This is the Whole Care Network. Music Helping you tell your story, one podcast at a time. Content presented in the following podcast is for information purposes only. Views and opinions expressed in this podcast are solely those of the host and guest and may not represent the views and opinions of the Whole Care Network. Always consult with your physician for any medical advice and always consult with your attorney for any legal advice. And thank you for listening to the Whole Care Network. Music What if you could make small changes and intentionally have conversations with your loved one that stimulates their brain? In this episode, Sue and I are talking with Dr. Daniel Fenton, head of Neuropsychological Services at New Days, about how we can structure conversations we have with our loved one to keep their brains active, socially engaged, and mentally challenged. We're sharing three tips. Welcome. We are Sue Ryan and Nancy Treister. This podcast brings our years of experience in a variety of family caregiving roles to prepare you to navigate your caregiving journey. We're sharing our personal experiences, not medical advice. And because it's our passion to support you on your journey, we believe no topic is on limits. Let's get started. Music Welcome, Daniel. We're excited to bring the concept of cognitive stimulation therapy through structured conversations to our listeners. While we know they don't reverse dementia, they do help people function at their best for longer. Today, we're discussing how to use conversations on fun and engaging topics to keep the brain alive, socially engaged, and mentally challenged. It's a way we can maximize the time we're already investing in our care receiver. It's not about doing one more thing. It's actually more about doing what you're already doing and sneaking in more benefits along the way. Daniel, you're a neuropsychologist who specializes in helping people with mild cognitive impairment and early stage dementia. Your work provides structured and what I think is most valuable, it's research-based care. And you're providing this to the people who are navigating memory or thinking changes so they can maintain their independence and improve their quality of life. And this is so valuable. Daniel, please tell us about cognitive stimulation therapy and why it's so important. Yeah, absolutely. Thanks so much, Sue and Nancy, for having me. I appreciate this opportunity. So cognitive stimulation therapy or what I'll call CST, it is indeed evidence-based and it's for people who are experiencing mild to moderate cognitive decline. And this includes conditions like mild cognitive impairment or MCI and early dementia, mild dementia. So instead of trying to repair damaged memory systems, as you were alluding to, Sue, CST really focuses on helping people use the cognitive abilities they still have, but using them more effectively. It involves sort of guided activities and conversations, and this includes things like discussing current events, solving word problems together, or even reminiscing about meaningful experiences. And all of these things really stimulate thinking and communication and different cognitive processes like attention. And it does this in a supportive and social environment. And the idea is the way I like to describe it, it's sort of like physical exercise. While we can't reverse aging, regular mental activity, these exercises, regular cognitive engagement, helps keep these cognitive skills stronger for longer. It's like exercising your body. So let's talk some more about that, because I know there are a lot of other benefits as well. Let's talk a little bit more about the benefits. Drill into that for us. Yeah, absolutely. So one of the biggest benefits of CST is that, as I was alluding to, it helps people keep their minds active and functioning as well as possible for longer. And the research shows that, in fact, it can lead to small but meaningful improvements, or even stabilization in specific cognitive areas like attention and language and thinking speed, or what we refer to as processing speed. And because CST is very interactive, it's inherently interactive because it's a conversation, it also strengthens communication skills. People practice expressing their thoughts, they practice expressing, or rather they practice finding words, which we know is a common symptom and complaint for people experiencing cognitive decline, MCI, myotementia. They're participating in discussions and all of these things improve confidence in everyday conversations. It also has really, it has important emotional and social benefits, cognitive stimulation therapy. The cognitive changes can sometimes cause people to withdraw socially. We see that often, but CST provides a supportive environment where people can stay engaged, they can stay connected, the interactions are purposeful, and ultimately this improves overall well-being. And in fact, sort of separately, a kind of fun nugget of information I always like to discuss is that there is research that shows that the cognitive benefits gained from CST are in fact comparable to certain dementia-related medications, now with the added advantage of social engagement and emotional support. You certainly don't get that with medications, but you do out of a semi-structured conversation. Daniel, all of this just sounds amazing. When is cognitive stimulation therapy the most effective? So, CST is most effective during the mild to moderate stages of cognitive impairment, and again, this includes MCI and mild dementia, and this is because it requires individuals to have enough language skill, enough attention capabilities, and enough social skills to participate in this intervention actively. What I love about this is the whole concept of cognitive stimulation therapy or CST is that we can actually take advantage of it at home as well. And so that leads us to tip one. Daniel, you're going to teach us how to really leverage the structure, create a simple structure that lets us do some CST at home. Exactly, yeah. So, CST does indeed require a structure. So, the way I like to build my CST sessions or interactions are sort of in three parts. The first part is orientation. I like to orient the people that I'm working with. I'm sure some of your listeners can relate. A lot of the people that I work with don't know what day it is, what season we're in, what year it is. And so I think it's always sort of important to remind them when it is and where they are. It's sort of creating a foundation for what we hope will be a meaningful conversation. The second piece of this is the activity itself, the meat and potatoes. And we'll get into that. I understand a little bit later on. And then the third piece of this structure is a wrap up and reflection. Again, we'll get into this later on. I find that the wrap up and reflection is actually critical to cognitive stimulation therapy. One of the things that I've noticed is that people with these conditions, people with cognitive impairment, with these memory difficulties, might not remember the content of the conversation that you have. And that's okay. Now, what they will remember, what they will hold onto is how the conversation made them feel. So if during the wrap up and reflection, we're able to focus on what this interaction brought up for them, these hopefully positive emotions and reinforce that and highlight that during the wrap up and reflection, that positive feeling will linger on much longer than a recollection of a conversation. So, Daniel, before we get into the actual activities themselves, the second tip, what are some examples of the orientation just to give our listeners a couple of examples when you say you like to orient people? What are a couple of examples of what you do? Yes, absolutely. So it is quite simple. And usually what I don't, in fact, ask them what day is it, what month is it? Because we certainly don't want this experience to feel like a pass or fail examination. And I'll get into that as well a little bit later on. So really what I'll do is just take it upon myself to say the day, what day it is, the date. So the date includes where we are in the month, the month itself, the year. And then I always like to say where we are physically. And if there are anything, you know, any upcoming important events, a birthday, an anniversary, a graduation, you know, feel free to include that in your orientation. Just, you know, orienting them to what's going on in their lives. Again, I always find that to be sort of a helpful foundation. Daniel, using the structure is very helpful. And so having activities of things we can be doing at home are going to be important. So that leads us to tip two, leverage these types of activities. Yeah, absolutely. So this is the, these are the activities. This is the meat and potatoes. So there are many, many things that you can do that sort of fall under the umbrella of cognitive stimulation therapy. So these are going to be just some, some typical things that, that I do. One of them is to discuss a current event. You can read a short story out of a, out of your local newspaper and ask your loved one opinion based questions on this story. What do you think about this? What do you think about that story? What are your opinions on it? Would you have handled it differently? If you were the president, what do you think is going to happen next? The key here is to focus on reasoning and to focus on opinion and not recall. We don't want this, as I mentioned, we don't want this to feel like a, like a pass, fail test. So what we're really all we're doing is just trying to elicit reasoning opinion in the, with the purpose of, you know, stimulating the brain and, and getting the gears turning, so to speak. One of the activities that I like to do is sort of name as many animals as they can. Now here we're not necessarily looking for speed. We're not necessarily looking at how quickly they can do this, but instead we're looking at quality and quantity. So for animals, for example, there is a difference if someone says dog or cat or fish when I ask them to name as many animals as they can. These are good answers. These are good responses and they're engaged and they're participating, but there is a difference between dog and cat and fish versus another type of response, which might be alpaca or lemur or flying tree squirrel. Both are good sets of responses, but they're different. One engages the brain a little bit more deeply, a little bit more strongly. Now I want to reemphasize both are good, both are fine. They're just different. Another activity I like to do that sort of follows this type of structure is packing for a trip. So I will ask the individual that I'm working with. I'll say to them, hey, you know, what would you pack in your suitcase if tomorrow we're going to Tibet and we're climbing Mount Everest. But then I got news for you a week later, we're flying to Hawaii and we're going to go lounge on the beach together. And so we requires, it requires a different type of conceptual thinking. It requires what we refer to as executive functioning, what we call cognitive set shifting. Now that engages the brain in a whole different way than the animals task I previously mentioned. Another kind of fun and engaging task I like to do is prompt my the individual I'm working with with a word just a random word. And actually for me, I like to prompt them with like an environment. So I'll say beach, or I'll say desert, or I'll say jungle. And then I'll ask them, well, you know, what's the first thing that comes to mind. And I'll have them describe to me what's in their mind. And again, there's no pass or fail. This isn't an exam. Really, all it is is stimulation at its purest form. I want them to think I want them to use their brain and flex those those cognitive muscles. Another kind of fun and really something that I do almost every time I meet with someone is a reminiscent style therapy. And perhaps some of your listeners are familiar with this type of therapy, reminiscent therapy. And this task, what I'll have the individual I'm working with do is pull out an old photo album, and we'll go through the photo album, picture by picture page by page. And I'll point to the photos, and I'll say, I'll say, wow, what's going on here what's happening in this photo. I'll point to another photo, and they have cake all over their face from a birthday when they were five and I'll say, wow, how do you think you felt during this photograph. And again, there's no pass or fail. This is just this is just to get them to think and reimagine what might I have felt like with cake all over my face when I was a little boy. And I'll point to another photo and I'll say, wow, this this was a special moment for you and your family watching your son graduate. What do you miss most about that time. Again, this is opinions, right, this is reasoning. And I found that emotions, you know, an emotion sort of based exercise really strengthens engagement, which is what we want, right, we want them to be engaged, we don't want them to feel like this is a chore. And if we're able to embed emotion, you know, that's, that's really, that's really wonderful. You know, I feel like we all struggle sometimes to have meaningful conversations with people have mild dementia. And so, and especially if we have people come to visit that don't really know how to talk to our loved one. You know, it's easy to get caught up in let's just watch TV or, you know, or just, you know, continue across our normal daily routine. But this gives us some focus, I think, in terms of how we have those conversations and, as we said in the beginning, makes us feel a little bit more like we're not doing anything additional. We're just being more intentional about what the conversations we are having with our loved one. I do want to circle back to tip three, though, because we did talk earlier in your structure about how important it is to make sure that we wrap up and reflect. So that's tip three, make sure we wrap up and reflect. Yes, exactly. So a wrap up session, or I should say a wrap up piece to this is is important, as I mentioned. So it does a few things. It reinforces what was discussed. You are able to revisit the main ideas of what was discussed the activities from the session. And this really helps the people, your, you know, the loved ones, the individuals you're working with, it helps them process and organize what they just did. And that supports different cognitive processes, supports thinking, it supports attention and comprehension. And even if memory is impaired, even if memory is a difficulty, summarizing the session can really help to strengthen the overall sense of experience. It harkens back to what I had said earlier where they're able to hold on to that emotional piece, maybe not the content of what was discussed, but the emotional piece lingers on. The wrap up also really helps to build confidence. It highlights success, or it should be used to highlight success. So for example, acknowledging good participation, thoughtful ideas, or even creative answers. Many people with cognitive decline worry about making mistakes. So ending the session by emphasizing what went well really helps to boost confidence and motivation to participate again, which is of course very important. And the, you know, the CST session follows a consistent structure. It's an introduction. It's the activities that mean potatoes part, and then it's the wrap up. And this predictability helps our loved ones. It helps the individuals we're working with feel oriented and comfortable. And this is especially important for people with cognitive difficulties. And you'll thank you so very much. What I think is so important about what you've created with cognitive stimulation therapy is that each of us can go out and do this today. This is something that we can do with our loved ones immediately and continue that and engage with them. So toward that, please share with us more about new days and, you know, how you're putting the concepts to work and how people can find you. Yeah, absolutely. So I am the head of neuropsychological services as both of you had mentioned for a virtual clinic called new days. And what we do at new days is essentially employ what I've just described here through two different avenues, two different mediums. So our clinic users, our members engage with us one on one, you know, human to human and you'll see in a minute why I say human. So, so I will talk to them virtually through the computer screen and we'll do cognitive stimulation together. And then they will meet hopefully on a daily basis with our AI brain trainer who we've named Sunny. So sort of a kind of fun and maybe easy way to think about this is equating it to something I was talking about earlier physical exercise. So if you if you sort of think of our clinic and you think of me as like a physical therapist or personal trainer, you know, I'm going to be working out with you one on one and I'm going to be giving you the exercises and telling you how to do this and telling you how to do that. And giving you quote unquote homework cognitive stimulation homework and you'll be able to complete that homework and engage those exercises on a daily basis with Sunny again our AI brain trainer. So that's sort of what we what we do at new days in a nutshell to find us. It's really easy. You know, visit our website new days. AI new days. And there's a lot of ways to get in touch with us. You can call our administrative staff directly. You can engage you can engage and sign up for a free account and talk to Sunny on your own and see if you jive with it. See if you like it. You can if you're into it and you're like, I want to join I'm ready. You can you can schedule your first appointment. If you're still kind of on the fence and not sure and you want some more information but you want to talk to someone. We offer free consultation. And so you can sign up for that as well and we'll talk to you about exactly what we do, maybe in a little bit more detail and answer all sorts of questions that you might have. Yeah, so that's a little bit about about what we do at new days and how to get ahold of us. Wonderful. Let's summarize. Thanks for me as well Daniel for joining us today and educating us on cognitive stimulation therapy and how we can apply it at home or if our loved ones in a community. It was really, really very powerful I think to help us understand how we can take advantage of it. We shared three tips. Tip one was to create a simple structure. Tip two, leverage these types of activities. And tip three was don't forget to wrap up and reflect. Now if you have tips on having conversations with your loved ones, please share those on our Facebook page or Instagram page. The links are in the show notes. If you like this podcast, please subscribe to it or follow it and please share it with others. We really, really appreciate it. For every podcast, there is a matching blog that effectively is the notes from the podcast. So you can go out to our website, use this podcast number, find the blog with the exact same podcast number and you'll be able to get the notes for this particular topic. We're all on this journey together. Yes, we are. We're here.
