Psychology Month Profile: Dr. Nasreen Khatri and Dr. Colleen Millikin, Adult Development and Aging Section

Adult Development and Aging

“This isn’t your fault. Your brain is letting you down.”

There is still, to this day, a lot of stigma associated with memory loss. That’s why Dr. Colleen Millikin uses this phrase when she talks to older adults experiencing mild cognitive impairment or dementia.

“You don’t take it personally when you’re walking along and your knee gives out. But people respond differently when it’s their brain. If your brain lets you down and you can’t think of that word, or you can’t conjure up that name, you tend to blame yourself much more than when it’s your knee letting you down.”

Dr. Millikin is a clinical neuropsychologist with the Winnipeg Regional Health Authority Clinical Health Psychology Program and assistant professor in the Department of Clinical Health Psychology, Rady Faculty of Health Sciences, at the University of Manitoba.  She is the Chair of the CPA’s Adult Development and Aging Section. She works mainly in the public system, assessing older adults where there is a possibility of Mild Cognitive Impairment or dementia. Mild Cognitive Impairment (MCI) is a term that is used to describe memory problems that exist between normal aging and dementia. Compared to others of a similar age, people with MCI are at higher risk of developing dementia over time.

“There are so many things that can interfere with memory that aren’t Alzheimer’s Disease or brain problems. Chronic pain and the medications for it, sleep problems, stress, PTSD, all kinds of things. Even thinking that you might have dementia can be a source of anxiety, and being anxious can make it harder to attend to information and remember it.”

The field of Adult Development and Aging Psychology is a wide-ranging one. It's the study, assessment and management of the physical, psychological, cognitive, emotional and social functioning of people 18 years and up and includes aging in all its forms, milestones, joys and challenges. Dr. Nasreen Khatri is an adult lifespan psychologist and neuroscientist at The Rotman Research Institute, a cognitive neuroscience institute fully affiliated with The University of Toronto. She is registered both as an adult clinical psychologist (18-65) and a gerontologist (65 years and up). She is the Treasurer of the Adult Development and Aging Section of the CPA.

“Specifically, I study the impact of depression and anxiety on the brain, beginning around age 30 and continuing all the way into old age. The biggest misconception about aging is that it is a static category or a state.  It is not.  It begins at conception and is a dynamic, ongoing process.  Aging is simply another word for living!”

Dr. Millikin speaks a lot about the breadth of the field, and the variety of work psychologists in this space are doing. In her field of cognitive impairment, she says,

“Age is the biggest risk factor for developing cognitive impairment, but I have seen people in their 90s with very good brain health and people in their 50s who are living with dementia. There is no single cause for cognitive impairment. In most cases, there is an interaction between a person’s genetics and other health issues.”

Those health issues have begun to be understood a lot more in recent years, thanks in large part to psychologists working in this field.

“We now know that exercise actually grows new cells in the part of the brain  that impacts mood and memory.  The best thing you can do for your brain and to age well is physical exercise. We have also learned that individuals with an untreated history of depression in mid-life have almost double the risk of developing dementia in later life, compared to those who do not share that untreated history. Depression is eminently treatable with a variety of evidence-based treatments. Dementia is currently incurable. Therefore, we do not want anyone to go down the cognitive path from untreated depression to cognitive impairment and dementia. Timely assessment and treatment of depression today may stave off dementia later on. In other words, taking care of your mental health today could save your brain tomorrow!”

Ideally, interventions to promote brain health should begin as early in life as possible. However, there is evidence that making lifestyle changes can reduce risk of progression to dementia even in people who already have mild cognitive impairment. This is what Dr. Millikin and her colleague Dr. Lesley Koven, a clinical geropsychologist, were seeking to address when they set up their Early Cognitive Change Clinic for Older Adults in 2013. They provide assessment to identify people who have mild cognitive impairment as well as an interview to evaluate the mental health needs of the person’s spouse or other close family member or friend.

“We run a psychoeducational program for people with MCI and their family members to help them learn about MCI, strategies to get around some of the memory difficulties, and lifestyle habits that assist brain health. Exercise and diet are important of course, and we’re also learning that sleep is a big one. Sleep is very important for brain health, but older adults tend to have difficulties with sleep at a higher rate. One of the challenges is that a lack of sleep is not good for your memory, but also that a lot of the prescription or over-the-counter medications people take for sleep can interfere with a brain chemical that is important for memory. Fortunately, there are behaviour changes that help with sleep and psychological treatments for insomnia!”

Family members of people with mild cognitive impairment can also experience significant stress. Again, Dr. Millikin stresses the impact early intervention can have.

“We’re increasingly recognizing the needs of caregivers. We’ve known for a long time that family members of people with dementia can experience significant stress. Even when a person has mild cognitive impairment, family members or close friends can still have some stress related to the situation, although they may not identify themselves as “caregivers.”  So if you’re going to do some intervention to help the family member with stress management, that really needs to start as early as possible.

There are many other facets of the psychology of aging and adult development, each as important as the last. Dr. Millikin provides a few examples.

“Dr. Kristin Reynolds, an assistant professor in the Departments of Psychology and Psychiatry at the University of Manitoba, started up a telephone-based program to help people with loneliness during the pandemic. The Past Chair of the Adult Development and Aging Section, Dr. Marnin Heisel, does research at Western University looking at ways to reduce risk of suicidality in older men. Dr. Norah Vincent, a colleague in my department, has developed online cognitive behaviour therapy treatment programs for insomnia.”

Dr. Khatri says the pandemic has had a profound impact on older adults, from mental health (e.g., depression and anxiety)  to exacerbating longstanding systemic issues  in long term care.

“It has shone a light on how we treat our elders and how we should treat our elders. This is a time for reflection to reconsider clinical, governmental and social policies that impact aging Canadians. Canada is an aging nation and as we go forward we will need to apply systemic policies that optimize our brain health (combination of mental and cognitive health) and allow us to grow older with dignity, autonomy and meaning. The future of brain health in Canada is in our hands, and one of the best ways to predict our future is to create it.

Last, the pandemic has taught us that we need to focus on lifestyle factors (diet, exercise, rest, social connection) at every age to keep us physically, emotionally and cognitively healthy and flourishing.”

In other words – there are many ways you might be able to keep your brain from letting you down. That said, it may happen anyway. And if it does, it’s important to know it is not your fault.