Meeting the cruelty of cognitive decline with gentleness, kindness and brilliance – Dr Samtani understands the power of social connection to nourish and strengthen our brains

Dr Suraj Samtani is a Post-Doctoral Fellow at the Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney. He is also a clinical psychologist. And just possibly Australia’s next national treasure. Working alongside Chris Hemsworth and his father in National Geographic’s documentary, “A Road to Remember”, Samtani contributed his considerable expertise on cognitive health to help guide a poignant and moving exploration on dementia and humanity. And yet after speaking with him, what stays with you is how he does so. In earnestness, gentleness and kindness, alongside a brain quite at home in the braininess of it all, Samtani’s value is not centered in the flashiness of brilliance but in the integrity of his character. Whether it’s supporting celebrity in elevating the conversation surrounding dementia or saying yes to local rotary meetings, Samtani is a treasure in this, like Atticus Finch, he is both the same on the world’s stage as he is at his local RSL. Samtani is thoughtfully and perseveringly committed to educating and uplifting humans in the most critical elements of life, our social connections, our memories, our brains.

The beginning

Origin stories are powerful, at least according to all the superhero tales of late. They have been used by storytellers and actors the world over to understand who we are, why we are. No less heroic, Samtani generously shares an intimate picture of his childhood, both tender and seismic in its impact on where he was to end up professionally.

“As a 6-year-old I spent a lot of time playing with my great grandfather, who I was very close to, he was 90 at the time. I remember having a plastic cricket bat and ball set. And we would play in front of our apartment that we used to live in at the time.”

“We moved house, and as he was so attached to me, he moved with us, but he stopped doing all his volunteering and social activities because he didn’t know anyone in this new area.”

“Six months later he was diagnosed with dementia and he couldn’t recognise me.”

Samtani is poignantly open, likely to strike a chord with the thousands of people in Australia and around the world who are journeying with a loved one through dementia, “so some of my earliest memories are that, as a 6-year-old it was quite scary, not understanding why he doesn’t know who I am anymore.”

The next story arc

A niggle remained, that something had happened to someone he loved, “it always stayed with me, that there must be something about being socially active that keeps our brain healthy.” And like any superhero worth their salt, well, he went and did something about it.

Finishing high school in NZ, he crossed the Tasman to alight on Australian shore and so began the next phase of his training. A psychology bachelors, masters and PHD in clinical psychology followed, and Samtani started work as a clinical psychologist, which he still does one day a week but the twist would come in the tale, a calling to something else.

“But then this job came up, at the Centre for Healthy Brain Ageing to look at social connections and dementia and I thought, I just have to do this.”

Reminiscing on the trajectory of his career, Samtani’s musing may be just the strategic gold aged care leaders are looking for in order to bring the best into aged care, that the personal underpinning the professional is not rhetoric, it is the perseverance to push through setbacks, it’s the tenacity to take another swing at a persistent problem, perhaps with a metaphorical hammer.

“Having the personal experience has completely shaped the direction I’ve taken in my professional life towards helping people and trying to raise awareness about people with dementia and also strategies to prevent it and interventions.”

Framing the point of excellence

Samtani has worked hard. He has showed academic brilliance, initiative, he’s ticked all the KPIs, all the markers of success. And yet with quiet and assured conviction he voices, “for me science is about improving everyone’s life.”

“There’s no point in having science only in a journal article that a handful of people may or may not read, our goal is to help people. That’s why I think it’s really important for scientists to be sharing their findings and knowledge with the world in a way that is accessible for everyone.”

As to his experience contributing to the documentary, “I really applaud National Geographic and Chris Hemsworth and his family, especially his father Craig, to be so vulnerable for the 57 million people around the world living with dementia and the global reach that they both have.”

“This is going to lead to a lot of honest conversations in many homes around the world about changes they may have noticed in themselves or loved ones. It will get people thinking about how they can keep their brains active and healthy.”

He seeks to always land the science in what it means, “it is possible to live well with dementia, it is possible to reduce our risk.”

Leadership is to educate

Samtani sees that an extension of being a professional scientist is to remember the point, the flip side of the coin, to reach those who need to hear the science, “as a scientist a big part of my role to be community education.”

And while the documentary has importantly been high-profile, to be in front of millions of eye-balls, Samtani sees his work at the local level to be equally as beneficial of his time.

“I make sure that every year I say yes to as many community talks as I can, whether its rotary club or PROBUS groups or Men’s Shed, or a local council organised talk or part of dementia awareness month.”

Being the same with celebrity as with Barry from Men’s Shed highlights a character trait we all may be looking for in our superheroes. Through whatever mechanism, it is in conveying the substance of science, to the human head and heart, that continues to propel Samtani onwards.

“It’s through doing those talks, and hearing the stories of the people that come up to you afterwards, what they got out of it, is the real benefit of doing this research. It is not in writing some paper… of course we need that evidence to back up what we’re saying, without that we have nothing to say… but it’s really key we’re sharing this with people in the community because otherwise why are we doing this work?”

Hope must have substance

In the cruelty of dementia there is no place for hollow platitudes or baseless hope. Those living with dementia, and the loved ones that are journeying alongside in moments of heartache that defy speech, the science must have clout.

“We have done a lot of research at CHeBA, on just how powerful social connections are for reducing our risk of dementia and slowing down cognitive decline.”

“We shared our findings with them [the Hemsworths] that come from large studies, where we brought together data from about forty thousand people from all around the world, who were followed for up to 14 years.”

“Even after accounting for all the known risk factors for cognitive decline, researchers found that people who were seeing friends and family at least monthly, or more often, and when people had someone to confide in about things that were stressful for them, those two ingredients put the brakes on the rate of cognitive decline.”

“That really surprised us. After we took into account smoking, drinking, diabetes, hypertension, everything else we know that increases our risk of dementia, social connections are incredibly protective.”

Open and honest

Samtani’s account of his work, and its ability to constantly surprise him is an encouragement to current and future leaders in aged care. To be free of the rigid idea of being a leader, can be to embrace the almost child-like wonder, alongside others, that started it all.

Samtani’s openness and passion is infectiously engaging, to bring others in and to share that he is still surprised creates an atmosphere of collaboration and wonder.

“It is really something that never stops surprising me, just how powerful it is to have those close social connections.”

With each new paper, Samtani sees the reinforcing of hope, of opportunity, “and we found that in multiple papers, that having a person we can be open and honest with, even if it’s one person, it not only slows down cognitive decline, it also prevents depression in late life. And it also helps us to reduce our risk of dementia and also helps us to live longer. It seems to be the one ingredient that is essential for a healthy body and mind.”

Rubber hitting the road

Samtani faces the question of how to cope with the complexity and cruelty of cognitive decline with a gentleness and thoughtfulness not often experienced in today’s frenetic world. While his work has contributed guidance on how to keep brains healthy, his heart and head are also tuned to those who have no choice but to walk what is before them.

“Right now with the Dementia Australia Research Foundation, I have a research fellowship from them, to run an intervention to reduce loneliness and boost social connections for people already experiencing changes in memory and thinking.”

He shares, “the biggest thing I’ve learned is that everyone’s experience of dementia either as a person living with dementia or as a carer is going to be quite different.”

“The one thing we all have in common, is that it’s going to have ups and downs. It’s really important to be kind to ourselves, and to the person experiencing the changes.”

“For me it’s really important to always respond to the person, as if they’re saying that sentence or asking that question for the first time”, Samtani says, “it’s really important to respect the person’s dignity and autonomy, not speaking for them, over them or correct them but to treat them with how you would want to be treated.”

“It is extremely important to remember that it is possible that we can live well with dementia.”

He advocates, “in fact, instead of withdrawing into ourselves, we encourage people to be very proactive, in terms of being physically active  by doing exercise, cognitively active by brain training, crosswords, learning a language, learning an instrument, or cultural activities, and being socially active by talking to friends and families, and talking to someone we trust.”

“In those activities we find moments of joy. Every day is going to be a mix of ups and downs, and it’s really key that we are focusing on moments of joy. They are the moments that are good for our brains and our bodies, they strengthen our bonds with each other.”

Brain nourishment

Samtani’s work is mesmerising and pragmatic from the get-go. Looking at what’s dubbed “social frailty”, he and his team are looking to “capture the resources that we may be lacking to fulfil our social needs.”

For those in the aged care industry, one that is certainly not for the faint of heart, the research may be the difference of burn-out and finding the key to thriving in the job that is loved.

Samtani asks everyone to think on, “do we have frequent interactions, do we have that person we can confide in, do we have that person we can lean on for support. It is not just how many people we have around us,  but also whether we can rely on those people and how satisfied we are with those social connections.”

“We are really interested in how physical frailty affects our health but how social frailty affects our health.”

The two bridges

Samtani explains the latest theories that could drive considerable changes in cognitive development treatment.

“We have a leading theory in this field that theorises two possible pathways for how social connections boost our brain health. Those pathways are called social bridging and social bonding.”

“Social bridging is where we do activities with people that stimulate the mind, and stimulating the mind leads to neurogenesis, which is the creation of new neurons. We forget that we are always making new brain cells throughout life, especially in the memory center of the brain, the hippocampus. Doing new and a variety of things that enrich our experience with other people is so beneficial for our brain.”

“The other pathway, social bonding, is having someone to confide in when we’re feeling stressed. We know chronic stress leads to inflammation, which can cause wear and tear in the brain decades before dementia emerges. It is really important that we have people we can trust and rely on so we feel less stressed and have less inflammation in the brain.”

And so the old adage of being lonely at the top, of being a solitary leader, is not only unhealthy for an organisation but unhealthy for any leader. When looking at providers that are thriving, having an executive team that is collaborative in trust, hard-working and with a readiness to laugh, the findings highlight why. The science supports no one going it or feeling alone, that taking on responsibility without connection can be potentially harmful.

Real life defies neat KPIs

On the front foot, Samtani distills complex and cutting-edge science into substantive truth that can be acted upon in the grey, in the routine. Without glossy magazines exclaiming that dementia either does not exist or is not to be feared, he enters with space to hold the brokenness, the exhaustion and the need for hope and joy.

“It is really normal to have moments of joy and despair as we experience degenerative chronic health conditions. It’s very normal to have moments of feeling completely overwhelmed.”

“Also it’s completely normal to have moments of joy and happiness. These moments come from quality social interactions, not how many people we are connected to but having one or two, or a handful of really high quality connections we have with people, that we trust… people we can rely on.”

The KPI of small talk

Samtani has conducted research in the aged care setting, “Recently we conducted a trial at Leigh place, a residential aged care facility in Sydney, This was an example of a place which was custom built to provide a sense of community. Their ethos was to not only for staff to look after the medical care of the people living there, but also to look after their social needs.”

“Not only is there a great program of activities for people to do, but also there were really strong one to one connections between professional staff on the floor and each person living there.”

He was struck by the fact that, “even if a person can’t join in the group activities on a particular day, they can still sit and have an in-depth, hear- to-heart conversation with any member of staff and have a real connection with them. I think that’s incredibly important.”

In supporting the approach of supporting care for the whole person, “my message to leaders in the aged care sector, is to focus not only on creating a calendar of social activities for people but making sure each person has a key contact, if they are in RAC.”

“And we are also encouraging nurses, aged care workers and allied health professionals not only to do clinical roles, which is providing health support but also making sure that you do that small talk with the person at the start and end, and during time with them, and checking in on them as a person. It is really important not to solely do clinical work, but also to provide care to the person as a whole.”

Echoing this Simon Kerrigan, a physiotherapist and now founder of an allied health provider, recalls with utter clarity, that it was in the opportunity to build relationships that he felt incredibly satisfied as front-line staff. Connecting relationally made a difference to the clinical goals. Samtani’s research directly supports this sentiment shared by thousands of front-line staff. In policy reform and funding conversations, this must be a central guiding principle.  

Someone has your back

The science is unequivocal, having people we know and trust, to meet with regularly and to share the ups and downs, the awful and awesome, is vital to thriving professionally and personally. For aged care leaders, front-line staff, seniors, family member carers, all human-being need trusted connections to safeguard the brain. Even when a diagnosis of cognitive decline has been given, hope remains, there is always an option to do in the face of change.

Samtani thinks back to his great grandfather, a precious and treasured connection in his life.

“I would say to my younger self, he still loves you, even if he doesn’t recognise you. And it’s really important that you spend time with him. Even if he doesn’t recognise you, he’s going to cherish each moment.”