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Redefining Dementia
resources and helpful life experiences, the podcast will look to connect with the audience to provide helpful and meaningful takeaways.
Redefining Dementia
Dr. Rob Winningham: Physical & Cognitive Health in Dementia
Join us as we delve into the fascinating world of cognitive health with Dr. Rob Winningham, a leading expert on memory and aging. With over 30 years dedicated to understanding memory processes and promoting healthy aging, Dr. Winningham shares powerful insights into how specific cognitive and physical exercises can boost memory and potentially slow down dementia progression.
Holding a Ph.D. in neuroscience from Baylor University, Dr. Winningham has spent much of his career at Western Oregon University, where he was instrumental in creating the Gerontology Department and served in various leadership roles, including Dean of the College of Liberal Arts and Sciences and Provost and Vice President for Academic Affairs. His extensive research has been published widely, and he has trained thousands of professionals in cognitive rehabilitation and wellness programs, presenting over 1,500 talks on memory and aging.
In this episode, Dr. Winningham explains how targeted cognitive stimulation, especially for those in the early stages of cognitive decline, can be as essential for brain health as physical workouts are for the body. He discusses activities that strengthen executive functions, revealing a "sweet spot" for therapeutic interventions that support ongoing cognitive improvement.
We also explore the concept of dual tasking—a groundbreaking approach that combines cognitive and physical activities to enhance brain function, making everyday tasks more automatic. Through tools like SmartFit and Dividat, these exercises bring dual tasking to life, transforming lives by enhancing cognitive and motor skills simultaneously. By incorporating such dynamic exercises, Dr. Winningham demonstrates how delaying the onset of dementia can significantly reduce disease prevalence and improve quality of life.
Alongside his expertise, Dr. Winningham’s books, Train Your Brain: How to Maximize Memory Ability in Older Adulthood and Cranium Crunches, offer further resources for those interested in boosting cognitive health. Available on Amazon, these works provide practical advice for memory enhancement at any age.
With Dr. Winningham’s wisdom, we explore how fostering environments that promote dignity and autonomy can enrich lives affected by dementia, providing promising pathways to a healthier aging process.
Links to additional resources:
Dual Tasking Menu
Personal Advance Directive for Quality of Life
Dr. Rob Winningham LinkedIn
About our Hosts:
https://www.personcentreduniverse.com/about/
Welcome to Season 2 of Redefining Dementia. I'm Jana Jones and I am thrilled to be joined by my co-hosts, daphne Noonan and Ashley King for another season of fresh conversations, new insights and valuable tips on navigating dementia care.
Speaker 2:Hi, I'm Daphne. This season, we're diving even deeper into topics that matter, from caregiver resilience to meaningful engagement. Plus, we'll have a fantastic lineup of experts to share their wisdom.
Speaker 3:And I'm Ashley At Person Centred Universe. We help you provide person-centered dementia care at home, work or in your community. Through this podcast, our goal is really to strive toward a better world for those affected by dementia by sharing resources and insights from experts around the world.
Speaker 1:We are also introducing a new format this season with rotating co-hosts. You'll hear from each of us as we take turns leading discussions with incredible guests, some familiar faces and some exciting new voices.
Speaker 2:So, before we begin, just a special note the information that we share in this podcast is for educational purposes only. If you or someone you know is experiencing symptoms of dementia, we'd encourage you to seek medical advice from a qualified healthcare professional.
Speaker 3:So don't forget to hit that subscribe button and join us every other Thursday as we explore the many dimensions of dementia care. One conversation at a time.
Speaker 1:Welcome back to the Redefining Dementia podcast. We are thrilled to have you join us today as we dive into another insightful conversation. In today's episode, we are joined by an expert who has dedicated the past three decades to studying memory and aging Dr Rob Winningham. Dr Winningham received his PhD in neuroscience from Baylor University and has been on the faculty at the Western Oregon University since 2000, where he played a key role in establishing the gerontology department and served in leadership roles, including dean of the College of Liberal Arts and Sciences and provost and vice president for the academic affairs. His research has had a profound impact on our understanding of memory in older adulthood.
Speaker 1:Throughout his career, dr Winningham has trained thousands of professionals on how to provide high-quality cognitive rehabilitation and wellness programs. He has given over 1,500 presentations and published extensively in the field of memory and aging, including two popular books Train your Brain how to Maximize Memory Ability in Older Adulthood and Cranium Crunches. Both are packed with practical strategies to help older adults maintain and improve cognitive function. In today's episode, we'll be exploring the fascinating connections between physical and cognitive health in aging. Dr Winningham will share insights on how exercise can enhance brain health, strategies for maintaining cognitive function and some of the most effective ways we can all work to support healthy aging in our communities. I'm so excited to dive into this conversation with Dr Rob Winningham. Let's get started.
Speaker 2:Okay, so hello, Dr Rob Winningham. We're so excited to have you here joining us on our podcast today and certainly very excited to dive right into conversation with you about all the things you are doing to support older adults who are walking a journey with dementia. Thank you for being here. Oh, it's my pleasure.
Speaker 4:Thank you for being here. Oh, it's my pleasure, thank you.
Speaker 2:So I'm going to start just with the first question just to kind of ease us into your important work. So you have spoken about how you help increase older adults' memory ability through cognitive exercises, and so I guess the question I would have is is it really possible to prevent dementia or the progression of dementia by staying mentally active?
Speaker 4:So the answer is yes, it is possible, and we've seen literally dozens of high quality randomized, controlled studies that have shown that it's possible to increase people's cognitive ability with targeted cognitive stimulation programs. There are some caveats there that are important. Different populations respond differently to these programs. Probably the most important thing is cognitive ability matters. So when we do these programs and we have younger adults or we have middle-aged adults and we do a high-quality cognitive stimulation program, we often don't see much of a difference because they're already performing what we would say near the ceilings we call these ceiling effects. It's hard to get them to perform better. So that's one population that the research shows doesn't benefit as much. The other population is people living with moderate to severe dementia. They do not respond as well as the cognitive stimulation programs. They can be great in terms of quality of life and give us things to do during the day, but the moderate to late stage dementia that's much more challenging to see significant improvements in their cognitive ability, particularly their ability to make new memories. That's what we're often focusing on Now. The middle, though. That's where a lot of the research has been done. The sweet spot is mild cognitive impairment. People experiencing mild cognitive impairment, which is an American Psychiatric Association diagnosis, they seem to improve the most. And then people that are having some impairment for their age but haven't quite reached the diagnosis of mild cognitive impairment, they can improve, and it's a little harder, but the early stage dementia can see some improvement as well, so that's an important caveat. The other thing that I think is important to keep in mind in this is that the activities need to be appropriate, and we have learned that we need to exercise what's called executive functioning, that's, your ability to pay attention, inhibit distractions, inhibit paying attention to other distractions, and if we have a targeted executive functioning program, that seems to work the best. The final thing I would say on that too, is, though, that the research shows, while we might be able to have improvements in cognitive ability with a good cognitive stimulation program, the benefits don't necessarily last if people don't stay engaged, and it's kind of frustrating.
Speaker 4:Like we'll start a new program at our senior center in our community to get the students at the university an opportunity to do that, and I'll see somebody in the community and I'll say hey, we're going to start a brain builders class at the senior center. Do you want to join? Like, oh no, I did a class back in 2016. I'm like, oh my gosh, you know it's like nobody would say that to a fitness instructor. Do you want to come join our spin class? It's a new exercise class. Oh no, I got physical exercise back in 2016. I'm good, but they will say that about cognitive stimulation. But just like physical exercise, you need to use it or you'll lose it.
Speaker 2:It's like that muscle that you build up over time. Right, yeah, that's right. Wow, that's fascinating. Thank you, that's amazing actually.
Speaker 1:Very fascinating. And of course, we hear more and more I guess mainstream, thankfully the importance of the many benefits of physical activity, and also we're hearing more and more about the positive effects of physical activity on memory ability. So what types of activities and exercise should we be focusing on for this purpose?
Speaker 4:Well, that's a great question and it's a great kind of segue talking from cognitive stimulation. There's more research on the effects of physical exercise on cognitive ability and your ability to pay attention, make a new memory, than any other intervention because it is the most effective. But it's a nice. We can have a nice segue from talking about cognitive stimulation because one of the types of programs that's receiving a lot of interest in the research and, I think, increasingly on the ground working with people in the community and I think increasingly on the ground working with people in the community is dual tasking, that's, doing a cognitive exercise and a physical exercise at the same time, and we can talk more about that, but that's been very effective. Dual tasking seems to be more effective than doing a cognitive stimulation only program or a physical exercise only program. But wow, the research on physical exercise, the physical exercise they find that works the best is a combination of aerobic training and strength training and actually the benefits you get for cognition and executive functioning. We see that physical exercise improves executive functioning and then once you have improvement in attention, that improved people's ability to make new memories. But the aerobic training and that might just be walking. You don't need to run a 5K. You can just walk, get the heart rate up. That has some benefits. But you get actually more benefits from what we call resistance training or strength training, and I think this is kind of out there, you know for in the popular press now the importance of strength training and the exciting thing is it appears that the benefits we get from aerobic training are independent of the benefits we get from strength training. So if you already have a good walking program, I'll use my dad for an example. He's almost 80 years old, he's moved to you know the community where my family lives now and he always walks and he has all of his trail friends. And even though he's almost 80, he always walks and he has all of his trail friends and even though he's almost 80, he gets nearly 10,000 steps a day. He actually averaged 12,000 last month. But then I was telling him about the research that if you add in strength training you get a benefit. So we got him some dumbbells, we got him some exercises, we got him some TheraBand and just doing that two times a week has been shown to lead to significant improvement, even in people with mild cognitive impairment. There was another study done even early people experiencing early stage dementia also had significant improvement by adding the resistance training. So that's really exciting. In addition to that, like I said, there's a lot of research exciting In addition to that. Like I said, there's a lot of research and to summarize that I would just throw out yoga has been shown to lead to significant improvements in cognition and if you think about it, yoga is kind of dual tasking.
Speaker 4:There's lots of different ways to do yoga. But if you're getting your heart rate up, you're getting some aerobic training. You're getting yourself up and down off the ground in and out of different positions. That's some strength training. But it's also cognitive training. Many yoga exercises you'll need to breathe in on one movement and breathe out on the other and kind of focus on that, pay attention to that. That is kind of the prototypical type of cognitive exercise that leads to improvement. So yoga tai chi has much of that and there's so many studies now on the yoga and tai chi that they're doing what are called meta-analyses, where they take the best randomized, controlled studies. They combine the data and lo and behold. Both yoga, tai chi, aerobic training, resistance training all lead to significant improvements in cognition.
Speaker 4:But once again, the population matters.
Speaker 4:We don't see significant improvement for people living with dementia kind of the mid-stage and the late stage.
Speaker 4:We don't see the improvement in cognition, but we still probably want to do the best we can to offer the programs to people experiencing more advanced dementia.
Speaker 4:There was a study published in the Journal of American Medical Association that they actually were working with people with more severe dementia and I think they all were living in kind of a memory care setting and all they did.
Speaker 4:They would just knock on their door and they would say, hey, I'm here to exercise with you in their room and I brought some exercise equipment. Would you be willing to exercise with me? And some did, some didn't. But just being in that program saved and this was in the cost of care. And when they did the analysis and it didn't improve their memory ability, it didn't improve their cognitive ability, but what they found was that people that engaged in the exercise who were living with more advanced dementia, they actually maintained their ability to be mobile. I mean, a big one was just getting to the bathroom on their own, being able to stand up on their own, and just that strength improvement improved their ability to get around. It improved their independence. They didn't measure this, but I would argue that if somebody can take care of toileting on their own, that's also going to improve their dignity, and I think that's important to keep in mind in this context as well.
Speaker 2:I agree totally and I think one of the things that we have developed at Person-Centered Universe is we offer a Tai Chi course.
Speaker 2:That's actually facilitated, co-facilitated by one of our colleagues, dr Gary Irwin Kenyon, who is a Tai Chi master. He's an expert in that field and we offer it to long-term care staff to do with residents and it's in the significant cognitive improvement, it's definitely quality of life, it's definitely, you know, that sense of community connection and that mindfulness as well, right, even that of, like, you know, just taking a breath and you know, in that moment of time, and yeah, so we're really excited and I totally could not agree more with what you're saying. So I'm going to actually I'll get you to backtrack because I'm fascinated and I think you know it sounds like you you'd love to tell us a little more about the concept that you've mentioned a couple of times, which is dual tasking, and how is it, how is it used to actually improve quality of life or why does it work, because you've kind of already described a little bit about what it is, and so, yeah, talk to me a little more about that. I'm fascinated by that.
Speaker 4:Yeah, it is a fascinating. It is a fascinating area and, particularly because the results are so astounding, it's being used in a lot of different contexts. So we're going to talk about it kind of in, you know, thinking about older adults, people with some memory challenges. It kind of in, you know, thinking about older adults, people with some memory challenges. But we do this with um with athletes. We do this, we do dual tasking with professional athletes. We do dual tasking with with people in the military um. So there's a lot of different settings where you would want to do this.
Speaker 4:But first I probably should just define dual tasking, because it kind of sounds like multitasking but it's different. So if you think about multitasking that you know I would define multitasking as doing two cognitive activities at the same time. You know you might be checking email while you're listening to a podcast or something like that. That doesn't work very well, you know, because we can only pay attention to one thing or another, and actually we probably should call multitasking just simply call it task switching, because that's what you do when you multitask you focus on one thing, then you focus on the other, and we find with the multitasking that when you switch you're more likely to make an error. Some people get really good at that and you can improve that, but you never do as good as just focusing on one task at a time. Frankly, I'm trying to tell my 14-year-old son that as he carries around a phone, it's kind of a problem right now Do one task or the other.
Speaker 4:So dual tasking is doing two tasks that have different goals. Now one is usually a cognitive task and the other is a physical task, and that's different because we're not doing two cognitive tasks at the same time. So an example of this might be well, it's what I do in the morning. I listen to a kind of a morning news podcast while I get ready after my shower, so I might be brushing my teeth. Am I doing other things getting ready? So I got a physical activity that's fairly automatized. You know our routine of getting ready in the morning while I have the cognitive task of listening to the podcast. So that would be dual tasking.
Speaker 4:Other examples of that that we do. We've done this a lot in the clinic. We're trying to get push out ideas for retirement communities and others. In the clinic we actually will go outdoors and we'll give older adults grocery bags with different colored tennis balls in them and then my students or therapists will walk with the older adults and they'll have a conversation and it's a little bit scripted. The students will know they're going to ask certain questions, engage them cognitively while they're walking, and then we also will ask them to grab a yellow tennis ball or grab a pink tennis ball or grab the tennis ball that has a one written on it while they're walking. We actually do that because one of the most common reasons that women fall is that they look into their purse while they're walking. So this is actually a way to assess that safety.
Speaker 4:But that's dual tasking and it leads to improvements in cognition. There's been some studies where they actually did brain imaging with dual tasking and they found that dual tasking led to some improvements in the frontal lobe. So that's the frontal front part of your brain and that's where executive functioning kind of resides your ability to pay attention or inhibit your attention, just distracting stimuli and so we see greater efficiency there. And the other thing that we use in the clinic with the dual tasking is when we have people dual task, they make the motor behavior becomes automatic faster. So after an injury or something or somebody needs to learn how to use a quad cane. If we dual task it, they actually we call it, it turns into a procedural memory using the cane or it kind of becomes automatic. That actually happens more rapidly. So some really interesting benefits from dual tasking.
Speaker 1:It's so interesting. I could probably talk to you about this all day. I think this topic is just so fascinating and I so appreciate you providing a scientific context to day-to-day experience that we all may have. I think we all have had those moments where we take a walk and feel like we've had, you know, we experienced much more mental clarity afterwards and I know Daphne has her her hand up and may want to interject before I ask the next question here.
Speaker 2:All right, I just wanted to say that, yeah, that whole that was so interesting, that piece, and I'm wondering cause you've referenced a couple of really practical examples from your you know, your clinic and things that you do, and is there a way that people could so say someone's caring for a loved one at home or is someone with a recent diagnosis you know anywhere in the world Is there, do you got? Can you find examples or suggestions anywhere, like on your website or different Like? Those were really great examples, especially the one about the purse. I'm always looking for something in my purse, so I know that's really relatable.
Speaker 4:You know, I can send you a dual tasking menu if you're able to link that to for your listeners. So I'd be happy to do that, but you do kind of point to a little bit of a challenge. I think that retirement communities that have the ability to purchase some equipment have access to this. There's a few products that are available now. One product is called Smart Fit SmartFit, and so it's a board where people will do, and it's kind of a big touchscreen board and people will do some cognitive activities while they're also doing physical, and it measures it too.
Speaker 4:The nice thing about some of these software projects is they actually can measure your dual task cost quickly, and it's kind of interesting how we do this. We see, for example, how fast can you do a physical activity just by itself. Then we have you do the same activity while you're also engaging in a cognitively stimulating activity. You might be thinking of a first name for women A through Z Abigail, betty, christine while you do the same activity, how much you slow down when you do both of them is the dual task cost, and that's really important because we can gamify it and people can try to improve their dual task cost. So that's the nice thing. So SmartFit does that.
Speaker 4:There's another product it's based out of Europe but they have an expanding footprint in the US. It's called DVDOT. It's spelled like divided attention, so D-I-V-I-D-A-T. That's actually probably one of the best products out there now and there's a lot of different activities that do that. It's kind of built in. But this is a challenge and I think some other people are trying to do some things on YouTube to make it accessible to people living in their homes or in smaller communities that can't afford the larger equipment. But I'll happily send you a dual tasking menu that has different cognitive activities and different mobility and motor activities and you can kind of just mix them at random to create effective dual tasking interventions.
Speaker 2:That would be amazing, thank you. We'd love to share that with our audience, and those tools sound wonderful. I'm going to be looking them up.
Speaker 1:Definitely Well, dr Rob. This final question that we have for you is something that we ask every one of our guests and we would love to hear about what is your hope for the future for people affected by dementia?
Speaker 4:Well, it's a great question and I think it guides. I think that that question can help guide our research. It can help guide the funding to help improve the quality of life for people living with dementia and their caregivers. My hope is simple. My hope is that we can delay the onset of dementia and thereby reduce the prevalence. There was some research done. This was done a while ago, over a decade ago but it was estimated that if we can delay the onset of dementia by four years, we will cut the incidence or the number of cases in half.
Speaker 4:It's such a late life disease. If we can delay it, push it off, for many people they won't experience significant effects and a lot of the types of things we're just talking about in terms of the cognitive exercise, the physical exercise, the dual tasking can do just that. So that's it. But then, in addition, while we're working towards that, I think we also need to educate people, and I think that's a wonderful thing about the podcast that's why I'm happy to kind of be here and share these ideas is we need to educate people as to how to best care for people living with dementia.
Speaker 4:I think that involves, you know, adjusting the environment appropriate, trying to maximize autonomy, choice, familiarity, and there's a place for you know, I'm a neuroscientist, a neuropsychologist there's a place for that neuroscience. Actually, in doing that, you know, we know that if somebody is in an environment they're familiar with, they can develop some sequences of behavior, some patterns of behavior. They can actually learn to do some new things. They can operate a TV, they might even be able to operate a coffee maker, and if they do it in the exact same order, it's actually it's a procedural memory again, and so that's been kind of a fun area of research to try to help people to set up those environment of research, to try to help people to set up those environment and all of that and some of the things we talked about earlier just maximize dignity. I hope we're doing things that maximize the dignity of people living with dementia and I think that's an important goal.
Speaker 1:Thank you so much. We so appreciate your work and look forward to hearing about your work in the future, and we will definitely be linking all of the resources you mentioned as well as some of your publications.
Speaker 2:Thank you. It's been such a pleasure to speak with you today and we're just very honored to have met you and excited to potentially stay in touch and collaborate in the future as well.
Speaker 4:Been an honor to be here, and I'd be happy to come back and share more tips.
Speaker 2:Oh my goodness, he was amazing.
Speaker 1:That was such a wonderful discussion and I'm just so grateful he was able to spend his day with us part of his day and spent his day with us part of his day I could have talked to.
Speaker 2:I think we could have, as you say, we could have talked to him for probably all day about all the different sort of pathways of knowledge that he has.
Speaker 2:You know, everything from the physical activity to the, you know, dual tasking and the just generally you know, thinking about that preventative approach. So hopefully maybe in the future be able to get him to come back. But there's just so much great work being done in the world about you know, with this idea of the wellness and the preventative around cognitive decline, I guess is what I know. I found it fascinating that he was, you know he was he's mentioning that they were quantifying, you know, like that, they know it's. The sweet spot is when someone with mci and you know, when he's talking about how they know the impact is a little bit more significant for that group and then later on they you know it's it shifts to more of a benefit of like quality of life as opposed to a cognitive improvement. But that, I guess, just speaks to for me of the different ways that you could approach helping someone to improve their wellbeing through these activities.
Speaker 1:A hundred percent agree and I think a lot of the time, a lot of the scientific research feels so out of reach for people, people, you know, the everyday person and I think one thing that this podcast in this so out of reach for people, people, you know the everyday person and I think one thing that this podcast, in this interview with Dr Rob Winningham, taught me, is that it is so accessible and it doesn't have to be a big, scary scientific thing that we don't understand. There is day-to-day things that we can employ every day, such as our Tai Chi course, for example, or any of the other examples that Dr Rob mentioned, are just, you know, easy to do from the comfort of your own home.
Speaker 2:Yeah, and it was fascinating. I agree, and it was fascinating. So I think it's it's pretty understood, generally understood now that exercise is good for us. But I thought it was fascinating when he said he talked about how you know if you have do one or the other thing and then you start to do both, like strength training and aerobic and then if you do one there's benefit, and then if you do both there's even more benefit. It's not you know. So the fact that they work best. Well, like that was really interesting because I'm not sure a lot of people, myself included, would understand necessarily the mental benefits to those things as opposed to you know, the physical, obviously, is you understand that? But so that was really interesting.
Speaker 1:Yeah, you hear, I guess so many people say they exercise as much for the mental benefits as the physical and obviously there is a lot of real science to that right. So it's all very fascinating and I really look forward to having him on again.
Speaker 2:Yeah, he was amazing and I'm so excited that he's going to share those tools with us and the menu on the dual tasking, so we'll be sure for our audience that we can share that with you as soon as it comes our way and have it on the show notes with the episode and that sounds like it's going to be a really practical tool that people can employ if they're just at home and trying to understand how to apply some of the concepts in day-to-day life.
Speaker 1:Definitely. We look forward to sharing that, and I think now you and I need to go for a walk and lift some weights.
Speaker 2:Yes, we definitely need to do both of those things. Thanks for listening everyone.
Speaker 1:Thank you for joining us for this episode of the Redefining Dementia podcast. We hope the insights shared today leave you feeling empowered and connected, no matter where you are on the dementia journey, whether you are living with dementia or you are a care partner, a professional or an advocate. Together, we can continue shifting the conversation.
Speaker 3:This season. We're grateful for the opportunity to bring you new voices and perspectives. As always, we strive to offer practical tips and heartfelt stories that resonate with your experience.
Speaker 2:A huge thank you to our incredible guests who generously share their time and knowledge with us, and to everyone behind the scenes. Our music is written and produced by Scott Holmes, and this podcast was produced by Jana Jones. Be sure to subscribe so you don't miss our upcoming episodes. And, as always, let's keep redefining dementia together.
