Since the beginning of time, humans have relied on our ever-expanding brain to survive and experience life in its entirety. Whether it’s gathering food like our stone age ancestors or build infrastructure during the enlightenment period, we have somehow managed to plan and execute every aspect of our being that has transcended into generations.
The brain is the most complex part of the body and scientists have come up with a variation of definitions as to other components that aid its function. Philosophers refer to it as the mind, an organism's mental processes and the structural and functional components on which they depend - or also known as in psychology as cognition (APA, 2018). Our cognition encompasses domains of the mind such as problem solving, memory, judgement, perception, conception and reasoning. These are characteristics that add to our being and without them, it makes the navigation of life challenging.
In psychological practice, clinicians have sought to stimulate cognitive domains through experiments. Unlike Skinner’s theory of behaviourism – whereby learning and experience occurs overtly, cognitive psychologists insist on studying mental processes. The most notable experiments include Miller’s magical number 7, where he expanded on previous work from other cognitive psychologists. Miller concluded that humans could hold an average of seven pieces of information in our short-term memory, no matter the form of the stimuli. This tested cognitive domains of memory and depending on the form of stimuli being tested (in Miller’s case for example) - was language. Another well-known experiment that tackled various parts of cognition is Asch’s 1951 conformity study where participants were asked to complete a “vision test.” They would have to determine which line on a card was longer, and conformity occurred when actors came in the room and gave wrong answers on purpose. This involved decision making, judgment as well as visuo-spatial skills to come up with their answers. It is evident that we use various features of our cognition, no matter how complex or minute. This is true also for people living with mental health and neurological disorders.
Working in psychology opens our world to observing vulnerable patients and how their conditions change due to internal processes, ultimately affecting their behaviour and vice versa.
One of the many ways we can understand how optimal someone’s cognition is, is by introducing it in as a form of therapy. Working with people that live with dementia is often seen as a ‘hopeless cause’ as individuals can’t retain much information to process their behaviour. This stigma has made it challenging for the healthcare industry to fund and uphold interests, solutions and values into older adults’ mental health services, as it is often seen as a waste of resources due to the general decline of the person at hand.
As an assistant psychologist (AP) working with people living with dementia, my main goal is to deliver quality person-centred care. This includes incorporating activities that will simulate, occupy and distract them from behaviours that challenge. Reminiscence therapy is a great way to incorporate these things. Woods et al. (2018) conducted a study to look at the effects of reminiscence therapy on people with dementia. They found that care homes showed the widest range of benefits, including better quality of life, cognition and communication. However, reminiscence often focuses on the past and may feel slightly one sided on the therapists’ part as they are the ones conducting the sessions and painting the picture for the intended persons. For example, planning a session based on school days or hobbies may feel quite limited as the participants may communicate answers based on the overarching theme. In contrast, Cognitive Stimulation Therapy (CST) as defined by Clare and Woods (2008) ‘targets cognitive function, which may have a social element—usually in a group, 1:1 or with a family caregiver. This includes activities which do not primarily consist of practice on specific cognitive modalities and may be described as reality orientation sessions’. In other words, this seeks to specifically focus on our cognitive processes and also being able to observe its effects over time.
It is important to highlight that CST also bases its interventions on manualised examinations such as the mini-mental state examination (MMSE; Folstein et al., 1975) and the Alzheimer’s disease assessment scale—Cognition (ADAS-Cog; Rosen et al., 1984) which are unlikely features of general cognitive activities (Spector et al. 2010). I have personally based my sessions on features that these assessments look at, but I have not directly sought to fulfil its criteria; as such, I refer to the use of CST as a universal form of cognitive activities that can informally focus on specific areas of interventions, such as attention, gnosis and praxis.
This form of therapy works for everyone, but is specifically used for those living with dementia, especially as their cognition declines. In my personal experience, I have observed positive effects – but not only for improvements of specific domains, but also observing social interactions and expressions change.
Case study
An elderly man with Parkinsons Disease (PD) has been declining physically, cognitively and psychologically. This primary change in muscle stiffness and mobility weakness has also manifested into his cognitive abilities: slurred and inaudible speech, poor sustained and divided attention and overall executive functioning. as an AP, I have noticed these changes and have brought them up with the patient to see whether something could be done to work on these symptoms (not change due to neurodegenerative nature). The first step is to do some research into the link between PD and cognition. Then based on empirical findings, look into incorporating modified versions of neuropsychological tests, if possible, and then following up with activities that could aid in maintaining those impaired features of cognition. In my case, I noticed a deterioration in attention, so I did my own research which directed me to using an altered version of the Cambridge Neuropsychological Test Automated Battery (CANTAB; 2012), a test that seeks to measure cognitive function. I then downloaded a fun activity based on the Stroop Test, which measures inhibition and attention, and ensured that they played this game every other day to notice any changes. I also took into consideration how the patient aways told me that they were tired and were sleeping multiple times a day, so I encouraged them to keep a Fatigue Management Diary, which ensured that they recorded their sleep hygiene and what they had planned that day. I asked this patient a month after how they felt like the incorporation of frequent cognitive activities coupled with a fatigue diary impacted them, and I got some positive feedback. They stated that though they still felt tired and there were no adverse changes to their cognition, recognising this and being able to stimulate their attention enabled them to find techniques in being able to concentrate during sessions with other clinicians and everyday life. This case study reinforced the ethos of CST which is ‘targeting cognitive function [for] 1:1’ as told by Clare and Woods (2008).
It is also vital to propose that CST doesn’t always seem to have its desired effects, and often times, participants may see it as an ordinary activity with no purpose or enrichment to their daily living. As a clinician one of the challenges, I have faced is being able to conduct CST for a wide population – especially non-English speakers. It is quite challenging to know whether you are testing an aspect of their cognition or whether the task at hand doesn’t make sense due to the language barrier. For example, one of my Portuguese speaking patients has been engaging in CST activities which also focus on a variety of cognitive domains. In these instances, I have ensured that I download CST worksheets from accredited websites specifically designated for dementia groups (Spaules & Spaules, 2022). Though feedback of the costs and benefits may not always be provided from non-native English speakers, it is always interesting to observe how participants answer set questions that can be applied universally to all backgrounds.
To end this piece, I believe that being able to actively work and maintain the best possible cognitive levels can allow us to see how everything that occurs in our lives all boils down to our mental processes. If these are not actively stimulated daily, there are risks of not being able to evolve our executive function to the best of its ability, ultimately creating a cognitive stagnation.
References
- APA Dictionary of Psychology. (2018).https://dictionary.apa.org/mind
- Woods, B., & Clare, L. (2008). Psychological interventions with people with dementia. Handbook of the clinical psychology of ageing, 523-548. DOI:https://doi.org/10.1002/9780470773185
- Folstein, M. F., Robins, L. N., & Helzer, J. E. (1983). The mini-mental state examination. Archives of general psychiatry, 40(7), 812-812. DOI:https://doi.org/10.1001/archpsyc.1983.01790060110016
- Cognition, C. (2012). CANTABeclipse test administration guide. Cambridge: Cambridge Cognition.
- Rosen, W. G., Mohs, R. C., & Davis, K. L. (1984). Alzheimer’s Disease Assessment Scale (ADAS). American Journal of Psychiatry, 141, 1356-64.https://www.valoreinrsa.it/images/strumenti_di_lavoro/declino/ADAS.pdf
- Spaules, & Spaules. (2022, April 6). Cadernos de atividades e estimulação - Associação Alzheimer Portugal. Associação Alzheimer Portugal.https://alzheimerportugal.org/cadernos-de-atividades-e-estimulacao/
- Spector, A., Orrell, M., & Woods, B. (2010). Cognitive Stimulation Therapy (CST): effects on different areas of cognitive function for people with dementia. International Journal of Geriatric Psychiatry, 25(12), 1253–1258. DOI:https://doi.org/10.1002/gps.2464
- Woods, B., O'Philbin, L., Farrell, E. M., Spector, A. E., & Orrell, M. (2018). Reminiscence therapy for dementia. The Cochrane database of systematic reviews, 3(3), CD001120. DOI:https://doi.org/10.1002/14651858.CD001120.pub3
