Conversational trouble and repair in dementia: Revision of an existing coding framework.

A decline in the effectiveness of everyday conversation is often observed for people with dementia. This study explored conversational trouble and repair between people with dementia residing in residential care and professional care staff. The aim was to examine the utility of an existing conversational trouble and repair framework by Watson, Carter and Chenery (1999) in a comparatively larger sample. Twenty conversations were coded for dementia-specific trouble and repair; however, the original framework could not adequately accommodate the variety of trouble and repair within the dataset. The data was subsequently used to inform a revised framework, which captures a wide spectrum of trouble and repair in dementia and offers more precise codes to researchers and clinicians working with this clinical population. Examples of divergent coding strategies between the original and revised framework are provided as well as examples of trouble and repair patterns observed in both carers and people with dementia.

Toward the Development of SMART Communication Technology: Automating the Analysis of Communicative Trouble and Repair in Dementia.

BACKGROUND AND OBJECTIVES: Communication difficulties have been reported as one of the most stress-inducing aspects of caring for people with dementia. Notably, with disease progression comes an increase in the frequency of communication difficulty and a reduction in the effectiveness of attempts to remedy breakdowns in communication. The aim of the current research was to evaluate the utility of an automated discourse analysis tool (i.e., Discursis) in distinguishing between different types of trouble and repair signaling behaviors, demonstrated within conversations between people with dementia and their professional care staff. RESEARCH DESIGN AND METHODS: Twenty conversations between people with dementia and their professional care staff were human-coded for instances of interactive/noninteractive trouble and typical/facilitative repair behaviors. Associations were then examined between these behaviors and recurrence metrics generated by Discursis. RESULTS: Significant associations were identified between Discursis metrics, trouble-indicating, and repair behaviors. DISCUSSION AND IMPLICATIONS: These results suggest that discourse analysis software is capable of discriminating between different types of trouble and repair signaling behavior, on the basis of term recurrence calculated across speaker turns. The subsequent recurrence metrics generated by Discursis offer a means of automating the analysis of episodes of conversational trouble and repair. This achievement represents the first step toward the future development of an intelligent assistant that can analyze conversations in real time and offers support to people with dementia and their carers during periods of communicative trouble.

Semantic Feature Disturbance in Alzheimer Disease: Evidence from an Object Decision Task.

BACKGROUND AND OBJECTIVE: It is widely held that semantic disturbance in Alzheimer disease (AD) involves the loss of distinctive features but the relative sparing of nondistinctive features. Many previous studies of semantic feature disturbance have used cognitively challenging tasks with verbal stimuli that allow for potential cognitive confounds. Our objective was to use a task with lower memory demands to investigate distinctive feature disturbance in AD. METHODS: We used an object decision task to compare the processing of distinctive and nondistinctive semantic features in people with AD and age-matched controls. The task included six conditions based on the relationship between each prime and target object. We tested the processing of distinctive and nondistinctive features by selectively altering distinctive and nondistinctive semantic features between prime and target pairs. RESULTS: Performance accuracy was significantly lower for participants with AD than for age-matched controls when distinctive features were manipulated, but no difference was found when nondistinctive features were manipulated. CONCLUSIONS: Our results provide evidence of semantic content disturbance in AD in the context of a task with low cognitive demands.

Evaluating the MESSAGE Communication Strategies in Dementia training for use with community-based aged care staff working with people with dementia: a controlled pretest-post-test study.

AIMS AND OBJECTIVES: The study aims to evaluate the effects of a communication skills training programme on community aged care staff's knowledge of communication support in dementia and on staff's care experience. BACKGROUND: Dementia can lead to impairments in communication. Therefore, quality community-based dementia care requires that staff be skilled communicators, equipped to facilitate interactions with people with dementia. The current investigation evaluated the effectiveness of the MESSAGE Communication Strategies in Dementia for Care Staff training programme with respect to knowledge of communication support and the staff/caregiver experience. DESIGN: A multi-centre controlled pretest/post-test design with randomised cohort allocation was used. Outcome measures were completed at baseline, immediately after training (training group only), and at three-month follow-up. METHODS: Thirty-eight care staff working in community aged care participated and completed all outcome measures (training = 22; control = 16).Training and control groups completed the following outcome measures: knowledge of communication support strategies, self-efficacy, preparedness to provide care, strain in nursing care and attitude to dementia care. Staff in the training group provided written feedback on the training. RESULTS: A significant improvement in knowledge scores from baseline was found for the training group both immediately after training and at three-month follow-up. There was also a significant training effect for self-efficacy and preparedness to provide care. No significant difference was found for the control group for any measure. No significant training effects were found for measures of strain or attitudes to dementia care. Feedback from staff suggests that the training was well received. CONCLUSIONS: The MESSAGE training was positively received by staff and had a significant effect on care staff knowledge, and confidence to provide care for people with dementia. RELEVANCE TO CLINICAL PRACTICE: The easily accessible multimedia training programme is well received by staff and has the potential to improve quality of care.

Balancing Self-Tracking and Surveillance: Legal, Ethical and Technological Issues in Using Smartphones to Monitor Communication in People with Health Conditions.

Smartphones are being used to track the health of individuals in their own environments. For example, a smartphone app could be used to monitor the impact and progression of Parkinson's disease, as well as indicate whether treatments may need to be adjusted, based on an analysis of voice and discourse. The app uses smartphone audio sensors to detect when conversations are taking place and activates an app to record the conversation. But what happens if a background conversation is also collected by the recording? The participants of the background conversation are unaware of and have not consented to the recording. Unauthorised recording could also raise legal issues under surveillance devices legislation and has ethical implications. It is a complex task to balance the potential benefits of self-tracking of health conditions to consumers and the health system, with the legalities and ethical issues related to privacy. The health-related monitoring industry is moving so rapidly that current legal and ethical processes and protocols may fail to balance these concerns. This article explores Australian legal and ethical perspectives on how to achieve the potential benefits of these technological approaches while preserving privacy.

An Automated Approach to Examining Conversational Dynamics between People with Dementia and Their Carers.

The progressive neuropathology involved in dementia frequently causes a gradual decline in communication skills. Communication partners who are unaware of the specific communication problems faced by people with dementia (PWD) can inadvertently challenge their conversation partner, leading to distress and a reduced flow of information between speakers. Previous research has produced an extensive literature base recommending strategies to facilitate conversational engagement in dementia. However, empirical evidence for the beneficial effects of these strategies on conversational dynamics is sparse. This study uses a time-efficient computational discourse analysis tool called Discursis to examine the link between specific communication behaviours and content-based conversational engagement in 20 conversations between PWD living in residential aged-care facilities and care staff members. Conversations analysed here were baseline conversations recorded before staff members underwent communication training. Care staff members spontaneously exhibited a wide range of facilitative and non-facilitative communication behaviours, which were coded for analysis of conversation dynamics within these baseline conversations. A hybrid approach combining manual coding and automated Discursis metric analysis provides two sets of novel insights. Firstly, this study revealed nine communication behaviours that, if used by the care staff member in a given turn, significantly increased the appearance of subsequent content-based engagement in the conversation by PWD. Secondly, the current findings reveal alignment between human- and computer-generated labelling of communication behaviour for 8 out of the total 22 behaviours under investigation. The approach demonstrated in this study provides an empirical procedure for the detailed evaluation of content-based conversational engagement associated with specific communication behaviours.

Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions.

Mobile phones and other remote monitoring devices, collectively referred to as "mHealth," promise to transform the treatment of a range of conditions, including movement disorders, such as Parkinson's disease. In this viewpoint paper, we use Parkinson's disease as an example, although most considerations discussed below are valid for a wide variety of conditions. The ability to easily collect vast arrays of personal data over long periods will give clinicians and researchers unique insights into disease treatment and progression. These capabilities also pose new ethical challenges that health care professionals will need to manage if this promise is to be realized with minimal risk of harm. These challenges include privacy protection when anonymity is not always possible, minimization of third-party uses of mHealth data, informing patients of complex risks when obtaining consent, managing data in ways that maximize benefit while minimizing the potential for disclosure to third parties, careful communication of clinically relevant information gleaned via mHealth technologies, and rigorous evaluation and regulation of mHealth products before widespread use. Given the complex array of symptoms and differences in comfort and literacy with technology, it is likely that these solutions will need to be individualized. It is therefore critical that developers of mHealth apps engage with patients throughout the development process to ensure that the technology meets their needs. These challenges will be best met through early and ongoing engagement with patients and other relevant stakeholders.

A new biomarker for subthalamic deep brain stimulation for patients with advanced Parkinson's disease--a pilot study.

OBJECTIVE: Deep brain stimulation (DBS) has become the standard treatment for advanced stages of Parkinson's disease (PD) and other motor disorders. Although the surgical procedure has improved in accuracy over the years thanks to imaging and microelectrode recordings, the underlying principles that render DBS effective are still debated today. The aim of this paper is to present initial findings around a new biomarker that is capable of assessing the efficacy of DBS treatment for PD which could be used both as a research tool, as well as in the context of a closed-loop stimulator. APPROACH: We have used a novel multi-channel stimulator and recording device capable of measuring the response of nervous tissue to stimulation very close to the stimulus site with minimal latency, rejecting most of the stimulus artefact usually found with commercial devices. We have recorded and analyzed the responses obtained intraoperatively in two patients undergoing DBS surgery in the subthalamic nucleus (STN) for advanced PD. MAIN RESULTS: We have identified a biomarker in the responses of the STN to DBS. The responses can be analyzed in two parts, an initial evoked compound action potential arising directly after the stimulus onset, and late responses (LRs), taking the form of positive peaks, that follow the initial response. We have observed a morphological change in the LRs coinciding with a decrease in the rigidity of the patients. SIGNIFICANCE: These initial results could lead to a better characterization of the DBS therapy, and the design of adaptive DBS algorithms that could significantly improve existing therapies and help us gain insights into the functioning of the basal ganglia and DBS.

Measuring the lifespace of people with Parkinson's disease using smartphones: proof of principle.

BACKGROUND: Lifespace is a multidimensional construct that describes the geographic area in which a person lives and conducts their activities, and reflects mobility, health, and well-being. Traditionally, it has been measured by asking older people to self-report the length and frequency of trips taken and assistance required. Global Positioning System (GPS) sensors on smartphones have been used to measure Lifespace of older people, but not with people with Parkinson's disease (PD). OBJECTIVE: The objective of this study was to investigate whether GPS data collected via smartphones could be used to indicate the Lifespace of people with PD. METHODS: The dataset was supplied via the Michael J Fox Foundation Data Challenge and included 9 people with PD and 7 approximately matched controls. Participants carried smartphones with GPS sensors over two months. Data analysis compared the PD group and the control group. The impact of symptom severity on Lifespace was also investigated. RESULTS: Visualization methods for comparing Lifespace were developed including scatterplots and heatmaps. Lifespace metrics for comparison included average daily distance, percentage of time spent at home, and number of trips into the community. There were no significant differences between the PD and the control groups on Lifespace metrics. Visual representations of Lifespace were organized based on the self-reported severity of symptoms, suggesting a trend of decreasing Lifespace with increasing PD symptoms. CONCLUSIONS: Lifespace measured by GPS-enabled smartphones may be a useful concept to measure the progression of PD and the impact of various therapies and rehabilitation programs. Directions for future use of GPS-based Lifespace are provided.

Alzheimer's disease is associated with distinctive semantic feature loss.

A central topic of discussion in the exploration of semantic disturbance in Alzheimer's disease (AD) concerns the relative contribution of semantic content (e.g., semantic features) and semantic process. Studies have suggested that semantic dysfunction in AD is the result of deficits to either semantic process, semantic content or both. Studies that have supported the loss of semantic content have been criticised for their use of verbal stimuli and cognitively challenging experimental tasks. The current study used a novel version of the yes-no recognition memory task to compare the processing of distinctive and non-distinctive features in participants with AD whilst controlling the cognitive demands of the task. The task involved five conditions which denoted the relationship between the items in the test and study phase. A 'non-distinctive' and a 'distinctive' condition were included where non-distinctive and distinctive semantic features were manipulated between study and test, respectively. Task accuracy of participants with AD decreased relative to control participants when distinctive features were manipulated between the study and test phase of the experiment. There was no significant difference between groups when non-distinctive features were manipulated. These findings provide evidence to support the loss of semantic content in AD.

Memory and communication support strategies in dementia: effect of a training program for informal caregivers.

BACKGROUND: People with dementia have a range of needs that are met by informal caregivers. A DVD-based training program was developed using research-based strategies for memory and communication in dementia. The effectiveness of the training on the caregiver experience and the well-being of the person with dementia was evaluated. METHODS: A pre-test/post-test controlled trial was undertaken with caregiver-care-recipient dyads living in the community. Measures of the carers' knowledge of memory and communication strategies, burden, positive perceptions of caregiving, and perceptions of problem behaviors were taken pre- and three months post-intervention. The depression and well-being of the person with dementia were also evaluated. Satisfaction with the training and feedback were measured. RESULTS: Twenty-nine dyads (13 training group, 16 control group) participated. Bonferroni's correction was made to adjust for multiple comparisons, setting α at 0.00385. A significant improvement was found in caregivers' knowledge for the training group compared to the control group (p = 0.0011). The training group caregivers reported a reduction in the frequency of care recipient disruptive behaviors (p = 0.028) and increased perceptions of positive aspects of caregiving (p = 0.039), both at a level approaching significance. The training group care recipients had increased frequency of verbally communicated depressive behaviors at a level approaching significance (p = 0.0126). The frequency of observed depressive behaviors was not significantly different between groups. CONCLUSIONS: This approach to training for caregivers of people with dementia appears promising for its impact on knowledge and the caregiving experience. Further research could monitor the impact of the training on broader measures of depression and well-being, with a larger sample.

We are not educating the future clinical health professional workforce adequately for e-health competence: findings of an Australian study.

This paper reports on a national study of the present approaches in Australian tertiary education, to preparing future clinical health professionals to work competently in an increasingly e-health enabled healthcare sector. The argument for increasing clinical health professionals' knowledge about e-health and health informatics has been advanced repeatedly over past decades in Australia and elsewhere. However, peer-reviewed accounts of good practice in implementing and evaluating e-health education in health profession degrees anywhere are scarce. Our study reports on surveying approximately 100 degree coordinators in 40 clinical health professions in 30 universities across Australia. It finds that currently, teaching and assessment of future clinical health professionals does not ensure that Australia will have a clinical workforce that is adequately professionally empowered to work with e-health. This paper provides important baseline data for planning improvements to e-health education for Australia's future clinical health professionals.

A dual task priming investigation of right hemisphere inhibition for people with left hemisphere lesions.

BACKGROUND: During normal semantic processing, the left hemisphere (LH) is suggested to restrict right hemisphere (RH) performance via interhemispheric suppression. However, a lesion in the LH or the use of concurrent tasks to overload the LH's attentional resource balance has been reported to result in RH disinhibition with subsequent improvements in RH performance. The current study examines variations in RH semantic processing in the context of unilateral LH lesions and the manipulation of the interhemispheric processing resource balance, in order to explore the relevance of RH disinhibition to hemispheric contributions to semantic processing following a unilateral LH lesion. METHODS: RH disinhibition was examined for nine participants with a single LH lesion and 13 matched controls using the dual task paradigm. Hemispheric performance on a divided visual field lexical decision semantic priming task was compared over three verbal memory load conditions, of zero-, two- and six-words. Related stimuli consisted of categorically related, associatively related, and categorically and associatively related prime-target pairs. Response time and accuracy data were recorded and analyzed using linear mixed model analysis, and planned contrasts were performed to compare priming effects in both visual fields, for each of the memory load conditions. RESULTS: Control participants exhibited significant bilateral visual field priming for all related conditions (p < .05), and a LH advantage over all three memory load conditions. Participants with LH lesions exhibited an improvement in RH priming performance as memory load increased, with priming for the categorically related condition occurring only in the 2- and 6-word memory conditions. RH disinhibition was also reflected for the LH damage (LHD) group by the removal of the LH performance advantage following the introduction of the memory load conditions. CONCLUSIONS: The results from the control group are consistent with suggestions of an age related hemispheric asymmetry reduction and indicate that in healthy aging compensatory bilateral activation may reduce the impact of inhibition. In comparison, the results for the LHD group indicate that following a LH lesion RH semantic processing can be manipulated and enhanced by the introduction of a verbal memory task designed to engage LH resources and allow disinhibition of RH processing.

The influence of dopamine on automatic and controlled semantic activation in Parkinson's disease.

Two semantic priming tasks, designed to isolate automatic and controlled semantic activation, were utilized to investigate the impact of dopamine depletion on semantic processing in Parkinson's disease (PD). Seven people with PD (tested whilst on and off levodopa medication) and seven healthy adults participated in the study. The healthy adult participants demonstrated intact automatic and controlled semantic activation. Aberrant controlled semantic activation was observed in the PD group on levodopa; however, automatic semantic activation was still evident. In contrast, automatic semantic activation was not evident in the PD group off levodopa. These results further clarify the impact of PD on semantic processing, demonstrating that dopamine depletion can cause disturbances in both automatic and controlled semantic activation.

Effect of aging on learning new names and descriptions for objects.

The present study consisted of two experiments to compare new word learning in healthy young (N?=?11) and older (N?=?17) adults within an explicit learning paradigm. Experiment 1 investigated the new name learning for familiar objects, while Experiment 2 investigated learning names and descriptions for unfamiliar objects. Participants attended five learning sessions over 5 consecutive days, during which they viewed objects with novel names with/without descriptions. The older adults were as accurate as the young adults when recalling and recognizing new names during the learning sessions. With respect to response times, the older adults were as rapid as the young adults at recognizing the new names for the familiar objects, but were slower during the follow-up sessions. The older adults were also slower when recognizing new names for unfamiliar objects. When recognizing unfamiliar object descriptions, the older adults were significantly less accurate than the young adults. These results may have implications for the treatment of acquired naming difficulties and second language learning in older adults.

Evaluation of a caregiver education program to support memory and communication in dementia: a controlled pretest-posttest study with nursing home staff.

BACKGROUND: There is a need for simple multimedia training programs designed to upskill the dementia care workforce. A DVD-based training program entitled RECAPS and MESSAGE has been designed to provide caregivers with strategies to support memory and communication in people with dementia. OBJECTIVES: The aims of this study were: (1) to evaluate the effects of the RECAPS and MESSAGE training on knowledge of support strategies, and caregiver satisfaction, in nursing home care staff, and (2) to evaluate staff opinion of the training. DESIGN: A multi-centre controlled pretest-posttest trial was conducted between June 2009 and January 2010, with baseline, immediately post-training and 3-month follow-up assessment. SETTING: Four nursing homes in Queensland, Australia. PARTICIPANTS: All care staff were invited to participate. Of the 68 participants who entered the study, 52 (37 training participants and 15 controls) completed outcome measures at baseline and 3-month follow-up. 63.5% of participants were nursing assistants, 25% were qualified nurses and 11.5% were recreational/activities officers. METHODS: The training and control groups were compared on the following outcomes: (1) knowledge of memory and communication support strategies, and (2) caregiver satisfaction. In the training group, the immediate effects of training on knowledge, and the effects of role (nurse, nursing assistant, recreational staff) on both outcome measures, were also examined. Staff opinion of the training was assessed immediately post-training and at 3-month follow-up. RESULTS: The training group showed a significant improvement in knowledge of support strategies from baseline to immediately post-training (p=0.001). Comparison of the training and control groups revealed a significant increase in knowledge for the training group (p=0.011), but not for the control group (p=0.33), between baseline and 3-month follow-up. Examination of caregiver satisfaction by care staff role in the training group revealed that only the qualified nurses showed higher levels of caregiver satisfaction at 3-month follow-up (p=0.013). Staff rated the training positively both for usefulness and applicability. CONCLUSION: The RECAPS and MESSAGE training improved nursing home care staff's knowledge of support strategies for memory and communication, and gains were maintained at 3-month follow-up. Moreover, the training was well received by staff.

Nicotine effects on general semantic priming in Parkinson's disease.

In young healthy nonsmokers, effects of nicotine on semantic processing have been observed under strategy-based priming procedures but not under more general priming procedures (Holmes, Chenery, & Copland, 2008; Holmes, Chenery, & Copland, 2010). Effects of nicotine under general priming procedures, however, may be mediated by baseline priming levels that are below optimum such as when compromised by disease. Nicotinic mechanisms may be involved in the cognitive sequalae of Parkinson's disease (PD). Evidence suggests that semantic processing may be compromised in PD but the potential benefit of nicotinic stimulation is unknown. This study investigated the effects of nicotine on semantic processing in nonsmokers with PD (n = 12) and nonsmoking matched controls (n = 17) using general priming procedures. Specifically, an automatic priming task (0.15 relatedness proportion, RP, and 200 ms stimulus onset asynchrony, SOA) and a controlled priming task (0.8 RP and 1000 ms SOA) were used. Prime-target category relation (category related, noncategory related) was also manipulated. Transdermal nicotine patches (7 mg/24 h) were administered in a double-blind, placebo-controlled, crossover design. For the automatic task, nicotine did not influence priming effects for PD. Unexpectedly, compromised automatic priming for controls was ameliorated. For the controlled task, nicotine influenced priming effects for PD but not controls. The patterns of priming and nicotine effects across the tasks suggest an age-related slowing of the rate of semantic activation for controls, which may be exacerbated in PD. Overall, the findings indicate that nicotine can improve compromised semantic processing in PD, and also influence semantic processing in healthy older individuals.

Acute nicotine enhances strategy-based semantic processing in Parkinson's disease.

Nicotinic mechanisms may play a role in the cognitive deficits of Parkinson's disease (PD). Recently, on a cognitively demanding strategy-based priming task, nicotine selectively affected controlled semantic processing in young adult non-smokers as reported by Holmes et al. (International Journal of Neuropsychopharmacology 11, 389-399, 2008). Such controlled semantic processing is compromised in PD. This study investigated the effects of acute transdermal nicotine on controlled semantic processing in non-smokers with PD (n = 10) and non-smoking matched controls (n = 16) using a strategy-based semantic priming paradigm. Transdermal nicotine patches (7 mg/24 h) were administered in a double-blind, placebo-controlled, crossover design. Participants were instructed to expect target words from specified semantic categories based on the primes, while unexpected targets were also presented. Priming conditions included those concurring with trained expectations (expected-related and expected-unrelated), those which did not (unexpected-related and unexpected-unrelated), and neutral-baseline conditions. Controls evidenced significant expectancy effects (i.e. reaction-time differences for expected vs. unexpected conditions) under both drug states. An expectancy effect was not evident for PD under placebo due to a lack of reaction-time slowing for unexpected conditions. However, under nicotine an expectancy effect was present for PD at a level comparable to controls. Overall the findings indicate that nicotine can improve impaired controlled semantic processing in PD possibly via enhanced expectancy or inhibitory mechanisms.