Cognitive Stimulation Therapy for Early Dementia Support-Interview with Jill Aitken

Forgetting a name once can feel like a warning siren, especially if dementia has touched your family. We sit down with Jill Agin, founder of Four Better Minds, to talk about what actually helps brain health as we age and what caregivers can do when they feel helpless watching cognitive changes unfold.

Jill explains Cognitive Stimulation Therapy (CST), an evidence-based, non-drug approach for mild cognitive impairment and early to mid-stage dementia. CST is not a quiz and it is not about right answers. It is structured, conversation-based therapy that builds cognitive confidence, communication, and quality of life through guided topics like food, art, music, creativity, and gentle orientation to the world. We dig into the specific skills it can support, including memory, word finding, language fluency, executive function, following directions, and oral comprehension.

We also talk about the bigger picture of healthy aging and dementia prevention: why “aging well” is an active process, not something that just happens. Jill shares practical brain health pillars you can start in your 50s and 60s, including physical exercise, social engagement, and cognitive engagement, plus nutrition strategies like the MIND diet (inspired by the Mediterranean diet and DASH diet) to reduce dementia risk. We get real about caregiver burnout, patience, and how small changes like turning off distractions and truly listening can make conversations feel safer and more successful.

If you want more support, Jill offers CST through Zoom for English-speaking clients across the US, Canada, and Europe. Subscribe, share Patty’s Place with someone who needs hope, and leave a review so more caregivers can find these tools.

https://forbetterminds.com/

Transcript

Welcome And Why This Exists

SPEAKER_01 0:09

Welcome to Patty's Place, a place where we're going to talk about grief, dementia, and caregiving. I'm your host, Lisa. I named this podcast in honor of my mom, Pat, who passed away from dementia about two and a half years ago. So hopefully I want this place to be a place where you don't feel alone and you can find some good resources to help you through this difficult time. So grab your cup of coffee, your cup of tea, or if you're having that really bad day, your glass of wine, and let's get talking. Today I'm really excited. Uh our guest is Jill Agin. She's the founder of Four Better Minds and a passionate advocate for helping people protect and improve brain health as they age. She specializes in CST, which is cognitive stimulation therapy. It's an evidence-based non-drug approach shown to improve cognitive confidence, communication, and quality of life for people living with mild cognitive impairment and early stage dementia. Welcome, Jill.

SPEAKER_00 1:03

Thank you. Thank you. It's nice to be here.

SPEAKER_01 1:06

Yes, I'm very excited about this because brain health is very important. Very, very important. So just tell us a little bit about yourself. How'd you get into interested in working with this particular field?

Jill’s Path Into Dementia Care

SPEAKER_00 1:20

Well, I've worked with people living with dementia now for over 10 years. And I used to own a home health care business where I placed healthcare aides and and nurses in people's homes. So kind of one-on-one care. And we were always looking for innovative solutions. We're always looking for, you know, tips and new ways to give really good care. And in about 2015, I was introduced to CST. I think I discovered it at a conference and I was really taken by it. And uh I always kept it in mind as something I wanted to do. And then I tried it out eventually. And then I stopped with my home care business in 2022 and decided to do CST full-time. I just thought it was such a compelling service. It is evidence-based, like you said. So what that means for people who don't know, it means it's scientifically proven. So the program that I use has been around for 25 years and it is really well trialed. And um the evidence for it, for it to improve people's cognition is is really there. And I thought it was so compelling, and it's just a wonderful program.

SPEAKER_01 2:42

So and as you've obviously you work with the older adults, and we always face that, you know, everyone always is worried the minute they forget something like, oh God, it's dementia. Um but you also you you said you work with healthy seniors who want to stay sharp. So what have you learned about aging that most people misunderstand?

Aging Well Is An Active Choice

SPEAKER_00 3:02

I think aging in general that most people understand is that in order to age well, it's an active process. So we really need to work hard at it. And uh if we take it passively and just allow it to happen, we're probably not going to age as well as we hoped.

SPEAKER_01 3:24

Okay.

SPEAKER_00 3:24

So I think in in aging well, we really need to look at our diet and our exercise levels.

SPEAKER_01 3:33

Okay.

SPEAKER_00 3:33

You know, there are some really basic things. We have to be very intentional about aging well and you know, keep our muscle mass, keep exercising, and uh eat a good diet. And I I think that's the most misunderstood thing. I honestly do, that uh we we really need to come together and and understand that we have to do a lot of things for ourselves. It's going to be intentional and it's going to take a lot of energy and time, and we need to invest in our own health in order to age well.

SPEAKER_01 4:08

Okay. So,

Why CST Is Still Underknown

SPEAKER_01 4:11

what would why do you think that the cognitive stimulation therapy is still not widely known?

SPEAKER_00 4:18

Well, that's a good question. And I often, you know, ever since I started with this, I have thought about that. Why is this not widely known? I think from the practical approach from this is that it was created by academics at the University of College of London in England. And so academics don't really have a marketing budget. This is true. Right. And so they are just producing papers and and they do have conferences, but they are not, you know, they don't have money to advertise it to the wider society. And I often think, let's just say if it was a if it was a service that was being delivered maybe by a large pharmaceutical company, we'd all probably know about it because they do have the budget to advertise and let people know. And then I think maybe just uh, you know, on the ground level, it's possible that because it's a non-pharmacological approach, that there are, you know, that it it may get mixed in or lost in the mix of non-pharmacological approaches that um that aren't effective. And then maybe, you know, at least um in some areas there would be things like staffing constraints. Like I know that I know some OTs that know about CST, but they can't do it in their workplace.

What Cognitive Stimulation Therapy Is

SPEAKER_01 5:42

So for those of us who aren't familiar with it, what exactly is CST?

SPEAKER_00 5:48

Good. So cognitive stimulation therapy. So it's a program that was created for people with mild cognitive impairment or early to mid-stage dementia. Okay. So it was created to relieve the symptoms of so mild cognitive impairment and early dementia. And what the program looks like, um, like I said, it's been trialed a lot, is that it is seven weeks. Okay. And um you meet with a facilitator, so like myself, twice a week. And the the facilitator walks the person through different activities that will stimulate their mind. So stimulate their thinking. The basis of the therapy is to get the person to generate ideas and come up with opinions and have their minds stimulated. So it's a really wonderful program in that it's there's no right or wrong answer, and it's not testing and it's not quizzing. Okay. And instead, it's generating ideas and generating opinions and in in a very safe space with uh with an effective listener.

SPEAKER_01 7:02

So it's kind of like you're having a conversation with the person.

SPEAKER_00 7:05

Absolutely. It's a conversation-based therapy.

SPEAKER_01 7:09

And that that doesn't sound scary either, you know, because I know with my mom's particular case, um, she refused to get diagnosed. Uh, she, you know, I knew that she had some issues and stuff, and she just she would not go, she wouldn't even take the little test, you know, like the 10 question test. She just wouldn't answer the doctor um with it till it got to be, you know, too far along. So this could be something for somebody that if they notice, like you said, it's mild, that they might be able to help them. Granted, there's no cure for dementia, but might help them have a little bit more elusive moments longer.

SPEAKER_00 7:49

Mm-hmm. Mm-hmm. It also helps with, so the things that it has been proven to help with are, you know, memory, language fluency, word finding, executive function, okay, following directions. Another big one is uh oral comprehension. So I don't know if you've ever noticed sometimes when you're speaking to older people that they don't have hearing impairments, so they can hear, but they might ask you a couple of times for you to repeat yourself. So they didn't quite get it. So that it really helps with that as well. It really helps with confidence with people speaking. And I see in the first couple of sessions, so like if the program is seven weeks and we meet uh twice a week, so it's kind of 14 sessions, and I can really see with people who aren't used to speaking, people aren't used to having an engaging conversation, or for people who, you know, just are really understimulated and no one has ever asked them a question in a long time, it takes them a couple sessions. I can really see their confidence building in it takes them a couple of sessions in order to organize their thoughts and come up with a coherent answer. And uh, even in the first two sessions, uh, people will pause for a long time, just coming up with, you know, what do I actually think about this topic? Okay, you know, the facilitator is asking me a question. I could be asking, say, about um, you know, just about food or about using money or about, and I'll just say, so what do you think of that?

SPEAKER_01 9:29

So this is even good for somebody who um may not necessarily have the mild cognitive impairment, but just maybe for older people. Because they always say that uh socialization is very important to aging as well, too, and for uh cognitive abilities for it. So that could help with them uh if they're just like maybe feeling mentally slower or less engaged or, like you said, understimulated.

SPEAKER_00 9:55

Absolutely. So even though this program was created for people with MCI and early dementia, they trialed it also with people who did not have cognitive decline and they had incredible improvements. Because I think if you don't have cognitive decline, uh your brain is still working normally or at least still working really well. And you know, it has that plasticity, that ability to change and respond to a therapy. So people have had really uh wonderful improvements in their cognition. And they really enjoy it as well. I mean, someone who doesn't have cognitive decline would then be able to just really pull back on memories and their former experiences in, you know, in answering the questions.

SPEAKER_01 10:47

So,

Everyday Mental Work That Counts

SPEAKER_01 10:48

why do you think so many people underestimate the power of structured mental stimulation?

SPEAKER_00 10:54

Well, that's also uh really good to ponder. I think possibly one because we don't know. You know, we're just coming up with this now, really, about uh, you know, in the last five or six years, there's been just so much research published on dementia and how to prevent it and how to slow it. And we're now coming to see, we're only really now coming to see that cognitive stimulation or in exercising our minds is just as important or more than exercising their bodies. So that's one thing. We're just starting to talk about it, but also to maybe because you know, we're still in a society where we kind of underestimate structured physical exercise, right? So if you right, if you make an appointment, if you you know, go all in and hire a personal trainer that's going to turn up or you're going to have an appointment with them. You know, there's the accountability there of there's a human being waiting for me. So I'm going to turn up at the appointment. And then that personal trainer has, you know, probably has an hour of planned activities and exercises for the person. And they're going to stick to it and they're going to finish it. They're going to follow through and they're going to finish it. And that's the same thing with me with cognitive stimulation therapy. So when someone makes an appointment with me, I have, I have an hour of planned activities and they're going to turn up, and I'm going to turn up, and we're going to follow through and do the full hour, and it's going to be great. So it's, I think it's really rare when you think of cognitive engagement or you think about, you know, being interested in something and exercising your mind, you know, how how often do we do that, even in everyday life, say for more than three or four minutes?

SPEAKER_01 12:49

That's true. So what would be some examples, something something simple from I mean, I I like with reading, is that a good one, or doing puzzles or those types of things?

SPEAKER_00 13:03

It is. And so for reading in particular, uh, researchers kind of quantify it in different ways. They say like reading a novel is different reading than say reading a magazine or reading a pamphlet, you know. So reading a novel. I often ask people, so if you were to read a chapter of a novel and you knew that after you read that chapter, you had to explain it to someone else. How carefully would you read that chapter? So you know, reading, reading can be on different levels, right? But definitely playing chess, playing checkers, uh, you know, board games, they're really good. Um, there's a whole list of things that we can do. Even uh, I know I remember seeing on the list that when we're out driving and navigating in unfamiliar areas, that is considered cognitive engagement or going out and walking in unfamiliar areas, right? You're just you're more engaged, you're more alert, you're thinking about where you're going.

SPEAKER_01 14:04

That's true. Yeah, because when you your brain, it's muscle memory when you drive the same places all the time. But when you have to go somewhere different, you're like on high alert, like, wait, where's my exit? Where's this? Where's that? Yeah.

SPEAKER_00 14:15

You are, you need a nap afterward.

SPEAKER_01 14:17

Yeah, that's the way I'm and then you like turn down the radio because you're like, you think that'll help you, you know. I think it's more on the concentration uh with that.

What Happens In A CST Session

SPEAKER_01 14:26

So, what does happen during a CST session and like that can create the measurable cognitive benefits?

SPEAKER_00 14:33

Yes. So, you know, the primary principle, of course, is stimulating someone's mind. So the facilitator has activities and has ideas, so all ready to go. So every session has a different topic, kind of doing similar exercises within those topics. So one session is on food, one session is on art, one session on music, and then we have a creativity session. So it changes up each time. And within that, um, like the first thing we do in every session, I pull a news article out. So that's a big part of orientation to what's going on in the world right now. And I don't use the traumatic news, I uh often pull from the good news network, but uh we will read through a very short news article and I will ask the person, so what do you think about this? And then if it's just say something like a decision from the courts or something, I will ask, so if you were the judge in this case, how would you have uh delivered the what would you have done? What do you think? You know, do you think this is fair or unfair? So I'm doing things to stimulate people's minds, and I'm asking their opinions and I'm asking them to come up with ideas.

SPEAKER_01 15:55

So that's actually, I mean, so that's something easy that a caregiver or family member can continue on with, you know, yes. In in some ways, like having that conversation and actually listening to them, asking them questions.

SPEAKER_00 16:11

Um yes, and uh I I get asked that all the time. You know, what can we be doing at home or what can we be doing throughout the week between sessions? And that's one thing that I do suggest that if you read the paper or if you get the paper, you can read through a couple of the articles and discuss them. Ask for an opinion, you know, do a little analysis, ask for an opinion and wait for the opinion. Um, listen to it and then reflect back, right? So really engage and discuss. So that is definitely something that people can do at home.

SPEAKER_01 16:47

And I would say that patience, because I know it myself. Sometimes my dad, I'm like waiting and I'm like, are you gonna answer or are you gonna keep going on and on and on? And like sometimes it's easy to lose patience and it's hard to like be like, okay, you know, let just be present here for this moment and listen. Cause they usually, you know, peop older people sometimes I think get forgotten um in this in our society, you know, and we forget that they have a wealth of information, a wealth of history, you know, they know a lot of different things that we forget about, you know, and um but sometimes I think we do lose patience, myself included, you know, sometimes you know, asking questions.

SPEAKER_00 17:28

I think I I think this is tricky for family members. I really do. Like uh so the people who created CST, they did a widespread research project with family members and family caregivers. And you know what? It just didn't work. And you know why it didn't work? Because half of the families didn't even do the first session. So it's like, so number one, it's like the family caregivers are either burned out or overburdened and they can't get around to doing it. And number, yeah, it just that's what happened. So it's not like did it work or didn't work? Well, they didn't even do it because they're just kind of overwhelmed themselves. And when you're talking about patience there, absolutely there is just there's really something different in the dynamic within a family, right? And so you do tend to lose patience more than say what a caregiver, what a therapist would. Uh, you know, hopefully no therapist would be losing patience. I mean, some of the things that a couple of things that might make it better would be to have zero, zero distractions. So no radio on, no TV on in the background, and maybe come to a table, clear the table, and and do it just, you know, two people across across the table from each other, make it slightly official or like, okay, now we're doing something.

SPEAKER_01 19:01

I think too what uh I I think the other issue is that I think as caregivers, it's a very hard thing to accept the dementia diagnosis and know how to handle it, you know, to be able to finally be like, I need to enter their world and stop correcting them. You know, if they say the sky is green, just go with it, you know. And if and I think that's what's really hard to get to that point um in doing that. But it it helps so much when you're able to get to that point with caregiving and being able to sit there and be in that moment with them and talk with them with those different things. Uh with that. I found it.

SPEAKER_00 19:47

Right, to see the change. I mean, I've even um sometimes when I'm in someone's home, I can kind of chuckle with a you know, with a a married couple that have been married for over 60 years. Like I just one gentleman that I can think of, you know, 89 years old, and his wife will take a break when I'm there and working with him one-on-one. His wife will be in in the bedroom, and sometimes I'll ask him a question, he'll say, No, you know, or just like, you know, have you ever been to Paris? Or yeah, no, no, no. And then I can hear the wife calling out, you have been 30 years ago. Right. So yeah, I think it's, you know, it's no right or wrong answer for me, and I'm going with it, and I'm doing my best to stimulate someone and to we're just we're having a great time and the mood is great. And it is, I I think it is difficult uh for family members to do it. You you have to really know that uh you're going into this, and and no matter what is being said, the most important part of it is that you are an active or an effective listener, you're reflecting back and you're giving the gift of stimulation and your time and attention to the person.

SPEAKER_01 21:02

Yeah, I I would agree with that. That it is hard. Like I know it was harder for my dad to get to that accepting with that. So,

Future-Proofing With Diet Exercise Connection

SPEAKER_01 21:11

how would somebody in their 50s or 60s and they want to future-proof their brain, how should you start? What can you do?

SPEAKER_00 21:20

Uh well, I think of this all the time, and I think about my own relationship with food and exercise, but definitely it just goes back to the same possibly boring diet and exercise. So, you know, our diets, when people talk about the standard American diet, um, we are eating processed food, we have higher sugar and high grain. And it is best that we reduce that sugar, reduce the grain, and reduce the processed food. So there is uh a diet that has been trialed now. It's called the mind diet. So M IMP and it is like a mix of the Mediterranean diet and the DASH diet. The DASH diet was created to lower people's blood pressure. So the MIME diet really emphasizes, you know, vegetables and fruit. It allows you to have whole grains only and a limited amount and very little processed food and then little, you know, just the tiniest bit of butter. So it says use olive oil instead of butter. For me, I have looked at all kinds of approaches to diet. And it seems like like people talk about the benefits of keto. And I think, yes, there are a lot of benefits. And you can really lower inflammation with keto. For me, it is too strict right now for me. I really love fruit and I like vegetables. And so for the mind diet, it has been trialed, it has been researched. And it even moderate adherence to that eating regime reduces your risk of dementia and it improves your cognition.

SPEAKER_01 23:13

And I think it I was gonna say I believe that that was researched uh by a hospital here near in Chicago though. Oh really? Rush University. Yeah, hot medical center with that. But and um I am familiar with the mind diet, but I think it is uh we don't we you know as Americans we like our fast food and processed food but you do feel better when you don't eat as much with that you really do you know uh I went to Ireland like two years ago and I was just like amazed at um the difference in the food meaning it was so good you know they had they have laws against the process and different chemicals in the food and it's like you didn't eat as much because it was all good food health you know um you know what I'm trying to say it was in a lot of whole foods yes that's the word I'm looking for yeah you know um it does make a difference with it but it's also good to know that yeah scientifically the mind diet they have been able to show that it does decrease the dementia risk uh with that do you think that cognitive decline is an inevitable part of aging or are there other ways we can protect or strengthen the brain well in terms of like when we think of what we call normal age related cognitive decline so this is something just kind of widespread across society that we have seen and we call it normal.

SPEAKER_00 24:44

So you know in our 30s our brains start to shrink a little bit every year. It's a very uh very small percentage but it does start in our 30s and then at about age 65 67 then it starts to shrink a little bit more every year. And so how this shrinkage or this atrophy kind of manifests is through like we will see our pro our um information processing will be slowing down a little bit our word finding our language fluency we're not great at executive function as much as we used to be so that's kind of it it's not interfering with our daily lives but we can see that we're slowed down a little bit. Maybe other people can see it and uh even the people that we know in say in their 80s and 90s that are really sharp, they're probably not as sharp as they were 40 years ago. So there is some subtle slowing um now that is probably inevitable. There are probably some people that are are really intentional about their health and and can not slide as much. But for dementia of course it is not inevitable. We're almost you know we almost feel like we are uh like it is inevitable. We do know people in their 80s and 90s that do not have dementia and uh I would hope that certainly in our 60s and 70s it is not inevitable. And uh and the things that we've talked about already are like the four lifestyle pillars of brain health that we can do to strengthen ourselves and to really protect our minds is of course diet and then exercising our minds with cognitive stimulation and then exercising our bodies with physical exercise and then social engagement.

SPEAKER_01 26:44

And I think that all four of those are important but I think too sometimes I think older adults do feel isolated sometimes and they don't socialize as much you know sometimes it's as simple as sitting outside and talking with your neighbor you know uh with that to it is important to socialize and get that um that cognitive stimulation uh with that yes and you know the older you get uh the more you are outliving your cohort yeah right social circle really dwind dwindles right when you get into your 80s yeah yeah it does why do you think so many people underestimate the power of structured mental stimulus stimulation sorry yes uh I think because uh I think because we haven't really uh thought about it uh it's not something that you know it's something that is fairly recently known and the the research is only just coming out now about how important it is.

SPEAKER_00 27:49

Uh so there was a really huge research project uh delivered in China and they looked at 40,000 people over 10 years. It was a really huge uh trial what they were looking at was they were just looking at people's memory. So at the start of the 10 years and at the end. And what they saw was the most important factor that gave them a good memory was diet, like we've already talked about and really high levels of vegetables and uh low processed food. And then number two the second most important uh feature of the people who had good memories after 10 years was cognitive engagement. So was that exercising the mind and the researchers were really surprised at that because they thought that number two might be exercise or they you know physical exercise or that number one was so they were surprised that exercising the mind was so high on you know uh for people who who had good memories at the end of uh 10 years. So number one was diet number two was cognitive stimulation or exercising the mind. Number three was exercising the body and number four was social engagement.

SPEAKER_01 29:11

And I think it's even more important in these days, especially with AI and everything it's so easy to not think these days to make sure that you do think and you know sometimes doing things the old way are is better for your brain with

How To Work With Jill On Zoom

SPEAKER_01 29:28

that. So speaking of that so your website is for betterminds.com that's right okay so if somebody goes to your website what can they find?

SPEAKER_00 29:38

So they can find more information about cognitive stimulation therapy and they can find some of the scientific evidence about it and they can also contact me and we can have a chat about them doing CST with me. Okay. So I deliver cognitive stimulation therapy through Zoom. I have clients right now in Europe and in the US and in Canada. So if you're English speaking uh we can work together because I don't speak another language and uh but other than that geography is not a barrier. So if you can use Zoom we can work together. And learning Zoom is good uh mental stimulation cognitive stimulation yes and you wouldn't believe the number of people that can use it I think it really happened during the pandemic a lot of people learned how to use Zoom.

SPEAKER_01 30:33

Yeah yeah technic tech technology is always a good one for cognitive stimulation uh I know for me anyway with it so um I think this is so interesting uh you know and there's like you said there's simple things that we can do to help the prevention of aging but if you do get that diagnosis the of the mild cognitive impairment again you can kind of slow um the progression a little bit by doing some of these things with it uh for that yes you can keep your skills up you can keep some of your mental skills up with cognitive stimulation therapy it also is shown to really help people's mood quality of life and for women it's been even shown to alleviate depression oh I you know I can see that yeah I I could see that because I think sometimes as women we feel like we have to take care of everything and it's a lot it's a lot to to handle some days.

SPEAKER_00 31:35

Yes yeah and I think the connection that you have in in this just such a rewarding and wonderful conversation to thank you well I just think it's important.

SPEAKER_01 31:46

I think you know people need to know what they can do. And if they're in the middle of having uh a loved one family member with dementia what can they do? What are other things to do? Because you feel so helpless so helpless uh you know because there's just nothing they can do for you. You know so at least there's something you could be like all right I even if it's learning how to have that conversation you know because my mom had opinions about things all the time still she she always did you know and you'd be like oh okay you know so I I think sometimes we we take our older adults for granted you know we can we push them in the background sometimes and we shouldn't so with that so we're gonna tell everybody your the link to your website will be on with our show and everything so people can check it out.

Final Takeaways And Closing

SPEAKER_01 32:39

It's very interesting lots of good things on there. So thank you for joining us today. This has been so stimulating this has been a stimulating conversation wonderful okay thank you for having me Lisa thank you so I hope you all have enjoyed the conversation so I hope you enjoyed your cup of coffee your cup of tea or if it's a really bad day your glass of wine and don't forget to leave us a review or subscribe to our YouTube channel and we will see you next time on another episode of Patty's Place