Latest / Unfinished Business / Who Do You Call When a Loved One's Brain Changes
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- Dr. Jennifer Caussade, Psy.D.: This is very taxing, and sometimes knowing the treatment is more work, Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: and they tend to burden themselves and put a lot on their plate. So, my takeaway for the family is Be there for them, but be there for yourself. And be mindful of the resources for you as the family member as well. Kimberly Griggs: welcome back everyone to Unfinished Business. Today's conversation is something most of us might not think much about until it touches someone we love. so here's the question: what happens when an unexpected injury or illness or neurological condition changes the way someone thinks, remembers, communicates, or you know, simply moves through everyday life? And more importantly, who do you call to help your loved one find their way forward? my guest today, which I'm thrilled to have a conversation with, is Dr. Jennifer Caussade Rodríguez she is a licensed clinical psychologist and the clinical director of the Dallas Neurorehab Center She works specifically alongside neurologists and neurosurgeons and rehabilitation physicians to help patients understand their neurological conditions and how this affects their thinking and their emotions and quite frankly, just their daily lives, and how we can help develop as loved ones and family members. help them to develop practical paths toward their recovery and independence. So Dr. Caussade thank you so much for joining us today and welcome to Unfinished Business. Dr. Jennifer Caussade, Psy.D.: Thank you for having me, Kimberly. I'm very excited to be here today. Kimberly Griggs: Yeah. So I always like to, you know, get a get a chance to understand who who the woman is behind the credentials, right? So I would love to hear your story, Jennifer. What drew you originally toward practicing psychology? Dr. Jennifer Caussade, Psy.D.: I always joke that I am a prime example of nature and nurture because my father's a psychiatrist. So Kimberly Griggs: How so Dr. Jennifer Caussade, Psy.D.: there we got our our nature going and he would always be showing me a lot of articles and TV shows that were very psychological heavy and and movies and just being like, That's what daddy does, that's what you can do in the future. And ironically both my brother and I went into the field. He's all he's a psychiatrist Kimberly Griggs: Really? Dr. Jennifer Caussade, Psy.D.: and I ended up be I I I went my own path. I went to psychology, not psychiatry, but still much within the family business. Kimberly Griggs: How interesting. So you have this curiosity, nature, nurture. What has fascinated you the most about this field? Dr. Jennifer Caussade, Psy.D.: you know, the funny thing, not just about the field but about my journey in it is that I always say never put limits on yourself about where you wanna end up because if you would have told bachelor level me that I was gonna be working with neurogenitic conditions and brain-based conditions, I would have like, ha ha, no no. I saw Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: myself doing counseling, working with specific populations, and I just fell in love with testing. I fell in love with the puzzle pieces and trying to see what goes beyond what's discuss in talk therapy and be able to get more information so we can provide more comprehensive treatment planning. And so I went from a grad student that enjoyed counseling to a predoctoral intern that was doing psychological testing in children with trauma to then when I graduate and finish my studies just focus on brain based related conditions, which is something I just never thought about. And I it's just where I stayed. We don't need to look anywhere else. Kimberly Griggs: So it was just a fascination, but was there a particular experience or person that helped influence that decision? Dr. Jennifer Caussade, Psy.D.: It to be honest, it's more about how life played out. Because I'm born and raised in Puerto Rico. I wasn't thinking about Texas at all. And this is where I ended up doing my predoctoral internship. And then the connections that I made from my internship to my postdoc is that's what I need to do as part of getting my license. He was working, that supervisor, he was working with a neuropsychologist that did a lot of brain injury. And that was my exposure. And and that's when I was kinda like, okay, I I kinda like this. This is this is beyond psychology. This is brain and body and how it gets together. And it was a lot more comprehensive and a lot more complex and just drew me in. And then you start meeting other people that are within that field and growing from their knowledge. And I once I was there by I stayed there. Kimberly Griggs: what is it about the brain specifically that that fascinates you? Dr. Jennifer Caussade, Psy.D.: Because you can have a similar case that looks so different, but then you have various people that look that that appear the same. Like for example, with Parkinson's or even Alzheimer's. You have Alzheimer's and you have some individuals that as they're declining they are still relatively themselves. versus other individuals that as they're declining, you start seeing more atypical behaviors like more aggression, more paranoia. and that's as it's progressing, but it's a different presentation, but it's expected within that disease. And same thing with Parkinson's. Kimberly Griggs: what causes that differentiation. Dr. Jennifer Caussade, Psy.D.: The differentiation can be a mixture of how the disease is progressing, but sometimes it's it's it's like when you have a criteria of symptoms and you have a you have a threshold like as long as you have four out of these, you have this condition. But you don't have to have the same combination of them. That's how it is with some of these conditions because with like I mentioned with Alzheimer's, you do see a specific presentation of memory decline. They have what's called an encoding difficulty, they do not learn information. So therefore they don't retain it and hints or cues aren't helpful. That's very typical for Alzheimer's. And you can see individuals that that is the main presentation. You don't see many behavioral variants of it, but then you see other individuals that are more paranoid, combative, and it's mainly because they don't remember that they did something. And same thing with Parkinson's like you can have individuals, most individuals have motor conditions, motor symptoms. Some don't. Some is just Kimberly Griggs: Really? Dr. Jennifer Caussade, Psy.D.: ri some is just rigidity and stiffness and swallowing difficulties. That's just because it's tremor predominant doesn't mean it's the only presentation. And some of them also can have imp impulse disorders associated. with the condition. Some of them may have an increase in gambling and inappropriate behaviors, or some don't. Kimberly Griggs: Really? Dr. Jennifer Caussade, Psy.D.: So if you hear about it, you're like, that's common. But also when you look at it through a macro, not everybody has it, so it's not as common, but it's not a surprise. So that's Kimberly Griggs: Okay. Dr. Jennifer Caussade, Psy.D.: what that's what's interesting about it. That you can see the same type of patient, but they can be completely different presentations and it's still within the realm of what you would expect. Kimberly Griggs: That sounds very complex from a treatment standpoint. many people hear the term neurorehabilitation but we really have no context as to what that means. help us to understand what Dallas Neurorehab does. Dr. Jennifer Caussade, Psy.D.: I will say that the name is not directly associated with what we do currently because when the owner opened the practice, he collaborated with a lot of other professionals and provided additional services that some have waned off and some have been added. so neurorehabilitation in itself is the type of therapy that is provided whenever there's a brain injury, when we're dealing with either cognitive difficulties or how our personality changes may impact our social life, there's several cognitive rehabilitations facilities still going on throughout the country, Dallas has several through hospitals and outpatient clinics. we don't provide that service anymore. We mainly focus on administration and treatment planning So we do the neuropsychological assessment. We typically get the referral from neurologist, psychiatrist, primary care physician. For the primary care physician, that's when things are in those earlier stages where you're kinda telling your doctor, I kinda feel like something's going on, but I think it's old age. I it maybe nothing and they send this the clients just to get a baseline. Or where the neurologist thinks maybe more confirmed or more progressed. Then we're either doing a reassessment just to see how we're doing now or an initial assessment for a baseline. And for Kimberly Griggs: Can Dr. Jennifer Caussade, Psy.D.: neurosurgery as well. Kimberly Griggs: and can you talk to us about what those assessments or reassessments entail? So it sounds to me like you work hand in hand as a partner, a referral partner, to dive deeper into the condition so that you can find the appropriate therapy. Okay. Dr. Jennifer Caussade, Psy.D.: So for because the I I always describe the the medical providers as the first line of defense because we don't even today, even though mental health has evolved, that's where we go to. I feel I feel off. Kimberly Griggs: Right. Dr. Jennifer Caussade, Psy.D.: Let me go to my primary care, or I have heart issues, a cardiologist. We always go to the MDs and so I mentioned with the primary care physician, when you feel like something's off or expressing something, but not overly too concerned with the neurologist. There may be a family history already, or things have progressed, where you've maybe missed a bill payment or forgetting your medications or higher more alarming behaviors. And that's where the medical providers will send out to us because they can provide testing to assess how things are presenting from a medical perspective. Now that we have biomarkers with our blood work, we can see if we have the genetic predisposition for Alzheimer's. also there's a skin biopsy to see if we have Parkinson's or other mm-hmm because there's Kimberly Griggs: Yeah, they can test it through skin Parkinson? Dr. Jennifer Caussade, Psy.D.: a a a couple of movement disorders that can be assessed through the skin punch biopsy. An MRI. Are there any structural changes? Did I do I have a tumor? Did I have a stroke? Is there any atrophy or brain-based changes in the temporal area which is related to memory that may be explaining some of these difficulties? that's their diagnostic, but doesn't let them know, okay, but how are they doing functionally? It's Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: like we have a picture of the house, but we don't know what's going on inside. How's the crown molding? How's how's the fixtures? How's that going? And that's where I come in. So then they send out to us and Kimberly Griggs: that makes so much sense. Okay, okay. So then what yeah. Dr. Jennifer Caussade, Psy.D.: we do a battery of tests. and I always explain it's interactive with you. It's not like an MRI where you go down a tube we're not putting you in front of a computer and stepping out. It's interactive. We do tests that assess how you're remembering things, how you problem solve, how you pay attention. How are your language skills? Are you able to both recognize words and express yourself? Because language is both expressive and receptive. So are both areas working appropriately? Are we able to visually deduce, problem solve, recognize? Cause imagine when we're driving. When we're driving, we are planning ahead. We are gauging the distances between vehicles so we don't crash in them. And we're seeing our peripherals to see what's going on, what's missing, what can I do? All those are visual reasoning abilities. and time tasks, how quick we are to do things. So if I'm driving, my reaction time is slow, I can have an accident. So some of these tests give us some real life information about how we would be presenting on the day to day and also about potential risks. I mentioned several areas that we assess because our brain is in charge of so many different things. When we think about dementia, we think just memory. But memory is just one aspect of everything. Kimberly Griggs: One's called a factor, yeah. Dr. Jennifer Caussade, Psy.D.: And then we th there's that behavioral component, potential paranoia, psychiatric hallucinations, the there's visual hallucinations at times, auditory. beliefs that people are stealing from you, hypersexual behaviors. Kimberly Griggs: Really? Dr. Jennifer Caussade, Psy.D.: there's a lot of psychiatric elements as well. And I mentioned earlier as well, impulsivity. So the brain be is in charge of all these areas in addition to to memory. It's in charge of our emotions and behaviors, because the frontal lobe is what tells us, hey, don't say that, that's inappropriate. don't don't do these behaviors as socially frowned upon. and when those areas are impacted, where's the break? There is no break. Kimberly Griggs: But if there's attributes or entry. Okay. Dr. Jennifer Caussade, Psy.D.: The break is is no longer existing. And also what keeps us in touch with reality. And so when we do the testing, we do a clinical interview, and that's where I assess kind of like, when did it start? Kind of ballpark, because sometimes when we're in the trenches, we don't know when it started. Life is so we're so busy on the day to day that dunno, a year, maybe ten years ago, five, I don't know. So we kinda talk about okay, so I so to get an idea how long, 'cause typically symptoms may have been present for five to ten years before they become more clinical. So like just ball park just think about it. How when did this start being concerning or impacting your life? And we start talking about How impacts socially and their ability to complete their personal functions, showering, hygiene, using the restroom to more complex, like driving. Are you getting lost, disoriented? Are you forgetting to pay your bills or paying them twice? You are you taking your medications as indicated? Are we finding medications like in batches because you forgot? Are we falling for scams? Any behavioral changes, any concerns. And a lot of times the patient will say no. And that's where the family being present and part of it is helpful. Because a lot of times the family will be like, No, let me talk to you separately and they disclose a lot of behavioral, important behavioral changes, like Kimberly Griggs: May I ask a a question about that? I mean, we were kind of talking backstage about, you know, some personal circumstances that touches my life, it impacts my life, Dr. Jennifer Caussade, Psy.D.: Yeah. Kimberly Griggs: my family. how how do you as a practitioner deal with that? Yeah, Dr. Jennifer Caussade, Psy.D.: The family involvement. Kimberly Griggs: you know, again, 'cause cause it is so sensitive when the especially at the beginning stages, which I'm imagining you see, you know, a variation of in the diagnosis or evaluation and reevaluation. But talk to me a little bit about how families get involved in that process and and what's the line there? Dr. Jennifer Caussade, Psy.D.: So usually family is the motivator why they're there. a lot of times I'll get the I'm doing this for my kid, not because I feel like anything's wrong or things like that. Or or my wife is the one supposed to be here, not me. So family is a big motivator to be here. It's helpful when everybody's on the same page. It's more difficult when they're not. Because it can be a very tense interview because Kimberly Griggs: And does that change the outcome of your evaluation? Dr. Jennifer Caussade, Psy.D.: I tend to be strategic when it comes to that. I tend to try to do the interview towards the end. So I they do the testing first, they're focusing, and whatever frustration they would feel about the testing, that's we that can't that won't change regardless of the interview. But I am not allowing any potential conflict from the interview to affect the testing. So I kind of work around when I because we get the paperwork completed beforehand. So I kind of see, okay, they're coming in by their own volition. Okay, we can do the interview early. When I see there's a lot more progression, they tend to tap out. So if I do an interview mid-testing, they may, because of the progression, the fatigue, they'll be like, okay, I'm done. It's like, no, you have to go back. And then there's a little bit more resistance. Like, let's finish the testing and then we'll do the interview. And vice versa. When there's family present and it could be conflicted. Okay, let's let's lead the more emotionally arousing aspect towards the end. And that way it won't impact testing. But it is very helpful when family is involved. Because Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: I remember I had a patient that I saw. And one of the things that we look at is the interview and the testing. You cannot provide a treatment planning or diagnosis based on just one. Because they could have performed terribly during the testing, but they are very independent and self-sufficient. And therefore, there may be some other element that might have impacted the testing because it does just not correlate. Or vice versa. They're very impaired, but their testing was not as bad as expected. So there may be more cognitive reserve to do these tasks, but independently left alone to do these things, they can't. So that lets me know about their progression. And this individual, his testing was impaired, but not the worst I've seen. And he came alone for the interview. And he was telling me about, I do everything by myself and independent and whatnot. Okay. So I'm thinking my diagnostic conclusion, we're seeing some mild cognitive changes since his his daily living skills are relatively intact. His wife was present for the feedback, which is where we discussed the results. I like to discuss why I give mild versus major, major being the more progressed diagnosis, and she's like Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: Uh-uh. He doesn't do that. Uh-uh. I took over that years ago, like, okay, I appreciate your clarification because that then shifted my diagnosis completely to major. Kimberly Griggs: Sure. Dr. Jennifer Caussade, Psy.D.: But that's those are things that are important because we need to have an accurate picture about everything. Cause even with the most minor things that we don't think about, whether it's lack of apathy, lack of motivation, the impulsivity, like Going back to Parkinson's, there's Parkinson's and then there's Lewy bodies. And Lewy bodies is another movement disorder, and it's very similar to Parkinson's, but a lot of people will say that it's this the different sides to the same coin, but their presentation is slightly different. it's a more intensified, aggressive presentation. So Knowing the severity, the trajectory, how it progressed, it's very important so that we can diagnose correctly, so we can treat correctly, and also modify any expectations we may have about family involvement and prognosis. So a lot of times I'll get the feedback like, I don't know, this is very tedious. Like I understand that, but I I promise there's some method to my madness. I'm not nitpicking because I just want to know. It's very it helps to clarify things diagnostically. if it's a mild stage, we talk about some things that can be preventive. Because just because we have mild cognitive changes doesn't mean we're gonna progress automatically to a major cognitive disorder. But Kimberly Griggs: No. Dr. Jennifer Caussade, Psy.D.: everything that was major started as mild. So we wanna make sure Kimberly Griggs: Yes. Dr. Jennifer Caussade, Psy.D.: that we give those resources so we stay as functional as possible. And but also when things are more progressed, okay, now we have to think about support and quality of life and maintenance. Also thinking about how to delay further decline, but it's a lot more involved in the in the resources. And on our process, we provide those referral resources. I discuss with the patients Kimberly Griggs: For child. Dr. Jennifer Caussade, Psy.D.: This is what I recommend. What are your thoughts? Do you want to proceed with that? We can help you find something near you within your insurance. Most times they'll say yes, please help me. And so we provide those referral resources and we send the report to the neurologist so that that way they see, okay, these are these are my medical results. This is the neuropsych. Now I have a game plan so that I can provide my own treatment. Cause sometimes they also come to us about that for diagnostic clarification. Are we looking at Alzheimer's? Are we looking for Parkinson's? stroke vascular. So Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: we because that may change their approach about what medication to use. There's a couple movement disorder specialists that we see. And the moment it turns into Alzheimer's, they refer out because they don't see Alzheimer's. They just see my cognitive impairment for Parkinson's. So that lets Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: them know when when they tap out and refer to a colleague. Kimberly Griggs: I love the way that you described kind of going back to, you know, that that first MD or even even the neurologist, once the patient has been diagnosed with something, is kind of that first line of defense, the house. They're taking a look at the house of, you know, the big picture. And I love how you described the work that you do is really taking a look at the the intricacies, the crown molding, the the different aspects internally. Is i do I have this right in that as part of your services, your job is to find the subcontractors within that house to Dr. Jennifer Caussade, Psy.D.: Mm hmm. Kimberly Griggs: help the patient you know, with a with a therapy that would be that would maintain that quality of life or that homeostasis as long as possible. Is that is that right? Dr. Jennifer Caussade, Psy.D.: Yeah, yeah. we we we do the assessment of the house, let you know what's going on, and we tell you what what sort of treatment the house needs and help us Kimberly Griggs: Yeah, yeah. Dr. Jennifer Caussade, Psy.D.: and help set that up, yes. Kimberly Griggs: So what is, you know, just kind of sticking with that analogy, what does success look like with all of those intricate factors? What, you know, what does a treatment plan look like or or a rehabilitation plan look like for someone that has a neurological condition? Dr. Jennifer Caussade, Psy.D.: success is a tricky term because there's reversible and non-reversible reasons for these difficulties. a reversible being if we're having these difficulties due to depression or due to a medication side effect or maybe a head injury that we're still recovering from. having that baseline of this is where we were at, and then we provide the referrals like if it was mental health psychiatry with a medication reassessment with counseling. We may do a reassessment in a year and significant improvement. So Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: it was but a blip in our life. Same thing with head injuries. You'll you'll have Cognitive changes because you had an impact to it, and you may have that brain fog and attention difficulties, anxiety depending on what was the reason for your head injury. If it was a car, you may get anxious when you're driving. So you have that psychiatric element there. so you address those from a mixture of psychiatry and cognitive rehabilitation, and they provide coping strategies to Give your brain a break because whenever our brain is working overtime, and that's when we're not having any external aids, it makes things harder. Like if I'm already struggling with attention and I'm telling myself, focus, focus, focus, it's not gonna do anything better, and I'm gonna stress myself out, which is gonna make me focus less. So, Kimberly Griggs: Right. Right. Dr. Jennifer Caussade, Psy.D.: okay, use a planner, use an alarm, use visual aids. Those are and those are things that we may think about doing ourselves. But the cognitive rehabilitation specialist kind of gives it little bit more structure. Like, okay, you had the strength in auditory, mix it. tape yourself, giving yourself an audio recording. And that way you have both the body memory that I did something and the audio of me saying it, multiple cues in one setting. So the cognitive rehabilitation is both to stimulate the brain, give you give yourself strategies. to be able to see that recovery, that improvement. Sometimes we see some, maybe we don't get to baseline, but we do see improvement. Kimberly Griggs: I love yeah. I love that you said that. Yeah. I love that you said that, even from a healthy perspective, because I think it's so I I think this is a fascinating suggestion for anyone, quite frankly, to get a baseline of their brain health. for Dr. Jennifer Caussade, Psy.D.: Mm-hmm. Kimberly Griggs: example, I did not know until I was well well past college and well into my adult life, maybe five years ago, that my auditory learning channel is one of the highest that I have. So I I think back in moments in my life when I was in college and and I would study really hard. And you know, I did decently in school and always always have, but I was working way harder than I needed to because I didn't know that that was a primary channel for me. So recording notes in class when I got into college was something that I didn't even know that was helpful that helped Dr. Jennifer Caussade, Psy.D.: Mm-hmm. Kimberly Griggs: helped me improve. And now even this, communicating like this via podcasts. the amount of retention that I have with information is so much higher. So I think this is fascinating even for, you know, a healthy individual. But that that really leads me to talking about the growing need for the work that you do. You know, ha speaking of, have you seen a need for, you know, neuro psychological services grow over the years? And how so, like, you know, where do you think that that is coming from? Dr. Jennifer Caussade, Psy.D.: We are definitely seeing a lot more growth because of the progression and the decline in cognitive functioning in older adults, especially with the growing diagnosis of Alzheimer's. there's a lot of assumptions and theories, but nothing really concrete. It's just a growing estimation. so because we are seeing a greater increase in that decline, now there's a bigger increase into okay, we need to have earlier diagnosis, earlier intervention so we can maintain that quality of life. Kimberly Griggs: Yeah. Do you do you think that part of the growing demand is because information like this is being presented and so people are more aware, or do you think that there really is an uptick in some of these neurological conditions just, you know, as an overall? Dr. Jennifer Caussade, Psy.D.: I think it's a mixture of both. Now that we know what is taking place, it's easier to get assistance because what was before? That's normal aging. That's just age. My neighbor goes through that all the time. And and and they don't have dementia. I'm fine. But it's not normal. To have those difficulties. There is a normal slowing. As we age, we're not as quick. And that's true. But it's not that you don't remember less, it's that you're not as quick to respond, or maybe not as quick to retrieve. But the ability to complete the task should not be changing because of that. Kimberly Griggs: Okay. Dr. Jennifer Caussade, Psy.D.: And they did a study a nun study where there were nuns that read and did all these cognitively stimulating activities. And they were in their 90s and they were smart, smart, fast, and no cognitive decline. So it's also about the habits and what we're exposed to. Right now, technology, friend and foe. What did we used to do when we were growing up? We would do maps. We would draw them out to get to places. Now it's GPS. So Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: the the question, do you get lost when you're driving? I use the GPS. So things have to be really progressed for us to catch that one because it you have to be really declined to get lost, even with the GPS. Or are you forgetting phone numbers? Well, I don't know my husband's phone number because Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: Because I met them when I had Kimberly Griggs: Like what is modern day life? Dr. Jennifer Caussade, Psy.D.: the phone. I can tell you my childhood phone number. I can tell you my mom's phone number. But but those Kimberly Griggs: All right. Dr. Jennifer Caussade, Psy.D.: those are things that technology limits us. And it it's a helpful aid, but it also doesn't let you think things through. So Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: now if you can't find something, you don't okay, retrace your steps. What did I do? You don't work those wheels. Now it's okay, Google, call my phone. And You're not allowing yourself to stimulate yourself. So that's one of the things that's also a big aspect of it. You are being mentally sedentary. And like any muscle, when we're sedentary, it causes quicker decline. So making sure that we are taking care of that, being mentally active, whether it's by socialization, hobbies, activities, not relying Using technology as needed, but not as the eternal crutch is is Kimberly Griggs: Yes. Dr. Jennifer Caussade, Psy.D.: i it's one of the things to do. But also, answering your earlier question, it's also the fact that some exposure to chemicals can also impact some of the conditions like movement disorders, if we're exposed to pesticides in a significant amount, that can be a reason for them. but in terms of Alzheimer's specifically, we're just seeing an uptick and it's just kinda hard to tease out if it's due to any changes in the in the environment or is it something that we're just developing more propensity to because of diet and all the things that are taking place? Kimberly Griggs: Yeah. What do you wish more people understood about brain health before it gets to, you know, a real decline? Dr. Jennifer Caussade, Psy.D.: I think that there needs to be that understanding that there is no such thing as this can wait. 'Cause even when I have interventions when people are in those earlier stages of Alzheimer's, but I don't need that now. I'm good. It's like that's good that you don't need it now. But it's a habit you need to develop now. Cause future you may not remember this. And if it's already a habit, it's easier to continue versus when the area of your brain that tells you start this up is not working anymore. Or education. we don't need to talk to coordinator. She's functional enough. That's good. But you kinda wanna know what's out there just in case. it's better to know your options than just assuming, hey, we don't need it. So there's a lot of dismissing because we're not seeing things as bad. I think Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: it'll be important to note we don't need to be in that terrible stage. to be able to get more knowledge or tools so that we can delay it or stay in the stage that we are at for as long as we can. Kimberly Griggs: good food for thought, having a baseline earlier and knowing where some of those resources are, just informing yourself would be the the best strategy to try to avoid catastrophe. Dr. Jennifer Caussade, Psy.D.: Early baseline, it's really dependent on if it's medically necessary, I'll be honest. but definitely good habits. Good habits is really what's important whenever we are not presenting anything. I've had some patients that they come with their children, and after the patient leaves, the child's like, But what about me? Like, I see this, what can I do? Should I get a baseline? It's like Kimberly Griggs: Yeah, like yeah. Dr. Jennifer Caussade, Psy.D.: If you're not having any issues, there's no medical necessity, but you can start having a good diet. There's a diet called the MIND diet. it's been developed and well proven to help maintain healthy brain functioning. I was telling Kimberly Griggs: What are some of the things that are in the mind diet? Dr. Jennifer Caussade, Psy.D.: Legumes, berries, healthy fats like salmon. it's a mediterranean-based with also a mixture of foods that were proven to be helpful for individuals with high blood pressure. Kimberly Griggs: Okay. Dr. Jennifer Caussade, Psy.D.: it lets you know which foods you should eat or just avoid or minimize like foods that inflame the brain are those processed foods. So chips and microwavables, easy, quick. Not that great red Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: meat can inflame the brain, high on sugar. So I know some things are guilty pleasures. That's why always say reduce, minimize, but there's some things that just removing is helpful. making sure you're exercising because being sedentary is not good for the body but also the mind, like we talked about. being in the house, four walls, no activity, being active is good for the for the brain. Even socialization, something as simple as having a conversation. my grandmother, I recognized in in hindsight that she was having earlier symptoms of cognitive decline. but it really erupted when she turned 90. But before that, I would visit her and she would tell me, you know, Jenny, when when you don't see people it's hard to think about the words you want to say because it's been a while since you've had conversations. And that's that word finding that word finding difficulty that you see a lot in cognitive decline. So and that's real. And you can't enforce it, practice it if you're isolated. It also Kimberly Griggs: Yes. Dr. Jennifer Caussade, Psy.D.: doesn't help with your mood, which impacts your cognition more. So making sure you're socializing. The Y of your local senior center, things that are that that that they provide both Exercise, socialization, sometimes cognitive activities, these senior communities with their mixers, hobbies, hobbies, playing pool, singing, photography, learning a language, learning an instrument. looking up pictures or being able to narrate information from memory or look it up. But you enjoy it and you're passionate about it. So it's not homework. It's something you enjoy and it's mentally stimulating. And then you have your games, your word games, and your memory games, which some studies are mixed that more life-based experiential activities are more fruitful than the ones that are on the phone. But it's also a good activity, keeps you mentally active, it makes you think and focus. So There's benefits to it as well. Kimberly Griggs: Love that. Those are very practical tips. So I yeah. Right. Dr. Jennifer Caussade, Psy.D.: Yeah, and these are things that we can do now, currently. That that's what I mean. Like we don't have to get to that point where we need a baseline, but we can take care of ourselves in the now. And I get so many patients like, I have all these tools, and their cognitive profiles are very good, very, very subtle things, and I always validate that. It's like, you know what? No doubt, because you've been so proactive. you volunteer, you know this language, you have all these hobbies, you're part of these clubs, you have all these external aids. Yes, I totally believe that this is all part of what you're doing. So my recommendations is adding something to your toolkit. And we'll Kimberly Griggs: Love that. Dr. Jennifer Caussade, Psy.D.: see and we'll do a reassessment in a couple of years and see where we're at. But this is very promising. I always validate that because You have to validate when people are doing a good job too. Kimberly Griggs: Yes, I was gonna say almost it it what makes me think of Dr. Caussade is like almost being like a modern day Renaissance man woman. you know, just interest in various things to again just kind of create that cognitive, you know, stimulation. Dr. Jennifer Caussade, Psy.D.: Yep, yep, yep. You have to Kimberly Griggs: Yeah. I love it. Dr. Jennifer Caussade, Psy.D.: it's it kinda like a soul a soul journey too. It's like what I always tell tell them, this is the time to think what has something you've always wanted to try? And try it. This Kimberly Griggs: Yeah, I know that. Dr. Jennifer Caussade, Psy.D.: is this is the moment. You have a good reason. Or even card games. Card games with the family. Like what did I play? What did you play? What were the rules? Am I keeping track of it? A lot of things that go on. So that that promotes bonding time. That promotes Kimberly Griggs: Yes. Dr. Jennifer Caussade, Psy.D.: family nights, picture charades, those are all great activities for the brain and just the family. Kimberly Griggs: I I love that you shared that. That gives me so many ideas for my family listening. I'm coming after you. That's awesome. Yeah. Dr. Jennifer Caussade, Psy.D.: Well, I'll give you another one for family. going through albums, music. Kimberly Griggs: Love it. Dr. Jennifer Caussade, Psy.D.: what happened here? Tell me the story. 'Cause now we're imagining what happened and we're going through those details and we're Kimberly Griggs: Yes. Dr. Jennifer Caussade, Psy.D.: conversing and we're talking about positive emotions as well as music. What what what reminds you this song? this reminds me when I was in the eighth grade and this happened and those are more activities when things are a little bit more progressed because when cognition is more progressive, you can't do these earlier ones because they're forgetting faster and that's more frustrating. So things that are less mentally demanding but more enjoyable, like listening to music, looking at pictures, those are are are really nice bonding activities with the family as well. Kimberly Griggs: That and you know, just to interject a little bit of, you know, again, kind of personal circumstances that that touch close to home, we do find that with the loved one in my life that that some of these conditions affect. he seems to be much much happier and more like himself when we're reminiscing. He loves the Beatles. And so anytime the Beatles are the are playing or we're doing trivia with the Beatles, he can tell you everything. And it's it's refreshing for all the way around. Dr. Jennifer Caussade, Psy.D.: Yeah. Kimberly Griggs: So I love that you you added that as well. Dr. Jennifer Caussade, Psy.D.: Yeah. my my father also loves the Beatles and Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: yeah, we this last Christmas, when we went there, my one favorite of memories with him was riding the car and listening to to silly love songs, like he would say. So Kimberly Griggs: Yes. Dr. Jennifer Caussade, Psy.D.: this last visit, we were literally air guitaring Beatles songs and singing together and Kimberly Griggs: Take it. Dr. Jennifer Caussade, Psy.D.: it was so nice because you could Again, the memory he was struggling to remember these lyrics that he knew for so many years, but he was so happy. He was so happy Kimberly Griggs: Yeah. Well Dr. Jennifer Caussade, Psy.D.: remembering and singing and and my brother took a video and he was like, I'm so happy we did this and so it's a nice activity for everybody. Kimberly Griggs: Yeah, I love that. Well, Dr. Caussade let's let's shift a little bit about, you know, building this organization. as the clinical director, you help lead an organization while also serving your patients. What has been the biggest challenge in helping to grow or get the word out about these services with Dallas Neurorehab Center? Dr. Jennifer Caussade, Psy.D.: Connecting with providers has been Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: a little bit more of a challenge because I came in through my boss and that is the person that they knew. And when you get a connection, when you feel a connection to somebody, it's really hard to disengage when it's not that person. So Kimberly Griggs: Yeah. Yeah. Dr. Jennifer Caussade, Psy.D.: being able to Build trust with established referrals is i is an area where it's a challenge because there's a little bit of a bias if if you're not that person you can be nice, you can be Jesus Christ, but I don't want you. Kimberly Griggs: Yeah. Yeah. That well, like you said, you you start to rely on that experience and that trust. So that that makes sense. If you were given an opportunity to speak to those personal relationships that you would love to make, what what would you want them to know about you? Dr. Jennifer Caussade, Psy.D.: them to know that we're very passionate about the people that we see and that even when we can't provide the service we always make sure that we're all taken care of either through a colleague or through a resource if things are more progressed in the meantime. I do like to emphasize the services, the type of population that we see, which is lifespan, from children as young as six to as old as 110. and that we always try to meet the patients where they're at. We modify things, we break things down in the testing. We provide accommodations financially as well if if needed. But we're we're a safe place where we care about the patient and we want to make sure that Also the clinician is able to provide their services as well. Kimberly Griggs: What what's ahead for Dallas Neuro Rehab? What excites you the most about the future of your field, but also this practice? Dr. Jennifer Caussade, Psy.D.: Well, right now we are trying to expand to more clinicians. we're trying to expand to other types of or re touch base on some previous ones because like I mentioned, we've gone through so many changes. We went from that neuro rehab to what we are right now to other ventures and right now we're trying to reestablish our grounding, trying to build up our referrals currently. And then once that's built up, we want to expand to more legal cases, more humanitarian related cases. Like we do citizenship evaluations. we do testing for other individuals that are English as a second language, like Spanish speakers, which would be with myself or any other languages like individuals from Pakistan, things of of that nature. So where we're at right now is kinda hard to answer that question, but I would just summarize it as stabilizing things more appropriate so that we're able to grow further. Kimberly Griggs: Yeah. Yeah. this has been a very fascinating conversation. I'm so thrilled to hear so many of the different ways forward to help again any loved one that finds themselves in this situation by happenstance or just natural progression. But I want to acknowledge you for just the way that you're showing up and and helping to support just the educational process. about what this is and what you do. but I want to be mindful over time, So I want to I want to get to kind of the last final questions that we ask every guest. I'm gonna call this the magic wand. You know, if if Dr. Jennifer Caussade, Psy.D.: Okay. Kimberly Griggs: you eliminate one challenge right now with patients that are, you know, recovering from some of these injuries or or disorders, what, you know, what would you make disappear for them or what would you change? Dr. Jennifer Caussade, Psy.D.: If I had a magic wand for the patients with these disorders. magic wand. I just would like them there to be a cure for for these conditions. I wish that there was that success that you mentioned earlier for the non reversible conditions. That would be my magic wand moment. But in the meantime Kimberly Griggs: What would that Dr. Jennifer Caussade, Psy.D.: we'll we try to make it as best as we can. Kimberly Griggs: Yeah. And in your experience, you know, dealing with the families knowing that it's not just the patient that you're treating, but also the family that supports them and the caregivers. What would a what would a solution resolution on all of that, what would that unlock for those patients and families based on your experience? Dr. Jennifer Caussade, Psy.D.: You know, I'll I'm gonna give you an answer you may not expect. It may not be as much for the family because they also need to take care of themselves. This is very taxing, and sometimes knowing the treatment is more work, Kimberly Griggs: Yeah. Dr. Jennifer Caussade, Psy.D.: and they tend to burden themselves and put a lot on their plate. So, my takeaway for the family is Be there for them, but be there for yourself. And be mindful of the resources for you as the family member as well. Because there's a lot of caregiver support groups. There's respite services, kind of like a daycare for these adults, so that there's activities, but also gives that, okay, I can actually do something that's not go to a doctor's appointments or make sure that they're taking their medicine or make sure they're being fed. I can just take this time for for me to grocery shop without having to multitask or just breathe. Do my hair, do my nails. So Kimberly Griggs: Pierce, pieraz. Dr. Jennifer Caussade, Psy.D.: that would be my takeaway to the family that think about your loved one, be there for them. Obviously you're part of the support group, but be there for yourself as well, 'cause we cannot help them if we're burned out. Kimberly Griggs: Thank you for sharing that. all right, final question. And this is kind of a hypothetical, but Dr. Jennifer Caussade, Psy.D.: Mm-hmm. Kimberly Griggs: let's just say that you accomplish everything that you set out to do. You start to build more referrals within the the you know neurosurgeons and and neuropsychologists among you to to really help families with with these types of situations. but you can't leave behind in your practice. any of your evaluations, any of the research, or any of the you know, contributions that you make, but what you do get to leave behind are three lessons for the aspiring entrepreneur, clinical director, or neuropsychologist to be, what would your three lessons or words of wisdom for them specifically be? Dr. Jennifer Caussade, Psy.D.: Gotta roll with the punches. You have to be flexible. Whether it's with the schedule, with the patients, or with how the day goes. you have to do things outside of your job requirement. Because the marketing is not part of my job requirement, but it does instill a lot more confidence when I'm there that the clinical director's making the the connections. And it's helpful to be transparent with your staff because they they feel the waves of change and that can affect them and other levels. So making sure that everybody's on the same page about where you're at, where you're moving, what's the goal, it helps maintain that unity. Kimberly Griggs: Very well said. Doctor Caussade what are your parting words for our audience today? Dr. Jennifer Caussade, Psy.D.: I I would like to hope that the talk helped, whether it is preventive, whether it's intervention, whether it's supportive, or just validation that you are doing a good job in what you're doing right now. Kimberly Griggs: Thank you for sharing that. All right. for everyone listening, we will definitely make sure that we link Dallas Neuro Rehab's contact information in our show notes. thank you again for tuning in to this episode of Unfinished Business, and we'll see you next time. Dr. Jennifer Caussade, Psy.D.: Thank you for having me, Kimberly.