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Dementia is a major global concern, with 50 million people already affected worldwide in 2018, and this number is expected to triple by 2050. Healthcare practitioners, specifically occupational therapists, are responsible for providing care and ensuring the well-being of people with dementia. However, occupational therapy students may not always have the necessary knowledge and skills to effectively communicate and support dementia patients, which could negatively impact the quality of care they provide. To explore this issue, a study was conducted with final-year pre-registration occupational therapy students at a public university in England. The study used a qualitative methodology, with semi-structured interviews of students. The objective was to understand the perspective of their learning experiences about communicating with dementia patients. The analysis revealed three main themes: dementia content and teaching methods, gaps in learning about communication with people with dementia, and limited placement opportunities. The study also encouraged occupational therapy students' suggestions for improving the curriculum for future students. The findings also contributed to existing literature in the field and suggested areas for further research.

The number of dementia diagnoses is ever-increasing in the aging population, meaning that healthcare staff need to be equipped with the appropriate knowledge, attitudes, and skills to care for people with dementia. However, recent research suggests that globally, both healthcare workers and students require greater dementia education opportunities to meet the needs of people with dementia. There seems to be limited research exploring dementia education opportunities within occupational therapy (OT) and physiotherapy (PT) programs. A scoping review methodology was chosen to explore the literature about dementia education in global OT and PT programs. There was limited literature in this area and only four articles were found after an intensive search through databases. Three overarching themes were developed: 'Attitudes, knowledge, and confidence', 'Benefits of experiential learning', and 'Experience and working with people with dementia'. Further, the benefits of virtual learning interventions, peer support, and communication strategies were explored. All experiential learning interventions had a positive impact on student's knowledge, confidence, and attitudes toward dementia. However, students need to be prepared with adequate knowledge prior to engaging in experiential learning interventions. Results from this study recommend the use of didactic teaching in conjunction with experiential learning within the healthcare curriculum. Peer support, communication strategies, and virtual dementia learning may be beneficial methods for educators to use and need to be explored in further detail concerning OT and PT curricula.

Purpose: Aging increases risk for hearing loss, cognitive decline, and social isolation; however, the nature of their interconnection remains unclear. This study examined the interplay between age-related hearing loss, cognitive decline, and social isolation in adults by testing the ability to understand speech in background noise, a challenge frequently reported by many older adults. Method: We analyzed data collected from 128 adults (20-79 years of age, M[subscript age] = 51 years) recruited as part of the Aging Brain Cohort at the University of South Carolina repository. The participants underwent testing for hearing, cognition, and social interaction, which included pure-tone audiometry, a words-in-noise (WIN) test, a hearing questionnaire (Speech, Spatial and Qualities of Hearing Scale [SSQ12]), a social questionnaire (Patient-Reported Outcomes Measurement Information System-57 Social), and the Montreal Cognitive Assessment. We used a single pure-tone average (PTA) threshold value and a single WIN threshold value for each participant because there were no differences on average between the left and right ears. Results: Poorer hearing was significantly associated with cognitive decline, through both PTA and WIN thresholds, with a stronger association observed for WIN threshold. Adults with poorer hearing also exhibited greater social isolation, as evidenced by their WIN threshold and SSQ12 score, although not through PTA. This connection was more pronounced with the WIN threshold than with the SSQ12 score. Cognition was not related to social isolation, suggesting that social isolation is affected more by the ability to understand words in noise than by cognition in a nondemented population. Conclusions: Understanding speech in challenging auditory environments rather than mere threshold detection is strongly linked to social isolation and cognitive decline. Thus, inclusion of a word-recognition-in-noise test and a social isolation survey in clinical settings is warranted.

Background: People with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy and young onset Alzheimer's disease may experience language and communication difficulties. However, the role of speech and language interventions for people with these non-language led dementias has received little attention. Aims: This study aimed to explore the experiences and perspectives of people living with these conditions, and their families, regarding their language and communication difficulties and how speech and language therapy could address these needs. Methods: This study employed a qualitative design to explore the experiences of people living with or caring for somebody with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy or young onset Alzheimer's disease, and to understand their opinions about speech and language therapy. Participants were recruited from a support service connected to a dementia clinic to attend one of five focus group meetings. Videorecorded focus groups and interviews were transcribed, and reflexive thematic analysis was used to analyse data from people affected by each type of dementia. Results: A total of 25 participants were recruited to the study, with representation across the different forms of non-language led dementias. The four main themes identified were: (1) communication difficulties as a key difficulty, (2) loss and loneliness, (3) speech and language therapy, and (4) the role of the caregiver. Sixteen subthemes were also identified which highlighted individual issues across disease types. Discussion: Although all the forms of dementia studied here are not considered to be language-led, people with these conditions and/or their care partners identified speech, language and communication as common challenges. These communication difficulties were reported to have a negative impact on their social participation and mental health and participants felt speech and language interventions could help. There is a need for research exploring speech and language interventions developed for and with people with non-language led dementias and their care partners, to ensure they meet the needs of the people they are designed for.

Adults with Down syndrome (DS) experience high risk for Alzheimer's disease (AD), but there is variability in the timing of transition from a cognitively stable state to prodromal AD and dementia. The present study examined the association between a modifiable lifestyle factor, employment complexity, and cognitive decline across two time points in adults with DS. Employment complexity, defined as the degree of problem-solving or critical thinking required for employment activities, was operationalized using the Dictionary of Occupational Titles, a system which classifies occupations based on three categories: "Data, People, and Things." Eighty-seven adults with DS (M = 36.28 years, SD = 6.90 years) were included in analyses. Partial correlations revealed that lower employment complexity involving People and Things were associated with increased dementia symptoms. Lower employment complexity involving Things was also associated with memory decline. These findings have implications for vocational programs focused on job training and placement for adults with DS.

Background: Dementia is a cognitive decline that leads to the progressive deterioration of an individual's ability to perform daily activities independently. As a result, a considerable amount of time and resources are spent on caretaking. Early detection of dementia can significantly reduce the effort and resources needed for caretaking. Aims: This research proposes an approach for assessing cognitive decline by analysing speech data, specifically focusing on speech relevance as a crucial indicator for memory recall. Methods & Procedures: This is a cross-sectional, online, self-administered. The proposed method used deep learning architecture based on transformers, with BERT (Bidirectional Encoder Representations from Transformers) and Sentence-Transformer to derive encoded representations of speech transcripts. These representations provide contextually descriptive information that is used to analyse the relevance of sentences in their respective contexts. The encoded information is then compared using cosine similarity metrics to measure the relevance of uttered sequences of sentences. The study uses the Pitt Corpus Dementia dataset for experimentation, which consists of speech data from individuals with and without dementia. The accuracy of the proposed multi-QA-MPNet (Multi-Query Maximum Inner Product Search Pretraining) model is compared with other pretrained transformer models of Sentence-Transformer. Outcomes & Results: The results show that the proposed approach outperforms the other models in capturing context level information, particularly semantic memory. Additionally, the study explores the suitability of different similarity measures to evaluate the relevance of uttered sequences of sentences. The experimentation reveals that cosine similarity is the most appropriate measure for this task. Conclusions & Implications: This finding has significant implications for the early warning signs of dementia, as it suggests that cosine similarity metrics can effectively capture the semantic relevance of spoken language. The persistent cognitive decline over time acts as one of the indicators for prevalence of dementia. Additionally early dementia could be recognised by analysis on other modalities like speech and brain images.

Purpose: Cognitive impairment is one of the most debilitating nonmotor symptoms in Parkinson disease (PD), and its presentation is heterogeneous. One proposed model to explain cognitive variability in PD is the dual-syndrome hypothesis. This hypothesis delineates two cognitive profiles, a "fronto-striatal" profile and a "posterior cortical" profile according to symptom presentation, associated motor phenotype, and risk for dementia. The current study examined the dual-syndrome hypothesis in individuals with idiopathic PD to evaluate the existence of these profiles, determine the association with the motor phenotype (tremor dominant vs. postural instability/gait disorder), and assess the relative risk for dementia. Method: A retrospective examination was conducted using data from the Parkinson's Progression Markers Initiative database at baseline (within 2 years of diagnosis) and 5 years after baseline. Descriptive categorizations, cluster analyses, generalized linear mixed models, and logistic regressions were used to address the research questions. Results: There was emerging evidence of cognitive profiles; however, these were not fully supported by cluster analyses. Baseline cognitive profile was associated with later motor phenotype, and as predicted, dementia risk was greatest in persons with baseline posterior cortical impairments. Conclusion: The current results provide mixed support for the dual-syndrome hypothesis, with some evidence that the posterior cortical cognitive profile is associated with postural instability and gait disorder as well as greater dementia risk.

According to the World Health Organization, there are currently more than 55 million people living with dementia worldwide, and this figure is expected to triple by 2050. Recent studies suggest that there may be a link between childhood trauma (which refers to exposure to overwhelmingly stressful experiences before the age of 18 years) and the onset of dementia in later life. Therefore, in communities caring for persons living with dementia, some residents may have been exposed to trauma in childhood. Currently, there is an increasing awareness of the negative impact of childhood trauma on later adult health and well-being, and a corresponding recognition of the need for services, including for dementia care, to be trauma-informed. In the last decade, the Montessori Method has become established as a legitimate approach to elder/dementia care. However, it has not yet been examined as a trauma-informed approach. The aim of this paper is to address that gap by (a) highlighting how Maria Montessori took steps to integrate interdisciplinary knowledge of trauma into her Method when she began to understand the potential of childhood trauma to adversely impact adult health and well-being, and (b) outlining how the Montessori Method, when applied to dementia care, incorporates many of the core principles of trauma-informed practice. This paper concludes that the Montessori Method for dementia care has the built-in capacity to be trauma-sensitive and trauma-responsive, but that its ongoing rollout should follow Montessori's lead by specifically integrating knowledge about the neurobiology of trauma into its training programs.

Maintaining healthy cognitive functioning and delaying cognitive decline in cognitively intact and cognitively impaired adults are major research initiatives for addressing dementia disease burden. Music interventions are promising, non-pharmaceutical treatment options for preserving cognitive function and psychological health in older adults with varying levels of cognitive function. While passive, music interventions have attracted considerable attention in the abnormal cognitive aging literature, active, music interventions such as music creativity are less well-studied. Among 58 older adults with different levels of cognitive function (cognitively healthy to mild cognitive impairment), we examined the feasibility and acceptability of "Project CHROMA", a Stage 1 clinical trial developed to assess the effects of a novel, music creativity curriculum on various health outcomes. Music intervention participation (93%), overall study retention (78%), and intervention satisfaction (100%) rates were comparable to other similarly designed clinical trials. Exploratory analyses using mixed-level modeling tested the efficacy of the intervention on cognitive and psychological outcomes. Compared to those in the control condition, participants in the music condition showed some improvements in cognitive functioning and socioemotional well-being. Findings suggest that a 6-week music creativity clinical trial with several multi-modal health assessments can be feasibly implemented within a sample of varying cognitive ability.

The number of individuals with dementia is on the rise, highlighting the need to create effective educational methods that can improve nursing students' understanding and attitude toward this group of people who require special care. Explore the effectiveness of introducing a new curricular course in improving nursing students' knowledge of and attitudes toward people living with dementia and the provision of care for them. A pretest-posttest quasi-experimental design was used. After the introduction of dementia lectures, both study groups had a significant improvement in knowledge and attitude toward people living with dementia (P [less than or equal to] 0.05). Adding clinical experience did not significantly enhance knowledge. It improved attitudes, but the result was not statistically significant (P > 0.05). The introduction of a new curricular course had a positive impact on the knowledge of and attitudes of nursing students toward people living with dementia. These findings emphasize the importance of incorporating dementia-focused education to enhance the quality of care provided by future nursing professionals.

Introduction: Health promotion MOOCs (hpMOOCs) can be designed to educate general audiences on global health issues and provide accessible evidence-based content. Thus, it is essential to assess the instructional design quality of hpMOOCs through more than one perspective to ensure course participants have an effective learning experience and their learning needs are met. Methods: Our study involved a comprehensive exploration of an hpMOOC about dementia risk reduction with sustained massive reach and established impact. To fully understand the quality of this course, instructional design elements were assessed from an instructional designer lens and a course participant lens. The designer lens involved a detailed review of the quality of the course against a recognized quality rubric. The participant lens involved topic modeling and thematic analysis of 1,531 responses to a feedback survey item in order to identify design elements preferred by participants. Results: While the course performs well and meets most quality standards, it falls short of fully meeting the criteria set by the rubric. However, the rubric could be further developed to better facilitate the quality assurance of hpMOOCs. The participant lens reveals the course meets participants' expectations and it offers two new avenues for enhancing the current presentation of course content. Conclusion: Assessing the quality of hpMOOCs through a dual lens provides triangulation that helps to gain a more comprehensive understanding of how to improve their instructional design quality.

Background: In Austria, due to its history, only relatively little research on the topic of intellectual disabilities and dementia has been conducted to date. The present study thus aims to explore the challenges and tasks currently facing formal caregivers, together with assessing their wishes for further development. Methods: Ten semi-structured interviews were held with formal caregivers. Interviews were transcribed and analysed by means of structured qualitative content analysis. Results: Caregivers must deal with conflicts between residents, and with increasing demands for care and emotional support. Education and training on dementia and intellectual disability are mostly of high quality, but still remain insufficient. Caregivers would like to see suitable adaptation of care premises, smaller groups, more staff and better training on dementia and intellectual disability. Conclusion: To ensure quality care and 'ageing in place', caregivers and providers need to pay greater attention to dementia-related changes when planning and adapting services.

Background: In the past few years there has been a growing interest in the employment of verbal productions as digital biomarkers, namely objective, quantifiable behavioural data that can be collected and measured by means of digital devices, allowing for a low-cost pathology detection, classification and monitoring. Numerous research papers have been published on the automatic detection of subtle verbal alteration, starting from written texts, raw speech recordings and transcripts, and such linguistic analysis has been singled out as a cost-effective method for diagnosing dementia and other medical conditions common among elderly patients (e.g., cognitive dysfunctions associated with metabolic disorders, dysarthria). Aims: To provide a critical appraisal and synthesis of evidence concerning the application of natural language processing (NLP) techniques for clinical purposes in the geriatric population. In particular, we discuss the state of the art on studying language in healthy and pathological ageing, focusing on the latest research efforts to build non-intrusive language-based tools for the early identification of cognitive frailty due to dementia. We also discuss some challenges and open problems raised by this approach. Methods & Procedures: We performed a scoping review to examine emerging evidence about this novel domain. Potentially relevant studies published up to November 2021 were identified from the databases of MEDLINE, Cochrane and Web of Science. We also browsed the proceedings of leading international conferences (e.g., ACL, COLING, Interspeech, LREC) from 2017 to 2021, and checked the reference lists of relevant studies and reviews. Main Contribution: The paper provides an introductory, but complete, overview of the application of NLP techniques for studying language disruption due to dementia. We also suggest that this technique can be fruitfully applied to other medical conditions (e.g., cognitive dysfunctions associated with dysarthria, cerebrovascular disease and mood disorders). Conclusions & Implications: Despite several critical points need to be addressed by the scientific community, a growing body of empirical evidence shows that NLP techniques can represent a promising tool for studying language changes in pathological aging, with a high potential to lead a significant shift in clinical practice.

Background: Word retrieval skills change across the lifespan. Permanent alterations in the form of decreased accuracy or increased response time can be a consequence of both normal ageing processes or the presence of acquired and neurodegenerative disorders (e.g., aphasia and dementia). Despite the extensive literature exploring the neuroanatomical underpinnings of word retrieval, psycholinguistic, biolinguistic and theoretical explanations, and the vast amount of evidence from primary and secondary language disorders, the best approach to consistently capture these changes is yet to be discovered. Aims: The goal of this paper is to determine which method(s) stand(s) as the most suitable candidate(s) to provide an accurate picture of word retrieval in the oral production of different groups of adult speakers, including cases of healthy ageing, preclinical Alzheimer's disease (AD), mild cognitive impairment (MCI), aphasia and dementia. Methods & Procedures: Using an integrative review of recent peer-reviewed journal articles, we provide an overview of the different behavioural methods traditionally used to measure oral naming skills in research-oriented and clinical protocols and discuss their main advantages and limitations. Main Contribution: Most existing studies are based on the results of people with diagnosed language disorders. Despite the growing interest, the reliability of the majority of the tasks to detect subtle changes associated with healthy ageing, MCI and preclinical AD are yet to be demonstrated, and the delicate balance between informativeness and efficiency (especially in terms of administration time and variable control) in experimental protocols is yet to be achieved. In this article we propose the pursuit of an integrative overarching methodology to characterize all naming deficits (from anecdotal to permanent) and all adult populations (from healthy to pathological ageing). Conclusions & Implications: A combination of spontaneous speech data and results from structured tasks stands as the best approach to capture changes in word retrieval skills of adult speakers with and without observable deficits. This review can guide future reflections on the necessary prerequisites of purpose-oriented, sensitive and reliable protocols for the detection of incipient word retrieval problems, thus contributing to the early diagnosis and the design of personalized multicomponent treatments.

Background: Vocabulary scores increase until approximately age 65 years and then remain stable or decrease slightly, unlike scores on tests of other cognitive abilities that decline significantly with age. Aims: To review the findings on ageing-related changes in vocabulary, and to discuss four methodological issues: research design; test type; measurement; and vocabulary ability as a proxy for general intelligence. Main Contribution: A discussion of cross-sectional and longitudinal research designs shows that cohort membership accounts for some but not all ageing-related changes in vocabulary, and that drop-out and test-retest effects do not alter conclusions regarding these changes. Test type affects age trends in vocabulary, and if researchers use only one test, they should choose a multiple-choice synonym test. While some authors suggest that vocabulary tests do not measure the same underlying ability in younger and older adults, more research of this suggestion is needed. A brief examination of the use of vocabulary ability as a proxy for general intelligence in healthy ageing and for premorbid abilities in dementia indicates that such practice is often questionable. Conclusions: Vocabulary knowledge increases through the mid-60s regardless of measurement method. However, there is little information on how word knowledge serves other verbal skills in old age, how and when adults learn new words, or how much exposure is necessary for meanings to remain in storage for a lifetime. Research of these issues may require new methodologies, as well as novel theoretical accounts of ageing-related effects on vocabulary.

Background: This study reports on new contexts in which formulaic language has been used in the years since 2013 when the last synthesis was carried out. The background presents an old but still useful definition and lists themes under which research was arranged in 2013 and which continue to be used. Aims: This study has a particular emphasis on the relevance of formulaic language to people living with dementia. Methods: Section 3, identifying new directions, reviews new 'third waves' of research priorities in several fields in which formulaic sequences play a major role, including sociolinguistic variation, corpus-based and corpus-driven analyses, pragmatics, human-computer interaction, and psycholinguistics, all of which are relevant to speech-language therapists. Section 4, outreach and expansions, illustrates new contributions from cognitively impaired person-to-person exchanges in online environments, recent examinations of infant- and pet-directed speech incorporating formulaic language, and online graphic explorations such as emojis. Section 5 focuses on growth of research in theoretical and clinical applications by Van Lancker Sidtis, as illustrated by references to her recent work. Main Contribution: The paper's main contribution is to summarize the work on formulaic language over the last 10 years, to indicate its continued importance and relevance in ordinary conversation, and especially in allowing people living with dementia to continue to interact with others. Conclusion: The paper concludes by suggesting that more focus be placed on the analysis of formulaic language with an emphasis on its relevance for speech-language therapists and other clinicians.

Background: Recent evidence suggests that speech substantially changes in ageing. As a complex neurophysiological process, it can accurately reflect changes in the motor and cognitive systems underpinning human speech. Since healthy ageing is not always easily discriminable from early stages of dementia based on cognitive and behavioural hallmarks, speech is explored as a preclinical biomarker of pathological itineraries in old age. A greater and more specific impairment of neuromuscular activation, as well as a specific cognitive and linguistic impairment in dementia, unchain discriminating changes in speech. Yet, there is no consensus on such discriminatory speech parameters, neither on how they should be elicited and assessed. Aims: To provide a state-of-the-art on speech parameters that allow for early discrimination between healthy and pathological ageing; the aetiology of these parameters; the effect of the type of experimental stimuli on speech elicitation and the predictive power of different speech parameters; and the most promising methods for speech analysis and their clinical implications. Methods & Procedures: A scoping review methodology is used in accordance with the PRISMA model. Following a systematic search of PubMed, PsycINFO and CINAHL, 24 studies are included and analysed in the review. Main Contribution: The results of this review yield three key questions for the clinical assessment of speech in ageing. First, acoustic and temporal parameters are more sensitive to changes in pathological ageing and, of these two, temporal variables are more affected by cognitive impairment. Second, different types of stimuli can trigger speech parameters with different degree of accuracy for the discrimination of clinical groups. Tasks with higher cognitive load are more precise in eliciting higher levels of accuracy. Finally, automatic speech analysis for the discrimination of healthy and pathological ageing should be improved for both research and clinical practice. Conclusions & Implications: Speech analysis is a promising non-invasive tool for the preclinical screening of healthy and pathological ageing. The main current challenges of speech analysis in ageing are the automatization of its clinical assessment and the consideration of the speaker's cognitive background during evaluation.

This study was aimed at investigating the effect of standardized patient simulation training on getting nursing students to gain care providing skill for the individual diagnosed with dementia. The study is a randomized controlled trial. Training was provided to the experimental group (n = 36) through patient simulation method, while the control group (n = 35) was trained through standard curriculum. As a result of simulation training, it was determined that the experimental group students' communication skills, ability to evaluate cognitive capacity, and ability to identify nursing diagnoses and interventions suitable for the individual diagnosed with dementia were higher compared to those of the control group students (p < 0.05). It was concluded that simulation training was effective in getting nursing students to gain care providing skill for the individual diagnosed with dementia.

Background: Cognitive reserve (CR) has not been studied in people with Intellectual Developmental Disability, a population with a high incidence of dementia. Commonly adopted CR proxies should be adapted to reflect more specifically the experiences of people with Intellectual Developmental Disability. Method: This scoping review intended to identify CR proxies relevant to people with this condition. Results: Some of these were the same already detected in a population without intellectual disabilities (education, occupation, physical activity, leisure, community and social activities); others were found to be specifically relevant for this population: type of schooling, parental educational level, environmental stimulation and living place. Conclusions: These proxies need to be considered in studies on CR and Intellectual Developmental Disability and in clinical practice. Research on the protective effect of CR aims to encourage policies promoting lifestyle-based educational and preventive interventions and overcome participation barriers for people with Intellectual Developmental Disability.

Objectives: Characterise the circumstances associated with death during admission of adults with Down syndrome (DS) and to identify predictors of mortality. Patients and Methods: Observational study based on data on all emergent admissions of adults with DS to hospitals of the Spanish National Health System between 1997 and 2014. We analysed epidemiological and clinical variables. Results: We analysed admissions of 11,594 adults with DS, mean age 47 years. 1715 patients died (15%), being the highest mortality (35%) in individuals aged 50-59. A past medical history of cerebrovascular disease (aOR 2.95 [2.30-3.77]) or cancer (aOR 2.79 [2.07-3.75]), gross aspiration's admission (aOR 2.59 [2.20-3.04]), immobility (aOR 2.31 [1.46-3-62]), and readmission within 30 days (aOR 2.43 [2.06-2.86]) were identified as predictors of mortality. Conclusions: Adults with DS have a high in-hospital mortality rate. The main predictors of death were cerebrovascular disease, cancer, early readmission, and conditions commonly associated with advanced dementia.

This article reports on findings from a case study of an intergenerational project between a nursery school and a residential care home for people with dementia in the South-East of England. It examines how multi-modalities support meaning-making between 3-year-old children and older adults. The study is qualitative, interpretative and explorative. Data were collected using naturalistic observations of children and older adults during intergenerational sessions at the care home and qualitative interviews with nursery school practitioners. The analysis draws on a dialogic narrative approach informed by the work of Mikhal Bakhtin. Our research demonstrates how multi-modalities support young children's engagement and meaning-making with older adults. The findings explore how the context of the intergenerational sessions was influential in shaping the interactions between the children and older adults. The study contributes to existing research, as well as offering new understandings about the interactions between children and older adults within a co-located intergenerational project. Our research would suggest a benefit in the re-establishment of intergenerational practice in a post-pandemic context when such encounters pose less physical health risks.

Background: Core lexicon (CL) analysis is a time efficient and possibly reliable measure that captures discourse production abilities. For people with aphasia, CL scores have demonstrated correlations with aphasia severity, as well as other discourse and linguistic measures. It was also found to be clinician-friendly and clinically sensitive enough to capture longitudinal changes in aphasia. To our knowledge, CL has never been investigated in individuals with neurologically progressive disease. Aims: As a preliminary investigation, we sought to investigate (1) whether CL scores correlate with dementia severity, (2) whether CL scores correlate with measures of discourse quality, and (3) whether CL scores correlate with other measures of lexical/semantic access. Methods & Procedures: Twelve participants with a cognitive impairment associated with dementia of the Alzheimer's type (DAT) completed several measures of language and cognitive ability, as well as provide a language sample from the wordless picture book, Picnic. Results & Conclusion: Results are informative, as they provide insight into characteristics of CL and provide support for potential use of CL in individuals with neurologically progressive disease. The results indicated that CL scores do correlate with dementia severity and several measures of language ability, indicating they may provide a useful measure of language abilities in DAT, but more research is needed.

Background: Caring for persons with profound intellectual and multiple disabilities (PIMD) demands specific expertise. Tacit knowledge seems to play an important role, but little is known about its nature, including what is necessary for its development and transfer. Aim: To gain understanding of the nature and development of tacit knowledge between persons with PIMD and their caregivers. Method: We conducted an interpretative synthesis of literature on tacit knowledge in caregiving dyads with persons with PIMD, persons with dementia or infants. Twelve studies were included. Results: Tacit knowledge is about caregivers and care-recipients becoming sensitive and responsive to each other's cues and together crafting care routines. Learning takes place in a constant process of action and response that transforms those involved. Conclusion: Building tacit knowledge together is necessary for persons with PIMD to learn to recognise and express their needs. Suggestions are made for ways to facilitate its development and transfer.

Understanding the key physiology and anatomy of the brain, and the mechanisms underlying dementia, represents essential components within a medical curriculum. This study assessed the implementation feasibility of an augmented reality (AR) three-dimensional (3D) brain visualisation learning mode and the knowledge improvements in medical students when compared to a text-based pamphlet. The pamphlet group learnt from a double-sided information pamphlet, while the AR group used an AR app. In AR, participants held a cube in front of the camera on the tablet, rendered on-screen as a 3D brain model, and received a narrated lesson containing the same information as the pamphlet verbatim. Both resources were also evaluated for perceived usefulness via pre-post tests and written survey. A total of 24 students participated in the study. A significant overall difference in knowledge scores (p < 0.001) was found for all participants but without significant differences between groups. Prior education was a significant covariate for pre-post change (p = 0.016) across all participants but had no impact on group outcomes. Positive feedback was received on both resources where the majority perceived them as easy to use, enjoyable, and helped develop their knowledge of dementia. Both the text-based pamphlet and AR delivery modes improved knowledge, although neither was significantly superior to the other. However, the AR lesson was perceived highly for learning, and has the potential for implementation within a medical programme.

Most massive open online courses (MOOCs) are offered in English, including those offered by non-English speaking universities. The study investigated an identified English language dementia MOOC's accessibility and effectiveness in improving the dementia knowledge of non-native English speaker participants. A total of 6,389 enrolees (age range 18--82 years; 88.4% female) from 67 countries was included in analyses. Dementia knowledge was measured by the Dementia Knowledge Assessment Scale (DKAS) before and after the MOOC completion. Rates of completion were also compared. Native English speakers (n = 5,320) were older, more likely to be female, less likely to be employed, and had lower educational attainment than non-native English speakers (n = 1025). Native English speakers were also more likely to care for or have cared for a family member or friend living with dementia than were non-native English speakers. Native English speakers had a significantly higher DKAS score both pre- (M = 33.0, SD = 9.3) and post-MOOC (M = 44.2, SD = 5.5) than did non-native English speakers (M = 31.7, SD = 9.1; and M = 40.7, SD = 7.7 for pre- and post-MOOC, respectively). Non-native English speakers with low pre-MOOC dementia knowledge scores gained significantly less dementia knowledge following course completion than did native English speakers (p <.001, adjusted for age and education). There was no significant difference between the two groups in their likelihood of completing the MOOC. Our findings suggest that non-native English speakers are motivated and able to complete the MOOC at similar rates to native English speakers, but the MOOC is a more effective educational intervention for native English speakers with low dementia knowledge.

Background: Life expectancy is on rise and the intriguing question is: When does cognitive decline occur among adults with intellectual disability, compared to adults with typical development? This cross-sectional study examined cognitive performance of crystallised/fluid intelligence, working and long-term memory of adults with intellectual disability of etiologies other than Down syndrome (IQ 50-68) and adults with typical development (IQ 85-114) in four age cohorts (30-39; 40-49; 50-59; 60-69). Method: The WAIS III[superscript HEB] and the Rey-AVLT were administered to both groups. Results: Four patterns of cognitive performance were found: (a) Vocabulary (crystallised intelligence), Spatial Span Forward and Retention yielded similar scores across all four age cohorts in participants with typical development and with intellectual disability. (b) Similarities, Raven and Digit Span Backward exhibit lower scores only in 50-59 or 60-69 compared to the 30-39 age cohort in both groups, (c) Digit Span Forward, Spatial Span Backward and Total Leaning (LTM) yielded lower scores in the 50-59 or 60-69 age cohorts in the typical group, but similar scores in participants with intellectual disability along the age cohorts, (d) Block Design (fluid intelligence) yielded a lower score in the 50-59 cohort versus lower scores only at ages 60-69 in participants with typical development. Conclusions: Our findings suggest a possible parallel trajectory in age-related cognitive performance for individuals with and without intellectual disability in six measures, and a possible more preserved trajectory in fluid intelligence and some memory measures in adults with intellectual disability compared to their peers. Caution should be exercised regarding Digit and Spatial Span Backwards, which yielded a floor effect in participants with intellectual disability. The Cognitive Reserve Theory, the Safeguard Hypothesis and late maturation might serve as explanations for these findings.

This review aimed to investigate the use of the Cambridge Neuropsychological Automated Testing Battery (CANTAB) for people at risk of cognitive impairment, especially those born with Down syndrome and those born preterm. Six databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, in addition to the bibliography index listed in the CANTAB site. Twenty four studies regarding Down syndrome and 17 regarding prematurity were reviewed and are here described. Both cognitive profiles were described, and their performance was compared on specific tasks and CANTAB tests. In this battery of tests, people with Down syndrome usually present impaired key cognitive domains, such as episodic memory and recognition memory. Results were presented considering general aspects described in the studies, specific findings such as dementia, the role of genetics, and cognitive profile, among other descriptions. Comparability between both populations in future studies is discussed.

Objectives: Volunteering promotes well-being and may provide added purpose to life after retirement. Limited evidence exists regarding the characteristics and study adherence among those who participate in longitudinal studies while also volunteering outside the study. We assessed characteristics and adherence of older adults who volunteered outside of participation in a regular monthly cognitive monitoring study. Method: All 124 participants with complete data were included. Participants were from a regular cognitive monitoring study that required completion of a 15-min monthly online cognitive assessment. Analysis of covariance and logistic regression analysis were performed to examine differences between volunteers and non-volunteers. Results: Those who volunteered outside the study were significantly less likely to be college-educated (although all participants were highly educated) but the two groups were cognitively similar. Volunteers had significantly lower scores for neuroticism. Those who volunteered also were significantly less likely to drop out but had poorer study adherence. The most frequent type of volunteering was religious activities. Volunteers were motivated mainly by altruism, although most reported multiple reasons. Conclusion: Older adults who enroll in a longitudinal research study and volunteer outside the study have similar personal characteristics as those who opt out of additional volunteering, with somewhat less education and more favorable personality traits. However, they may be more likely to drop out and need more reminders. Therefore, those who volunteer outside a study may need more attention from study administrators and potentially a more individualized schedule that works around their volunteer obligations.

This study explored the transformative outcomes of programmes and activities for family caregivers of people with dementia in Taiwan. Transformative learning theory was used to examine the relationship between participation and positive outcomes. A group of nonparticipants was included to provide a complete picture of the transformative learning process. In this qualitative study, 18 participants were interviewed with audio recording, and the data were transcribed verbatim. A thematic analysis was performed to determine the themes and subthemes in the results. The results revealed that participation in programmes and activities was not the single factor leading to transformative outcomes; family support, self-adjustment, the ability to cope, and coordinated intervention in accordance with individual preferences and needs also facilitated transformative outcomes for nonparticipants. Further studies should focus on interventions modifying factors of perceived caregiver burden, for instance, by providing psychological support to informal caregivers, offering programmes and activities targeting the management of neuropsychiatric symptoms in patients with dementia, and supporting quality of life.

Intergenerational practice, where children and older adults come together for shared activities, has grown in popularity in many Western countries. However, research about intergenerational practice, particularly in the UK, is limited. This paper reports on the findings from an exploratory case study about a small intergenerational project between a maintained nursery school and a residential care home for older adults with dementia in the South-East of England. The methodology was informed by a narrative dialogic approach drawing on the work of Bakhtin. Data was collected using naturalistic observations of children's weekly visits to the care home and qualitative interviews with nursery school practitioners. The analysis explores how meaningful interactions were created between the children, the older adults, and the nursery school practitioners. Our findings suggest that singing, unstructured moments, continuity, context (open spaces/flexible sessions), and objects contribute to meaningful interactions between young children and older adults. The ability to be flexible and "go with the moment" were identified as key skills for practitioners supporting children and older adults. We conclude that intergenerational projects afford benefits not just for children and older adults, but also for practitioners in the form of "emotional rewards". The importance of re-establishing intergenerational practice is recognised, as well as the ways in which barriers created by social distancing might safely be addressed through the use of outdoor spaces and digital technologies.

Background: Dementia disproportionately affects people with intellectual disability. Most qualitative studies explore their experiences by utilising proxy-reports. A smaller number of studies illustrate the possibility of exploring perspectives directly from people with intellectual disability and dementia. Method: This systematic review synthesised findings from existing studies (n = 8) that involve people with intellectual disability and dementia as participants to understand their experiences of dementia. Searches were conducted using CINAHL, PsychInfo and Social Services Abstracts. Results: Findings include descriptions of changes in individual functioning, a narrowing of social worlds and of how people made sense of the changes despite often having no knowledge of their dementia diagnosis. Additionally, discussion focuses on how people's experiences are shaped by their environments. Conclusion: The review recognises the complexities of speaking to people with intellectual disability about dementia, challenges views that people with intellectual and dementia cannot be involved in research and makes recommendations to support inclusion in future studies.

Here, intelligence is taken to mean scores from psychometric tests of cognitive functions. This essay describes how cognitive tests offer assessments of brain functioning--an otherwise difficult-to-assess organ--that have proved enduringly useful in the field of health and medicine. The two "consequential world problems" (the phrase used by the inviters of this essay) addressed in this article are (i) the ageing of modern societies (and the resulting increase in the numbers of people with ageing-related cognitive decrements and dementias) and (ii) health inequalities, including mortality. Cognitive tests have an ubiquitous place in both of these topics, i.e., the important fields of cognitive ageing and cognitive epidemiology, respectively. The cognitive tests that have sprouted in these fields are often brief and not mainstream, large psychometric test batteries; I refer to them as 'irregulars'. These two problems are not separate, because results found with mental/cognitive/intelligence tests have produced a growing understanding that intelligence and health have a reciprocal, life-long relationship. Intelligence tests contribute to the applied research that is trying to help people to stay sharp, stay healthy, and stay alive.

Music therapy can help social workers deal with negative behaviors and symptoms of dementia in older adults without drugs or physical restraints, thereby improving the quality of care. This study tested the effectiveness of music therapy activities for improving agitated behavior in older adults with dementia living in long-term care institutions. The study was quasi-experimental. Eighty older adults were recruited from two nursing homes. A purposive sampling strategy was used to select subjects aged 65 years and above with dementia and agitated behavioral tendencies residing in nursing homes. The music therapy program comprised 90 minute sessions 3 times a week for two months. The program evaluation focused on one criterion: the agitated behavior of participants at the beginning and end of the music theory program, which was measured using a structured scale. Ultimately, the music therapy program showed promise for improving agitated behavior in older adults with dementia living in nursing homes. Incorporating music therapy activities into social work may help make long-term care more diverse and innovative.

Background: Adults with intellectual disabilities are an at-risk group of developing dementia. In the absence of a cure for dementia, emphasis on treatment is the promotion of Quality of life (QoL). The aim of this review is to identify and describe QoL tools for people with intellectual disabilities and dementia. Method: A systematic review was carried out using 10 databases and papers from up to March year 2021. Results: Two instruments were identified and examined. The QoL in late-stage dementia, which showed evidence of good levels of internal consistency, intra-rater reliability, test-retest reliability, and convergent validity. The Dementia Quality of Life -- proxy was also used; however, its psychometric properties have yet to be studied within the intellectual disabilities population. Conclusion: It is recommended instruments should be developed and psychometrically tested specifically for adults with intellectual disabilities and dementia to help inform policy makers, measure outcomes of interventions and personal outcomes.

5.8 million Americans have Alzheimer's disease, and this number is rising. Social work can play a key role. Yet, the field is ill prepared for the growing number of individuals and families affected physically, emotionally, and financially. This mixed-methods concurrent study assessed the preliminary efficacy of an education event for students from eight social work programs. Pre- to post training survey included: (1) dementia knowledge; and (2) negative attitudes toward dementia. Bivariate analyses showed that knowledge (mean difference=9.9) and attitudes (10% lower) improved from pre- to post training (p<0.05). Collaboration between social work programs can increase student access to strength-based dementia education. Such programs hold the potential of improving dementia capability within the field of social work.

The World Health Organization's Active Ageing policy framework highlights the need for economic and social engagement in communities to maintain and promote healthy ageing and quality of life. This framework does not address the needs of those living with long-term health conditions such as dementia. Although continued employment is not appropriate for all, it is possible for many living with dementia. Despite the numerous contributions that career counselling could make to support people living with dementia we found no consideration of the specific career development needs of people living with dementia in the literature. In this paper we outline the key role that career development professionals could play in the multi-disciplinary teams of professionals supporting persons living with dementia.

Background: Eating, drinking and swallowing (EDS) difficulties are important to identify early. Awareness of EDS changes starts with those living with dementia or their family carers. However, little is known about early identification from the perspective of people with dementia. Aim: The aim of this study was to understand the experience of EDS by people living with dementia in their own home. Methods: Published evidence pertaining to EDS difficulties in dementia was used to inform an online semi-structured interview guide. Four people living with dementia and a third-sector Empowerment Lead were invited to become co-researchers. People living with dementia and their carers were invited to be interviewed. We enquired about their past and present experiences, and future expected changes in EDS, information needs, opinions on early problem identification, and lifestyle modifications following onset of EDS difficulty. Narrative concepts of heroes and villains in their 'stories' were identified. Responses were subjected to framework analysis informed by narrative enquiry. Results: Seven people living with dementia and five family carers were interviewed. The overarching theme was a 'missed connection' between EDS difficulty and dementia. Where EDS difficulties were identified, 'compensatory changes' and a need for 'access to information' were noted. Conclusions: The connection between potential EDS difficulties and a dementia diagnosis may not be made, even though EDS changes were recognised by people living with dementia and their family carers. This may be explained by behaviours that mask problems or allow individuals to cope or compensate. Reduced awareness may also be due to inadequate access to information and lack of specialist services. If the connection between dementia and EDS difficulty is missed it could further delay access to support services.

Background: In dementia with Lewy bodies (DLB), limitations in linguistic and cognitive abilities may lead to difficulties in participating in conversations. The conversational outcome is also dependent on how the conversation partner adjusts to potential communicative challenges. Aims: This study explored resources and barriers in communication in DLB. Methods & Procedures: Linguistic and cognitive function was explored through standard clinical testing. The dyad's perception of function in daily life was explored through semi-structured interviews analysed with content analysis. Interactional patterns and participation in casual conversation was analysed with conversation analysis. Outcome & Results: The results show how the husband diagnosed with DLB performed with high scores across most cognitive and linguistic test tasks. The interview data, however, revealed how both he and his wife experienced significant challenges regarding, for example, conversational tempo, as well as negative feelings relating to adjusting to these conversational changes. The interactional data from the casual conversation revealed, among other patterns, how the wife engaged in most of the storytelling in the conversation. The husband contributed details when his wife asked for help, or he acknowledged a faulty or missing detail in his wife's storyline. Thus, they both oriented to the husband's competence in monitoring and keeping track of the conversational content, despite challenges in taking the floor. Conclusions & Implications: A holistic picture of communication in DLB necessitates the use of different evaluation approaches. Both monological (e.g., test tasks revealing cognitive and linguistic resources) and dialogical information sources (e.g., observations of conversations revealing adjustments in conversations), as well as the perceptions of those engaging in everyday conversations (i.e., people with DLB and their conversation partner(s)), need to be evaluated when assessing resources and barriers in communication.

Background: Communication difficulties are common in people with dementia, and often present from an early stage. However, direct treatment options for people with dementia that positively influence their daily communication are scarce. Aims: To evaluate the potential impact and feasibility of a personalized logopaedic intervention. Methods & Procedures: A total of 40 community-dwelling persons with dementia and their caregivers were recruited. Five experienced speech and language therapists (SLTs) delivered the six-session Com-mens intervention at home. Com-mens aims to improve positive communication between people with dementia and their primary caregivers and comprises five elements: interactive history-taking, dynamic observational assessment, education about the consequences of dementia on communication, development and use of personalized communication tools, use motivational, and person-centred strategies by the SLT. We conducted a single-group mixed-methods pilot study with five measurements: baseline, directly after intervention, and at 3, 6 and 9 months follow-up. Semi-structured interviews and questionnaires for Experienced Communication in Dementia, quality of life, psychological well-being and caregiver burden were conducted. Process evaluation was performed by interviewing participants, drop-outs, SLTs and other stakeholders. Outcomes & Results: A total of 32 dyads completed the intervention. Repeated measures analyses revealed no significant changes over time. In the interviews, participants reported a positive impact on their feelings, increased communication skills and better coping with the diagnosis. Participants would recommend the intervention to others. Facilitators were timely delivery, personalized content and adequate reimbursement. Barriers were unfamiliarity with Com-mens among referrers, an overburdened caregiver or disrupted family relationships. Conclusions & Implications: This newly developed logopaedic intervention is feasible and has a perceived positive impact on both people with dementia and their caregivers, which is confirmed by a stable pattern over a period of 1 year. Future comparative studies are needed to test the effectiveness of personalized interventions in this patient population.

Background: Primary progressive aphasia (PPA) describes a group of language-led dementias. PPAs are complex, diverse and difficult to diagnose, and therefore conventional models of aphasia and dementia treatment do not meet their needs. The research evidence on intervention for PPA is developing, but to date there are only a few case studies exploring the experiences of people with PPA (PwPPA) themselves. Aims: To explore the experiences and opinions of PwPPA and their communication partners (CPs) to understand how speech and language therapy (SLT) services can better meet their needs. Methods & Procedures: A qualitative research approach was used whereby PwPPA and their friends or family members were recruited to participate in focus groups, via advertisements in the Rare Dementia Support PPA group newsletters. Consenting participants were allocated to attend one of four focus groups hosted on an online video conferencing platform. Participants were asked about their communication difficulties, and how SLT could address these needs. All meetings were transcribed, and data were examined using reflexive thematic analysis. Outcomes & Results: Six PwPPA and 14 CPs representing all three PPA variants and mixed PPA participated in the focus groups. Four main themes were identified during the analysis of the focus group discussions: (1) CPs' burden, (2) adjusting to the diagnosis, (3) communication abilities and difficulties and (4) beyond language. A further 10 subthemes were identified. Conclusions & Implications: This study provides a greater understanding of the experiences and needs of PwPPA and their families in relation to SLT. This work underlines the importance of a person-centred approach that considers the broader needs of both the PwPPA and the people around them. This will enable service providers to deliver SLT that meets the needs of PwPPA and their families and will also inform future research in this field.

Purpose: The purpose of this study was to explore the relationships between hearing loss, cognitive status, and a range of health outcomes over a period of 2 years in a sample of older adults who are enrolled in Program of All-Inclusive Care for the Elderly, which is a Medicare/Medicaid beneficiary program for individuals who are nursing home eligible but living in the community at time of enrollment. Method: The sample (N = 144) includes a diverse (47% White/non-Hispanic, 35% Black/African American, and 16% Latin/Hispanic) group of adults ranging from 55 to 93 years old. We used medical chart data to measure respondents' cognitive and health status, including chronic conditions and hospital use. Hearing status was measured once at the beginning of the 2-year review period. We used logistic regression and negative binomial hurdle models for analyses. We used latent class analysis (LCA) to explore the extent to which respondents cluster into a set of "health profiles" characterized by their hearing, cognitive status, and health conditions. Results: We found that hearing loss is weakly associated with heart disease and diabetes and associated with cerebrovascular disease and falls; cognitive impairment is also associated with cerebrovascular disease and the number of falls. LCA indicates that respondents cluster into a variety of health profiles with a consistent pairing of hearing loss and depression. Conclusions: The results are largely consistent with associations reported in epidemiological studies that include age-related hearing loss. Of particular interest in this study is the LCA that suggested that all of the profiles associated with a high likelihood of hearing loss included a high risk of depression. The co-occurrence of these two factors highlights the need to identify and treat hearing loss in older adults, especially as part of the treatment plan for individuals with depressive symptoms.

Purpose: In March 2020, the U.K. government announced that people should isolate to reduce the spread of the virus that causes COVID-19. Outside a pandemic, psychosocial factors, such as socialization and mental health, may impact the relationship between hearing loss and increased dementia risk. We aim to report the impact of psychosocial factors, including social isolation, depression, and engagement in activities, on hearing and cognitive function in younger and older adults during the COVID-19 pandemic. Method: An online survey and experiment assessed self-reported psychosocial factors, self-reported hearing ability and speech-in-noise perception, and cognition. Data were collected between June 2020 and February 2021. Older (n = 112, M[subscript age] = 70.08) and younger (n = 121, M[subscript age] = 20.52) monolingual speakers of English, without any language or neurological disorders participated. Multiple linear regression models were employed to investigate hypothesized associations between psychosocial factors, and hearing and cognition, in older and younger adults. Results: Multiple regression analyses indicated that older adults displayed poorer speech-in-noise perception and poorer performance on one of four cognitive tasks, compared with younger adults; increased depression was associated with poorer subjective hearing. Other psychosocial factors did not significantly predict hearing or cognitive function. Conclusions: Data suggest that self-reported hearing and depression are related. This conclusion is important for understanding the associations between hearing loss and cognitive decline in the long term, as both hearing loss and depression are risk factors for dementia.

Purpose: In this study, we aim to understand whether and how performance in animal fluency (i.e., total correct word count) relates to linguistic levels and/or executive functions by looking at sequence information and item-level metrics (i.e., clusters, switches, and word properties). Method: Seven hundred thirty-one Dutch-speaking individuals without dementia from the Second Manifestations of ARTerial disease-Magnetic Resonance study responded to an animal fluency task (120 s). We obtained cluster size and number of switches for the task, and eight different word properties for each correct word produced. We detected variables that determine total word count with random forests, and used conditional inference trees to assess points along the scales of such variables, at which total word count changes significantly. Results: Number of switches, average cluster size, lexical decision response times, word frequency, and concreteness determined total correct word count in animal fluency. People who produced more correct words produced more switches and bigger clusters. People who produced fewer words produced fewer switches and more frequent words. Conclusions: Concurrent with existing literature, individuals without dementia rely on language and executive functioning to produce words in animal fluency. The novelty of our work is that such results were shown based on a data-driven approach using sequence information and item-level metrics.

Background: The prevalence of dementia is increasing, bringing a range of challenges, such as eating, drinking and swallowing (EDS) difficulties, that are associated with aspiration, which can be fatal. Early identification of EDS difficulty in early-stage dementia could prevent complications, but reliable indicators are needed to help develop pathways to support the diagnosis. Previous reviews of this area require updating. Aims: To identify reliable and clinically measurable indicators of EDS difficulty used in early-stage dementia. Methods & Procedures: A systematic search was conducted using common databases (MEDLINE, EMBASE and PsychInfo). Articles reporting indicators of EDS difficulty in early-stage dementia or mild cognitive impairment were included. The reliability of included studies was critically appraised using the risk of bias tools. Study outcomes were narratively reviewed by considering the reliability, clinical measurability and applicability of EDS indicators to early-stage dementia. Outcomes & Results: Initial searches returned 2443 articles. After removing duplicates, limiting to English language and human studies, 1589 articles remained. After reviewing titles, 60 abstracts were reviewed, yielding 18 full-text articles. A total of 12 articles were excluded that did not report at least one indicator of EDS difficulty in early-stage dementia, or where the reported association was not strong. Six included studies that reported eight indicators of EDS difficulty in early-stage dementia (four studies including people with Alzheimer's disease). On the balance of measurability, reliability and applicability, the most promising indicators of EDS difficulty were: delayed oral transit, rinsing ability, sarcopenia and polypharmacy. Additional, less reliable and applicable indicators included: always opened lips and non-amnestic mild cognitive impairment, especially in men. The delayed pharyngeal response is subjectively measured when instrumental assessment is not available and the 'candy sucking test' cannot be recommended because there is an inherent choking risk. Conclusions & Implications: EDS difficulty in early-stage dementia can be highlighted by indicators that could be combined to create enhanced pathways to support the early identification of EDS difficulties for people living with early-stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration. Exploring the experiences of people living with dementia and their families' perspectives on potential indicators of EDS difficulty may add to the existing evidence base.

This paper presents an account of current literature on the topic of music and memory, supplemented by qualitative research in the form of interviews with seniors who are living with dementia. Music is a strong memory trigger, often linked with emotion, and stored in parts of the brain that, for most people, still function after other memories have vanished. Strong, sequential aural-vocal musicianship education programs are linked to improvements in children's working memory and ability to retrieve long-term memories, as well as influencing their ability to learn language and better process other subject information. This paper suggests that using music education to give children a greater ability, inclination and aptitude for collecting musical memories across their lifetimes has the potential to increase their quality of life long into the future.

The COVID-19 pandemic has led to a radical lifestyle change, which may unintendedly change physical activity levels. We aimed to perform a systematic review to investigate the physical activity changes in people with neurological diseases, and to examine the relationship between physical activity and disease symptoms, and psychosocial factors. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of the literature across five databases (PubMed, CINAHL, Web of Science, SCOPUS, and Cochrane Library) was carried out using the keywords relating to COVID-19, physical activity, sedentary behaviour, exercise, and the name of the neurological diseases. The systematic search was updated on 4 February 2021 with the same keywords. Fourteen studies (n = 7662 persons with neurological diseases, n = 1663 healthy controls) were eligible for this review. The study populations were Parkinson disease (n = 7), dementia (n = 1), multiple sclerosis (n = 1), spinal cord injury (n = 1), hereditary spastic paraplegia (n = 1), neuromuscular diseases (n = 1), Charcot-Marie-Tooth neuropathy (n = 1), and epilepsy (n = 1). Thirteen studies reported a decreased physical activity level, one study reported a high interruption rate of physiotherapy/rehabilitation. Furthermore, the physical activity reduction was associated with worse disease symptoms, depression, perceived health, and mental and physical components of quality of life. The COVID-19 pandemic has a negative impact on the physical activity levels of people with neurological diseases, and this change was related to the worsening of disease symptoms and psychosocial factors. "Registration number" A protocol of the review was registered with the PROSPERO database (CRD42020207676).

This paper demonstrates the effects of education on cognitive functioning which could serve as an alternative preventive method to halt or delay cognitive decline in older adults. The purpose of this proposal is to discuss and illustrate the benefits of improving cognitive ability through continuing education. As such, taking advantage of educational programmes that are already in place would not only provide mental stimulation for older adults, but would be a source for social networking, as well as technology training and physical education activities. To establish a link between cognition and education, this paper provides examples from a number of studies as well as a review of a longitudinal study on educational differences in the prevalence of dementia. The findings of this systematic review revealed a connection between cognitive decline and education after considering regions and economic status. Suggestions from these reviews imply that keeping one's mind stimulated could be influential in delaying the onset of dementia resulting in possibly extending the time older adults are independent.

Purpose: This study aims to investigate the different degeneration processes of categorical perception (CP) of Mandarin lexical tones in the normal aging population and the pathological aging population with mild cognitive impairment (MCI). Method: In Experiment I, we compared the identification and discrimination of Tone 1 and Tone 2 across young adults, seniors aged 60--65 years, and older seniors aged 75-80 years with normal cognitive abilities. In Experiment II, we compared lexical tone identification and discrimination across young adults, healthy seniors, and age-matched seniors with MCI. Results: In Experiment I, tone perception was intact in seniors aged below 65 years. Those aged above 75 years could also maintain normal tone identification, whereas they showed poorer tone discrimination correlated with age-related poorer hearing level. In Experiment II, healthy seniors showed normal CP of Mandarin tones. Tone identification was also normal in those with MCI, whereas their tone discrimination had significantly degenerated. Conclusions: In the normal aging population, age-related hearing loss decreased signal audibility, accounting for poorer discrimination of Mandarin lexical tones in seniors above 75 years. In the pathological aging population with MCI, the poorer discrimination of lexical tones may be attributed to the additive effect of age, hearing loss, and cognitive impairment (e.g., impaired working memory and long-term phonological memory). This study uncovered the roles of low-level sensory processing and high-level cognitive processing in lexical tone perception in the Chinese aging population.

Introduction: Dementia is one of the most significant issues of our time and there are varying prevailing attitudes towards dementia, including negative stigma and perception. Massive open online courses (MOOCs) are a widely available online learning resource accessed for free which may present an opportunity to address prevailing attitudes. Methodology: We conducted a questionnaire before and after a six-week MOOC where participants learned about dementia. We collected data using a survey instrument and analysed them with statistical testing. Results and findings: Although there was no statistically significant change between pre- and post-MOOC questionnaires, the change was observed in some questions and for particular groups. Conclusion and recommendations: Our findings indicate this MOOC has a greater effect on changing the attitudes of non-healthcare workers, older people and those living in the United Kingdom. We recommend further analysis of MOOC as a change intervention and consideration of their application in other disciplines.