30 Jun 2020
Dr Rebecca Koncz’s research explores the pathophysiological mechanisms of Alzheimer’s disease, particularly amyloid accumulation, as a hallmark feature of the disease. Utilising data collected from CHeBA’s Older Australian Twins Study, she is attempting to answer the classic “nature vs nurture” question – specifically, what proportion of amyloid burden is attributable to genes, and what proportion is determined by environmental, or modifiable, risk factors.
How did you get into researching the ageing brain?
I’ve always had an interest in the brain sciences, having completed a major in neuroscience in my undergraduate degree. I further dabbled in brain-related research during my medical school years at Westmead, when I completed my Honours thesis looking at specific EEG correlates in first episode psychosis. Then in 2015, during my psychiatry specialist training, I took a secondment from Sydney Local Health District to begin my training in neuropsychiatry at the Neuropsychiatric Institute, Prince of Wales Hospital. It was an exciting opportunity and the first-time this position as a Neuropsychiatry Clinical and Research Fellow was offered. This position not only shaped the trajectory of my clinical practice as a neuropsychiatrist but is what pivoted my research focus towards brain ageing. That was five years ago and I am now completing my PhD with Professor Perminder Sachdev at CHeBA.
Did you experience a ‘defining moment’ which led you to this field?
There was no defining moment as such, but perhaps more a confluence of being open to opportunity, discipline, mentorship and good fortune. Like many aspects of my career, finding this field seems to have partly happened by accident, although it has certainly been for the better. What led me to the field initially was my interest in clinical neuropsychiatry, and it was a natural fit to look further into neuroimaging aspects of brain ageing and neurodegenerative disease. The first project I worked on was looking at incidental findings on MRI scans in the Older Australian Twins Study. I really enjoyed it, in particular the neuroimaging side of things, which lead me to commence my PhD in this area.
Do you have any personal interests or activities which are protective behaviours against cognitive decline?
I enjoy spending time in nature and keeping physically active. A few years back I discovered dance classes through the local gym, which to me have been an absolute lifesaver for my physical and mental wellbeing – not to mention a great social outlet as I have connected with many wonderful people along the way.
Dancing is a cognitive challenge. I have to pay close attention to keep up, otherwise I make a complete fool of myself! It’s a place I certainly can’t take myself too seriously. It’s also great physical activity.
So both the physical and complex mental activity components contribute to better brain health. Over the years, what has also developed is a beautiful social community who join these classes from all walks of life. Since I am unable to attend classes at the moment, I have started doing yoga online and getting back into nature. It’s also forced me to start jogging, which is something I have never felt I was good at but have, surprisingly, found myself enjoying these past few weeks.
What are you currently researching?
My PhD is looking at amyloid as a hallmark feature of Alzheimer’s disease, using a type of brain imaging called amyloid PET, which stands for positron emission tomography. My research uses twins from CHeBA’s Older Australian Twins Study. The twin methodology is a unique way in which we can look at what proportion of amyloid is due to genetic factors, and what proportion is due to environmental or modifiable risk factors. With regard to modifiable contributors to amyloid burden, I have been interested in how vascular risk factors contribute to the risk of this burden. Things such as hypertension, diabetes, cholesterol, or a history of heart disease or smoking. In other words, I am asking – do these cardiovascular risk factors directly influence the build-up of amyloid? This is highly relevant because if we can identify modifiable risk factors, then we may be able to alter the trajectory of amyloid accumulation as we age. The other component this research looks at is the interaction between amyloid burden and cerebral small vessel disease burden. We know vascular risk factors contribute to cerebral small vessel disease, but not yet whether small vessel disease and amyloid accumulation have a direct interaction with one another. At this stage, based on the available evidence, it seems that they are independent processes but are probably additive in their effects on cognition.
Why is your research important?
It is important because the build-up of amyloid is thought to be one of the critical initial triggers for a cascade towards the development of Alzheimer’s disease. In fact, it occurs decades prior to the onset of symptoms such as memory loss, making it a potential early marker of who might be at risk of developing dementia. We know that Alzheimer’s disease, which is the leading cause of dementia, has a tremendous public health burden, particularly as the world’s population ages. If we can better understand the genetic and environmental determents of amyloid, we might be able to work towards earlier detection and diagnosis of people at risk of Alzheimer’s disease, as well as identify appropriate strategies to reduce this risk.
What do you love about working at CHeBA?
Working with CHeBA has provided me with a diverse range of professional opportunities. In doing so, I especially love the opportunity to think creatively. This may sound funny because as researchers we are meant to follow rigorous scientific methodology. However, my work with CHeBA enables me to think outside the box about complex problems, how to analyse them and find innovative solutions. The other major component I love about working with CHeBA is the people!
The mentorship, collegiality, support and friendships found during my years with CHeBA has been highly influential and extremely important to me. There is definitely a strong sense of collaboration, both within CHeBA and extending to our external partnerships, which I believe is core to the culture of CHeBA and part of what contributes to its success.
What is the ultimate hope you have for your research?
I feel it is early days in my research career, but in these initial stages I hope my current work contributes to bettering our understanding of pathophysiological processes of Alzheimer’s disease. Ultimately, I hope there is translational benefit from this research to our broader community globally, in helping people to not only reduce their risk for developing Alzheimer’s disease, but ultimately building strategies to develop cognitive resilience in the pursuit of healthy brain ageing.
This interview was undertaken during the COVID-19 self-isolation period. Dr Rebecca Koncz found that having video calls with her family and friends kept her feeling socially connected while physically isolated.
Dr Rebecca Koncz is a Neuropsychiatrist and PhD candidate at CHeBA investigating the genetic and environmental determinants of amyloid burden in the Older Australian Twins Study cohort. She works clinically with Sydney Local Health District, and is a Senior Lecturer within the University of Sydney’s School of Medicine at Concord Clinical School. Her broader research interests include neuroimaging of the ageing brain, particularly structural magnetic resonance imaging and amyloid positron emission tomography (PET). In her spare time, Dr Koncz enjoys spending time in nature and keeping active.