood pressure. That’s why people got on top of all of those conditions,” Kiernan says. 

As a result of this decline, dementia assumed top spot. But while the disease has not yet had its “quit smoking” moment, there’s a growing understanding of the issues that support better brain health – and, as a corollary, the issues that cause it to decline – and the development of promising new therapies and treatments.

To understand the issues caused by poor brain health, and the treatments being developed, it helps to understand the difference between brain health and mental health.

“Brain health tends to be structural, and mental health tends to be more functional. It’s a dualism, the brain and the mind,” Kiernan says.

Neurology, the study of the brain as a physical organ – its blood supply, its proteins, its “wiring” – diverged from psychiatry, which is the study of mental function and mood, more than a century ago thanks to a single historical episode.

Neurologists and psychiatrists used to do the same training, Kiernan says, until a neurologist named Sigmund Freud went to work at La Salpêtrière hospital in Paris, with Jean-Martin Charcot. “Charcot was into what he called hysteria,” Kiernan says, or what we now know as psychiatry. But when Freud went back to Vienna, his mother (who else?) told him he’d be unlikely to make money from neurology, and he’d be better off focusing on hysteria.

“That was the split between neurology and psychiatry,” Kiernan says, and the consequences were significant. Psychiatry, focused on functional symptoms such as depression, anxiety, schizophrenia and bipolar disorder, has historically lacked the diagnostic and treatment tools that are available to neurologists.

“The psychiatrists [treating patients with] schizophrenia, what do you treat? They go, ‘I don’t know’. They’ve been left behind,” Kiernan says.

But the two fields are now converging. 

“There are probably shared mechanisms. Psychiatry and neurology probably have the same disease mechanisms.”

The current “frontier” treatments in neurology, including monoclonal antibodies, biomarkers and MRI scanning, are beginning to be picked up in psychiatric research. The question being asked now is whether the same biological interventions that can halt the progression of a disease such as multiple sclerosis might also alter the trajectory of psychotic illness.

“At the moment, psychiatry only has symptom-based treatment. It doesn’t have any disease-altering medication.”
– Matthew Kiernan

“At the moment, psychiatry only has symptom-based treatment. It doesn’t have any disease-altering medication,” Kiernan says.

Slow, expensive, invasive

Diagnosing dementia is currently slow, expensive and invasive. To diagnose Alzheimer’s disease requires a clinical history and examination, neuropsychological testing, a lumbar puncture to test the fluid around the spine for amyloid and a PET scan to look for amyloid in the brain. 

“That’s basically $6,500 to $8,000,” Kiernan says. “But what we want is the family to bring, or the person themselves take themselves to the GP and maybe find there’s some changes in the protein, and then ultimately this could, for instance, [show] you’re maybe at risk of getting these conditions in 10 to 15 years’ time. Can you start intervening in your 20s, 30s, 40s, 50s so it never happens?”

In order for treatments to be developed and available through the Pharmaceutical Benefits Scheme, it’s necessary to build an Australian research database. The pharmaceutical giant Roche has selected NeuRA as its partner to gather the necessary data. 

“I’m going to fund all of the research here in the future from that platform, that’s going to be the model,” Kiernan says. And this is where super funds might come into the picture.

“We need more focus on medical research, and I must say, after a [Retirement Magazine] roundtable^[1], a number of the individuals contacted me, they’ve reached out, and there’s interest.

“Part of it is getting the message across, that these conditions are avoidable, modifiable, preventable, and now we’re starting to get [to], dare I say, treatable. You go to other fields of medicine, and they can treat everything. We have been limited in our therapeutics because we didn’t understand the disease mechanism, how it progresses. Now we’ve got that, and we’ve got an understanding now we need to intervene with medications.”

The Bismarck pension folly

Kiernan’s ambition is to help individuals keep their brains healthy and functioning normally for as long as possible, so that when death does eventually come it is from something unrelated to cognitive decline, such as a heart attack, kidney failure or a bizarre gardening accident.

“The best news would be instead of developing Alzheimer’s disease and dying at the age of 67, you will have normal brain function, and you’ll die of something totally unrelated to brain function at the age of 92,” he says.

“That’s what we’re trying to do. We’re trying to keep the brain in control for as long as possible.”

The prospect of people living life with full cognitive function is exactly the scenario that superannuation funds need to prepare for. And while that’s a separate issue from increased life expectancy, the two issues are linked: if Kiernan is successful in preserving brain health while people are living longer anyway, it will have profound implications for the structure of the retirement system.

Kiernan says life expectancy for a child born in Sydney today is already more than 100 years. With pension age originally set in the 1880s by German chancellor Otto von Bismarck – when few people lived long enough to qualify for a state pension anyway – something has to give. 

The maths of working and saving for 40 years and then retiring and living off those savings for another 40-odd years simply doesn’t work. Either contribution rates must increase massively, or people need to retire later.

Kiernan says people may need to work to age 75 to accumulate enough to retire on. If that’s true, the case for maintaining brain health is only stronger.

‘The brain never retires’

Kiernan says the best possible retirement is not only about drawdown strategies or account balances. It is also about engagement, connection and maintaining cognitive vitality.

“The brain never retires. The brain looks at any new challenge like a renaissance.” Retirement is an opportunity for that to happen. A fund manager Kiernan knows is stepping back from an executive role and relishing what comes next. 

“He said he can’t wait. He doesn’t want to get back into the office anymore. The challenges of the new life are so compelling, he’s so excited, and the brain loves all of this,” Kiernan says.

The brain continues to adapt and develop well into old age, provided it is given the opportunity. 

“As you get older, you get more and more wisdom because you have experience. So the brain is actually getting better and better and better. It can still undergo plastic change. If you get a new challenge, it actually performs really, really well.

“Being in a network, having friends and family, being… not isolated. If we start getting a mood disturbance, if we start getting depressed, being treated very actively. All of these things are the way that you can keep your brain function optimum.”

The task for super funds

Kiernan sees a role for superannuation funds, not only as potential funders of medical research but as having a direct interest in the brain health of their members.

Kiernan sees a role for superannuation funds, not only as potential funders of medical research but as having a direct interest in the brain health of their members.

The link between brain health and financial vulnerability is one funds are encountering more often, even if they don’t couch it in those terms. 

Elder abuse, the manipulation of ageing or cognitively impaired members into changing wills, signing away assets or accessing superannuation inappropriately, is a recognised problem. 

“If someone changes their will it’s relatively unusual, but if they change their will a number of times before they die, right at the end there, there’s a problem.

“Let’s say we are dementing. We’ll tend to maintain certain knowledge, like, for instance, the value of our estate. But we can be manipulated.”

If an individual is dementing and is financially abused by a relative it’s often not picked up until after the event.

“Then I’ve got a full history, they give me all the GP notes, and the person’s turning up, they’re falling over, and usually falls are an indication that they’re cognitively not working properly,” Kiernan says.

“All I have to do is put some of the medical history together, and everyone realises the person’s demented. But the solicitor says, ‘I said, do you want to change your will, and he said, yeah’ – no, that doesn’t cut it anymore.

“That abuse is rampant, and it’s a major problem, especially when people have significant estates and or superannuation. Again, it’s a critical part of maintaining brain health.

Kiernan says individuals and the people who run their superannuation funds put so much effort into aiming for the best possible retirement that it makes no sense that a significant element of what makes a great retirement is overlooked.

“The person and the brain and their families want them to have a great retirement, so let’s try and facilitate that together,” he says.

“Let’s try and maximise the function of the brain, brain health, so that it’s a happier retirement, and a longer retirement.”

Kiernan argues that funds should think about brain health as part of overall member wellbeing, with communication about modifiable risk factors such as physical activity, diet, social connection, cognitive challenge, as actively as they communicate about investment returns. 

And they should consider whether the capital they deploy could support medical research that could transform the lives of their members. After all, the financial problem of funding retirement and the human problem of living well in retirement are two sides of the retirement coin.

To learn more about Neuroscience Research Australia or to donate, visit www.neura.edu.au. NeuRA is a charity partner of Conexus Financial, publisher of Retirement Magazine.