Interview with Alzheimers NZ Fellow Dr Gary Cheung

Kia ora Gary. Congratulations on being awarded the Alzheimers NZ Fellowship! Can you tell us a bit about the focus of your work?

Thank you! I was very excited to hear that I had been awarded the Fellowship, which will support my work looking at the way we assess the health of older people in Aotearoa New Zealand. For the last ten years, this has been collected through a standardised process called an interRAI assessment. This captures important information around a person’s physical and mental health, as well as the ways they stay socially connected in the community.

Using this data, I have been specifically looking at the connection between dementia and mortality, with another focus on the needs of people living at home by themselves. Not everyone with dementia will have an interRAI assessment, but I think using this data to make sure we are providing the best support for people with different living situations is going to be increasingly important as the numbers of people with dementia continue to rise.

You’re also involved with something called Cognitive Stimulation Therapy (CST). What is it and how does it work?

Cognitive Stimulation Therapy (CST) is a psychosocial group treatment which helps to improve memory and quality of life for people living with mild to moderate dementia. It was started by University College London in the UK around twenty years ago, and since then has really taken off.

It works by bringing 6-8 people living with dementia together twice a week for a seven week course. Each session has a different activity and is focused on getting participants actively engaging and sharing their opinions and thoughts.

For example, one of the activities is centred around having a debate about an article that the group chooses from a newspaper. People with dementia can often shy away from expressing their thoughts and feelings, but activities like this one encourages them to voice their take on things in a supportive group environment. This is important because sadly, too often people with dementia are left out of conversations.

Another favourite topic of conversation is (unsurprisingly) food! We recently had a great session where we all discussed our favourite holiday and celebration foods. This was a great opportunity for people to share recipes from their own families and cultures, and we all left with lots of ideas of new things to try and an extensive ingredient list to buy!

Together with Dr Kathy Peri, we have delivered CST facilitator training to over 500 people. While not all those people have ended up running regular groups, many of them have a lot back with them from the sessions in terms of their thinking and approach.

What sort of impact does CST have?

The evidence we have shows that the impact can be huge. Talking to the participants, you can really see how a supportive group setting coupled with stimulating activities really does make a difference for people. We have been working on an adaption of the programme for Māori, and are excited to be rolling that out soon.

As a result of the research UCL has done in the UK, 80% of NHS Memory Clinics there are now offering CST. I’d love to see our health system do the same!

I’d encourage anyone interested in CST to have a look at the Dementia Learning Centre website for more information and to get in touch.

In your experience, what impact has Covid-19 had on people with dementia?

I think it’s been different for different people, but in my experience I’d say most people have been negatively impacted by the pandemic. For example, some day programme services that closed at the start of the first lockdown are still not up and running again. For the people who were attending those several times a week, that’s left a huge gap in their social calendar that’s been hard to fill. For the carers too, services have been reduced massively and that takes a huge toll on them.

Anecdotally, clinical colleagues of mine say they have seen a much more rapid cognitive decline in some of the people living with dementia they support, and people having to move more quickly into aged residential care than they perhaps may have done had services been running as normal.

While it’s undoubtedly helped to keep us all safe, the lockdowns have definitely had an impact on all aspects of our health, physical and mental. Both of which are just as important for our brain health, it’s all connected!

How do you think technology could help us meet some of these new challenges?

I’m really interested in the role of telehealth, which uses technology to deliver healthcare. I think video calling technology like Zoom opens up heaps of opportunities we didn’t have before.

For example, during the first lockdown we facilitated our first online CST training session, which was a great success. We didn’t want to lose our momentum, so we gave it a go, and it worked really well. There’s now some research being done in the UK and Hong Kong to test the effectiveness of virtual CST.

I’m also looking at an online intervention programme for older adults with loneliness, and there’s also some work being done to set up an online support group for carers of people with dementia in the Chinese community, based on the WHO iSupport initiative. So lot’s going on!

I think with the right support for those that need it, we can overcome the barrier technology can present. There are so many potential benefits, particularly for our more rural populations, and for those wanting to cut down on travel and emissions.

At the end of the day, I think there’s a role for both telehealth and more traditional face to face services. I don’t think it has to be either/or. For lots of our kaumātua and older people, the benefits of an in-person trip to the doctor can’t be replaced, so I don’t think we should lose sight of that. We just need to open to the possibilities that technology offers, and make sure we are supporting people to access the options and services that are right for them.