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In Context
The next generation of leaders advocating for brain health
A monologist, a musician, an event producer, and an animal behaviourist are working to change
how society thinks about aging and dementia. These individuals are part of the first cohort of
Atlantic Fellows at the Global Brain Health Institute and are using their talents to transform the
way we think about and care for elders and people with dementia. Dana Smith investigates.
The Global Brain Health Institute
(GBHI) has undertaken the ambitious
goal of “reducing the scale and
impact of dementia” worldwide
by training the next generation of
leaders in brain health. Based at the
University of California, San Francisco
(CA, USA) and Trinity College Dublin
(Dublin, Ireland), GBHI facilitates
dedicated and creative individuals in
addressing the wide-ranging effects
of dementia through prevention
research, education, and advocacy.
The Atlantic Fellows training
programme at GBHI—which includes
artists, journalists, and entrepreneurs,
as well as neuroscientists, neuro­
logists, and psychologists—takes
an inter-professional approach to
disrupt conventional thinking about
aging and dementia. Fellows from
differing disciplines nurture and
learn from each other in a unique
bi-directional thought exchange,
fostering innovative interventions.
Four of these Fellows are working
to change the narrative around
dementia by sharing stories about
the steps people can take to protect
their brains, reframing how we think
about aging, and helping patients
with dementia cope through art and
interpersonal connections.
Josh Kornbluth is a theatrical
monologist based in San Francisco
(CA, USA), who tells autobio­
graphical tales onstage and onscreen.
Kornbluth’s stories often relate
to issues of social justice, and his
comedic approach makes difficult
and often misunderstood topics
more accessible. Following the
diagnosis of his step-father with
Alzheimer’s
disease,
Kornbluth
turned his attention, passion, and
skill for storytelling to the subject of
dementia. He is developing a one-man
show based on his experiences at GBHI
to educate audiences about brain
health and the experiences of patients
with dementia and their caregivers.
Kornbluth is also helping patients
and caregivers tell their own stories
onstage. His objectives are twofold:
shift audiences’ pre­conceptions about
what it’s like to live with dementia,
and provide patients and caregivers
with a form of art therapy to express
themselves, empowering them to
reclaim their personal narratives.
Retelling, and thereby reshaping, the
narrative around a traumatic event,
such as a dementia diagnosis, can
“People [with dementia] feel
that their life story is bifurcated
or, even in a sense, that the real
life ended when the symptoms
or the diagnosis began. I want
to get them to communicate
that their lives were not
bifurcated.”
change how a person perceives their
experience of it. Research has shown
that so-called expressive writing—
writing about one’s experiences and
emotions—can reduce depressive
symptoms, boost working memory,
and even improve physical function
in patients with cancer. James
Pennebaker, Professor of Psychology
at the University of Texas (Austin,
TX, USA) and the author of Writing
to Heal thinks that “there is now a
great deal of research to suggest that
writing about personal upheavals
can improve people’s physical and
mental health.” He also thinks that
narrating personal upheavals through
theatrical performance might also be
valuable, “to the degree that people
are able to organise their thoughts
around very complex personal
problems.” For Kornbluth, the power
comes from simply reminding these
patients that they still have stories to
tell. “The narrative that people feel—
both the people who get the disease
and the people who love them and
care for them—these people feel that
their life story is bifurcated or, even
in a sense, that the real life ended
when the symptoms or the diagnosis
began,” he says. “I want to get them
to communicate that their lives were
not bifurcated. That this was a full life,
certain things had happened, certain
things had changed, but it was the
same person who was experiencing
this.”
For patients who have lost verbal
communication skills, music can
provide an alternate source of
enjoyment and connection. Exposure
to music can reduce blood pressure
and stress hormones, and music
therapy can improve behavioural
and psychological symptoms of
dementia. Musician Heidi Clare taps
into these benefits by performing
for elders and people with dementia
in Marin County (CA, USA). She
describes the transformative effect
music can have: “When I first walk
in, they’re shut down…But by the
time I leave, even after just the
first time I work with them, they’re
changed, they’re open. And after
three times of working with them,
they’re rowdy!” Jessica PhillipsSilver, a cognitive neuroscientist at
Georgetown University (Washington,
DC, USA), explains that these
energising effects are due to the
ability of music—and particularly of
rhythm—to activate a widespread
www.thelancet.com/neurology Published online October 16, 2017 http://dx.doi.org/10.1016/S1474-4422(17)30359-9
Lancet Neurol 2017
Published Online
October 16, 2017
http://dx.doi.org/10.1016/
S1474-4422(17)30359-9
For more on the Global Brain
Health Institute see http://
www.gbhi.org/
For an example of Kornbluth’s
work see https://www.youtube.
com/watch?v=MPnQ3EzUEE4
For more on expressive writing
and its effects see Psychol Sci
1997; 8: 162–66
and
J Clin Oncol 2014; 32: 663–70
For more on music therapy see
Reviews Lancet Neurol 2017;
16: 648–60
1
Scott MacDonald
In Context
Atlantic Fellows for Equity in Brain Health at GBHI joined by supporters Chuck and
Helga Feeney, and their daughter Juliette Timisit
For the Brain Song Radio
podcast see http://www.
brainsongradio.org/
For more on the Bealtaine
Festival see http://bealtaine.ie/
For The Baring Foundation
report see http://
baringfoundation.org.uk/wpcontent/uploads/2009/08/
AgeingArtfully.pdf
For more on dementia
assistance dogs see http://www.
memorydog.org/
2
network in the brain. “We often think
of music as for the ear, but we’re
actually engaging a multi-sensory
ability, and those abilities seem
to centre around the auditory and
motor domains,” she says. “There’s
something about the regions of
the brain that are responsible
for anticipation and planning of
movement that interact with the
sound and seem to result in these
very highly intense and pleasurable
experiences.” Clare is also using
music to educate audiences about
the importance of brain health.
Alongside her co-host, Bruce Miller,
co-director of GBHI and director
of the Memory and Aging Center
at the University of California, San
Francisco, Clare produces Brain Song
Radio, a podcast about creativity and
the benefits of music on the brain.
Together, they interview high-profile
musicians who, because of their
careers, often have interesting stories
and perspectives about resilience and
adaptability—two traits important
for brain health. Through their fans,
they also have a wide audience base
who might like to listen to what they
have to say. Clare’s goal with the
podcast is to influence listeners to
make healthy lifestyle choices that
are ultimately good for their brains,
while humanising and destigmatising
people with dementia.
Dominic Campbell is leveraging the
unique atmosphere of festivals to
spread the gospel of brain health. For
seven years, Campbell produced the
Bealtaine Festival in Ireland, which
celebrates the arts and creativity
of elderly people. The benefits of
engaging elders in the arts are welldocumented. In Ageing Artfully, a
report by The Baring Foundation
(London, UK), director David Cutler
writes, “In addition to the intrinsic
and fundamental joys of creativity,
artistic expression, and entertainment,
at its simplest the benefits from work
in this area can be divided along two
dimensions: health—physical and
mental wellbeing—and relationships—
personal or immediate (family,
friends, carers, staff) and societal, or
broader (community development).”
Campbell’s new initiative, a travelling
arts festival, will continue to focus on
aging. Inspired by his time at GBHI, he
plans to incorporate more science into
the festival acts, featuring researchers
who will disseminate innovative
ideas and interventions directly to the
audience. “Through festivals, people
enter a different kind of state. They are
much more likely to try out a new thing
at a festival than they are if they’re
walking down an average street,”
Campbell explains. He hopes that this
openness will inspire people to try new
foods, exercises, or hobbies that might
help improve their brain health later in
life in the hopes they adopt them once
they return to their everyday lives.
Animal behaviourist and entre­
preneur Adam Waskow joined GBHI
after more than 20 years working at
Guide Dogs for the Blind. He hopes
that his new endeavour, Memory
Dog, will do for people with dementia
what Guide Dogs does so well for the
blind. Spending time with animals is
a generally soothing experience that
can decrease stress and agitation.
Animal assisted therapy has been
linked to lower levels of loneliness
and depression by providing social
and emotional support, as well as
facilitating interactions with other
people. Therapy animals can also
act as triggers for memories of past
pets or serve as a substitute for pets
that have to be left behind when a
patient enters a care facility. With
Memory Dog, Waskow wants to
provide therapy animals to patients
with dementia at different disease
stage, ranging from those who
still live in their own homes to fulltime residents at care facilities. He
thinks that therapy dogs can assist
dementia patients with agitation,
apathy, and compliance with
medication, hydration, and hygiene.
“Therapy dogs are something that
are scalable and affordable, that we
can teach people to use, and that we
can get into a lot of places,” Waskow
explains. One of the first alumni of
the Atlantic Fellows programme
at GBHI, Waskow is now raising
funds to launch his initiative. The
money will go toward building a
memory dog centre in Marin County
(CA,USA), and to train memory dogs
for people with dementia.
Regardless of the type of
intervention, the four Fellows agree
that inter-personal connection is key.
Narrative, music, art, and animals
provide varying means to engage
with elderly audiences, but the result
is the same—feelings of community,
empathy, joy, and purpose. Kate
de Medeiros, a gerontologist at
Miami University (Oxford, Ohio,
USA), supports this idea. “People
forget that people with dementia,
regardless of type, have capacity to
engage in meaningful things.” She
adds that people often “overlook
this very important aspect of human
engagement” and that “the arts are
a really good way of making that
connection with people.” Through
their work, the Atlantic Fellows hope
to improve the lives of old individuals
and those with dementia, and they
strive to change society’s narrative of
dementia from a loss of self to a gain
of new ways to connect with others.
Dana Smith
www.thelancet.com/neurology Published online October 16, 2017 http://dx.doi.org/10.1016/S1474-4422(17)30359-9
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