The experiences and needs of unpaid family caregivers for persons living with dementia in rural settings: A qualitative systematic review.

PURPOSE: Unpaid family caregivers provide extensive support for community-dwelling persons living with dementia, impacting family caregivers' health and wellbeing. Further, unpaid family caregiving in rural settings has additional challenges because of lower access to services. This systematic review examines qualitative evidence to summarize the experiences and needs of rural unpaid family caregivers of persons living with dementia. METHODS: CINAHL, SCOPUS, EMBASE, Web of Science, PsychINFO, ProQuest, and Medline were searched for articles investigating the experience and needs of rural family caregivers of persons living with dementia. Eligibility criteria were: 1) original qualitative research; 2) written in the English language; 3) focused on the perspectives of caregivers of community-dwelling persons with dementia; 4) focused on rural settings. Study findings were extracted from each article and a meta-aggregate process was used to synthesize the findings. FINDINGS: Of the 510 articles screened, 36 studies were included in this review. Studies were of moderate to high quality and produced 245 findings that were analyzed to produce three synthesized findings: 1) the challenge of dementia care; 2) rural limitations; 3) rural opportunities. CONCLUSIONS: Rurality is perceived as a limitation for family caregivers in relation to the scope of services provided but can be perceived as a benefit when caregivers experience trustworthy and helpful social networks in rural settings. Implications for practice include establishing and empowering community groups to partner in the provision of care. Further research must be conducted to better understand the strengths and limitations of rurality on caregiving.

Aging effects on neural processing of rhythm and meter.

When listening to musical rhythm, humans can perceive and move to beat-like metrical pulses. Recently, it has been hypothesized that meter perception is related to brain activity responding to the acoustic fluctuation of the rhythmic input, with selective enhancement of the brain response elicited at meter-related frequencies. In the current study, electroencephalography (EEG) was recorded while younger (<35) and older (>60) adults listened to rhythmic patterns presented at two different tempi while intermittently performing a tapping task. Despite significant hearing loss compared to younger adults, older adults showed preserved brain activity to the rhythms. However, age effects were observed in the distribution of amplitude across frequencies. Specifically, in contrast with younger adults, older adults showed relatively larger amplitude at the frequency corresponding to the rate of individual events making up the rhythms as compared to lower meter-related frequencies. This difference is compatible with larger N1-P2 potentials as generally observed in older adults in response to acoustic onsets, irrespective of meter perception. These larger low-level responses to sounds have been linked to processes by which age-related hearing loss would be compensated by cortical sensory mechanisms. Importantly, this low-level effect would be associated here with relatively reduced neural activity at lower frequencies corresponding to higher-level metrical grouping of the acoustic events, as compared to younger adults.

The importance of the motor system in the development of music-based forms of auditory rehabilitation.

Hearing abilities decline with age, and one of the most commonly reported hearing issues in older adults is a difficulty understanding speech when there is loud background noise. Understanding speech in noise relies on numerous cognitive processes, including working memory, and is supported by numerous brain regions, including the motor and motor planning systems. Indeed, many working memory processes are supported by motor and premotor cortical regions. Interestingly, lifelong musicians and nonmusicians given music training over the course of weeks or months show an improved ability to understand speech when there is loud background noise. These benefits are associated with enhanced working memory abilities, and enhanced activity in motor and premotor cortical regions. Accordingly, it is likely that music training improves the coupling between the auditory and motor systems and promotes plasticity in these regions and regions that feed into auditory/motor areas. This leads to an enhanced ability to dynamically process incoming acoustic information, and is likely the reason that musicians and those who receive laboratory-based music training are better able to understand speech when there is background noise. Critically, these findings suggest that music-based forms of auditory rehabilitation are possible and should focus on tasks that promote auditory-motor interactions.

The relationship between acoustic and musical pitch processing in adolescents.

Amusia is defined as a difficulty processing the tonal pitch structure of music such that an individual cannot tell the difference between notes that are in-key and out-of-key. A fine-grained pitch discrimination deficit is often observed in people with amusia. It is possible that an intervention, early in development, could mitigate amusia; however, one challenge identifying amusia early in development is that identifying in- and out-of-key notes is a metacognitive task. Given the common co-occurrence of difficulties with pitch discrimination, it would be easier to identify amusia in developing children by using a pitch change detection task. The goal of this study was to explore the behavioural and neurophysiological profiles of adolescents with poor pitch processing (Poor PP) abilities compared with those with normal pitch processing (Normal PP) abilities. Neurophysiologically, the Poor PPs exhibited a similar event-related potential (ERP) profile to adult amusics during both acoustic and musical pitch discrimination tasks. That is, early ERPs (ERAN, MMN) were similar in Poor PPs compared with Normal PPs, whereas late positivities (P300, P600) were absent in Poor PPs, but present in Normal PPs. At the same time, behavioural data revealed a double dissociation between the abilities to detect a pitch deviant in acoustic and musical context, suggesting that about a third of the children would be missed by selecting a fine-grained acoustic pitch discrimination task to identify the presence of amusia in early childhood.

Memory Deficits for Health Information Provided Through a Telehealth Video Conferencing System.

It is critical to remember details about meetings with healthcare providers. Forgetting could result in inadequate knowledge about ones' health, non-adherence with treatments, and poorer health outcomes. Hearing the health care provider plays a crucial role in consolidating information for recall. The recent COVID-19 pandemic has meant a rapid transition to videoconference-based medicine, here described as telehealth. When using telehealth speech must be filtered and compressed, and research has shown that degraded speech is more challenging to remember. Here we present preliminary results from a study that compared memory for health information provided in-person to telehealth. The data collection for this study was stopped due to the pandemic, but the preliminary results are interesting because the pandemic forced a rapid transition to telehealth. To examine a potential memory deficit for health information provided through telehealth, we presented older and younger adults with instructions on how to use two medical devices. One set of instructions was presented in-person, and the other through telehealth. Participants were asked to recall the instructions immediately after the session, and again after a 1-week delay. Overall, the number of details recalled was significantly lower when instructions were provided by telehealth, both immediately after the session and after a 1-week delay. It is likely that a mix of technological and communication strategies by the healthcare provider could reduce this telehealth memory deficit. Given the rapid transition to telehealth due to COVID-19, highlighting this deficit and providing potential solutions are timely and of utmost importance.

Mapping Tonal Hierarchy in the Brain.

In Western tonal music, pitches are organized hierarchically based on their perceived fit in a specific tonal context. This hierarchy forms scales that are commonly used in Western tonal music. The hierarchical nature of tonal structure is well established behaviourally; however, the neural underpinnings are largely unknown. In this study, EEG data and goodness-of-fit ratings were collected from 34 participants who listened to an arpeggio followed by a probe tone, where the probe tone could be any chromatic scale degree and the context any of the major keys. Goodness-of-fit ratings corresponded to the classic tonal hierarchy. N1, P2 and the Early Right Anterior Negativity (ERAN) were significantly modulated by scale degree. Furthermore, neural marker amplitudes and latencies were significantly correlated with similar magnitude to both pitch height and goodness-of-fit ratings. This is different from the clearer divide between pitch height correlating with early neural markers (100-200 ms) and tonal hierarchy correlating with late neural markers (200-1000 ms) reported by Sankaran et al. (2020) and Quiroga-Martinez et al. (2019). Finally, individual differences were greater than any main effects detected when pooling participants and brain-behavior correlations vary widely (i.e. r = -0.8 to 0.8).

National survey of Canadian residents and program directors regarding parental leave during residency.

BACKGROUND: Despite the advantages of having a child as a medical resident, the transition back to residency after parental leave can be challenging. This study is the first to investigate this issue using a nation-wide Canadian sample of both residents and program directors. METHOD: A questionnaire was developed and made available online. Respondents included 437 female residents, 33 male residents, and 172 residency program directors. The mean length of parental leave was nine months for female residents and six weeks for male residents. Almost all female residents (97.5%) breastfed with an average duration of 12 months. The top challenges reported by residents were feeling guilty for being away from their family, long and unpredictable work hours, sleep deprivation, and finding time to study. When female residents and program directors were matched to both school and program (N = 99 pairs), there was no difference in the total number of challenges reported, but program directors reported offering significantly more accommodations than female residents reported being offered, t(196) = 13.06, p < .001. RESULTS: Our data indicate there is a need for better communication between resident parents and program directors, as well as clear program-specific parental leave policies, particularly for supporting breastfeeding mothers as they return to work.

CONTEXTE: Malgré les avantages d'avoir un enfant au cours d'une résidence en médecine, le retour à la résidence à la suite d'un congé parental peut s'avérer difficile. Cette recherche est la première qui étudie cette question en utilisant un échantillon national comptant à la fois des résidents et directeurs de programmes canadiens. MÉTHODE: Un questionnaire a été préparé et affiché en ligne. Parmi les personnes interrogées, on comptait 437 résidentes, 33 résidents et 172 directeurs et directrices de programmes de résidence. La durée moyenne des congés parentaux était de neuf mois pour les résidentes et six semaines pour les résidents. Presque toutes les résidentes (97,5%) ont allaité en moyenne pendant douze (12) mois. Les plus grands défis que les résidents ont signalés étaient la culpabilité de ne pas être avec leur famille, les longues et imprévisibles heures de travail, le manque de sommeil et la difficulté à trouver le temps pour étudier. Lorsque les résidentes et directeurs et directrices de programme étaient jumelés à l'école et au programme (N = 99 paires), le nombre total de difficultés rapportées est demeuré inchangé. Cependant, les directeurs et directrices de programme ont signalé qu'ils offraient beaucoup plus d'accommodements que ce que les résidentes ont déclaré qu'on leur proposait, t(196) = 13.06, p < .001. RÉSULTATS: Nos données indiquent qu'il est nécessaire d'améliorer la communication entre les résidents parents et les directeurs de programme ainsi que les politiques qui régissent les programmes de congés parentaux, notamment pour aider les mères qui allaitent au moment de retourner au travail.

Autodidacticism and Music: Do Self-Taught Musicians Exhibit the Same Auditory Processing Advantages as Formally Trained Musicians?

Multiple studies have demonstrated that musicians have enhanced auditory processing abilities compared to non-musicians. In these studies, musicians are usually defined as having received some sort of formal music training. One issue with this definition is that there are many musicians who are self-taught. The goal of the current study was to determine if self-taught musicians exhibit different auditory enhancements as their formally trained counterparts. Three groups of participants were recruited: formally trained musicians, who received formal music training through the conservatory or private lessons; self-taught musicians, who learned to play music through informal methods, such as with books, videos, or by ear; non-musicians, who had little or no music experience. Auditory processing abilities were assessed using a speech-in-noise task, a passive pitch oddball task done while recording electrical brain activity, and a melodic tonal violation task, done both actively and passively while recording electrical brain activity. For the melodic tonal violation task, formally trained musicians were better at detecting a tonal violation compared to self-taught musicians, who were in turn better than non-musicians. The P600 evoked by a tonal violation was enhanced in formally trained musicians compared to non-musicians. The P600 evoked by an out-of-key note did not differ between formally trained and self-taught musicians, while the P600 evoked by an out-of-tune note was smaller in self-taught musicians compared to formally trained musicians. No differences were observed between the groups for the other tasks. This pattern of results suggests that music training format impacts auditory processing abilities in musical tasks; however, it is possible that these differences arose due to pre-existing factors and not due to the training itself.

The effects of short-term musical training on the neural processing of speech-in-noise in older adults.

Experienced musicians outperform non-musicians in understanding speech-in-noise (SPIN). The benefits of lifelong musicianship endure into older age, where musicians experience smaller declines in their ability to understand speech in noisy environments. However, it is presently unknown whether commencing musical training in old age can also counteract age-related decline in speech perception, and whether such training induces changes in neural processing of speech. Here, we recruited older adult non-musicians and assigned them to receive a short course of piano or videogame training, or no training. Participants completed two sessions of functional Magnetic Resonance Imaging where they performed a SPIN task prior to and following training. While we found no direct benefit of musical training upon SPIN perception, an exploratory Region of Interest analysis revealed increased cortical responses to speech in left Middle Frontal and Supramarginal Gyri which correlated with changes in SPIN task performance in the group which received music training. These results suggest that short-term musical training in older adults may enhance neural encoding of speech, with the potential to reduce age-related decline in speech perception.

Musical training improves the ability to understand speech-in-noise in older adults.

It is well known that hearing abilities decline with age, and one of the most commonly reported hearing difficulties reported in older adults is a reduced ability to understand speech in noisy environments. Older adult musicians have an enhanced ability to understand speech in noise, and this has been associated with enhanced brain responses related to both speech processing and the deployment of attention; however, the causal impact of music lessons in older adults has not yet been demonstrated. To investigate whether a causal relationship exists between short-term musical training and performance on auditory tests in older adults and to determine if musical training can be used to improve hearing in older adult nonmusicians, we conducted a longitudinal training study with random assignment. A sample of older adults was randomly assigned to learn to play piano (Music), to learn to play a visuospatially demanding video game (Video), or to serve as a no-contact control (No-contact). After 6 months, the Music group improved their ability to understand a word presented in loud background noise, whereas the other 2 groups did not. This improvement was related to an increase in positive-going electrical brain activity at fronto-left electrodes 200-1000 ms after the presentation of a word in noise. Source analyses suggest that this activity was due to sources located in the left inferior frontal gyrus and other regions involved in the speech-motor system. These findings support the idea that musical training provides a causal benefit to hearing abilities. Importantly, these findings suggest that musical training could be used as a foundation to develop auditory rehabilitation programs for older adults.

The impact of aging on neurophysiological entrainment to a metronome.

In music, entrainment to the beat allows listeners to make predictions about upcoming events. Previous work has shown that neural oscillations will entrain to the beat of the music or rhythmic stimuli. Despite the fact that aging is known to impact both auditory and cognitive processing, little is known about how aging affects neural entrainment to rhythmic stimuli. In this study, younger and older participants listened to isochronous sequences at a slower and faster rate while EEG data was recorded. Steady-state evoked potentials had amplitude peaks at the stimulus rate and its harmonics. Steady-state evoked potentials at the stimulus rate and the first harmonic was attenuated in older adults compared to younger adults. Additionally, no amplitude difference was found for the second and third harmonics in older adults, while there was a decrease in amplitude in younger adults. This age-related decline in the entrainment specificity of the brain responses to the stimulus rate, suggests that aging may decrease the ability to entrain to stimuli in the environment, and further suggests that older adults may be less able to inhibit neural entrainment that is not directly related to the incoming stimulus.

How age-of-death and mode-of-death impact perceptions of the deceased.

The goal of the current study was to explore how age-of-death (AOD) and mode-of-death MOD simultaneously influence ratings of sympathy, empathy, and tragedy toward the deceased in order to assess social value. Three hundred and fifty-eight participants, mainly undergraduates, responded to a series of vignettes that described a MOD (suicide, accident, or stroke) counterbalanced with three AODs (younger, middle-aged, and older). Overall, ratings of sympathy, empathy, and tragedy declined as AOD increased; however, the effect of AOD was not consistent across all MODs. The pattern of results suggests that death norms and perceived control of death impact the perception of the deceased.

Playing Super Mario increases oculomotor inhibition and frontal eye field grey matter in older adults.

Aging is associated with cognitive decline and decreased capacity to inhibit distracting information. Video game training holds promise to increase inhibitory mechanisms in older adults. In the current study, we tested the impact of 3D-platform video game training on performance in an antisaccade task and on related changes in grey matter within the frontal eye fields (FEFs) of older adults. An experimental group (VID group) engaged in 3D-platform video game training over a period of 6 months, while an active control group was trained on piano lessons (MUS group), and a no-contact control group did not participate in any intervention (CON group). Increased performance in oculomotor inhibition, as measured by the antisaccade task, and increased grey matter in the right FEF was observed uniquely in the VID group. These results demonstrate that 3D-platform video game training can improve inhibitory control known to decline with age.

Random Feedback Makes Listeners Tone-Deaf.

The mental representation of pitch structure (tonal knowledge) is a core component of musical experience and is learned implicitly through exposure to music. One theory of congenital amusia (tone deafness) posits that conscious access to tonal knowledge is disrupted, leading to a severe deficit of music cognition. We tested this idea by providing random performance feedback to neurotypical listeners while they listened to melodies for tonal incongruities and had their electrical brain activity monitored. The introduction of random feedback was associated with a reduction of accuracy and confidence, and a suppression of the late positive brain response usually elicited by conscious detection of a tonal violation. These effects mirror the behavioural and neurophysiological profile of amusia. In contrast, random feedback was associated with an increase in the amplitude of the early right anterior negativity, possibly due to heightened attention to the experimental task. This successful simulation of amusia in a normal brain highlights the key role of feedback in learning, and thereby provides a new avenue for the rehabilitation of learning disorders.

Neurophysiological and Behavioral Differences between Older and Younger Adults When Processing Violations of Tonal Structure in Music.

Aging is associated with decline in both cognitive and auditory abilities. However, evidence suggests that music perception is relatively spared, despite relying on auditory and cognitive abilities that tend to decline with age. It is therefore likely that older adults engage compensatory mechanisms which should be evident in the underlying functional neurophysiology related to processing music. In other words, the perception of musical structure would be similar or enhanced in older compared to younger adults, while the underlying functional neurophysiology would be different. The present study aimed to compare the electrophysiological brain responses of younger and older adults to melodic incongruities during a passive and active listening task. Older and younger adults had a similar ability to detect an out-of-tune incongruity (i.e., non-chromatic), while the amplitudes of the ERAN and P600 were reduced in older adults compared to younger adults. On the other hand, out-of-key incongruities (i.e., non-diatonic), were better detected by older adults compared to younger adults, while the ERAN and P600 were comparable between the two age groups. This pattern of results indicates that perception of tonal structure is preserved in older adults, despite age-related neurophysiological changes in how melodic violations are processed.

Modulation of electric brain responses evoked by pitch deviants through transcranial direct current stimulation.

Congenital amusia is a neurodevelopmental disorder, characterized by a difficulty detecting pitch deviation that is related to abnormal electrical brain responses. Abnormalities found along the right fronto-temporal pathway between the inferior frontal gyrus (IFG) and the auditory cortex (AC) are the likely neural mechanism responsible for amusia. To investigate the causal role of these regions during the detection of pitch deviants, we applied cathodal (inhibitory) transcranial direct current stimulation (tDCS) over right frontal and right temporal regions during separate testing sessions. We recorded participants' electrical brain activity (EEG) before and after tDCS stimulation while they performed a pitch change detection task. Relative to a sham condition, there was a decrease in P3 amplitude after cathodal stimulation over both frontal and temporal regions compared to pre-stimulation baseline. This decrease was associated with small pitch deviations (6.25 cents), but not large pitch deviations (200 cents). Overall, this demonstrates that using tDCS to disrupt regions around the IFG and AC can induce temporary changes in evoked brain activity when processing pitch deviants. These electrophysiological changes are similar to those observed in amusia and provide causal support for the connection between P3 and fronto-temporal brain regions.

Playing Super Mario 64 increases hippocampal grey matter in older adults.

Maintaining grey matter within the hippocampus is important for healthy cognition. Playing 3D-platform video games has previously been shown to promote grey matter in the hippocampus in younger adults. In the current study, we tested the impact of 3D-platform video game training (i.e., Super Mario 64) on grey matter in the hippocampus, cerebellum, and the dorsolateral prefrontal cortex (DLPFC) of older adults. Older adults who were 55 to 75 years of age were randomized into three groups. The video game experimental group (VID; n = 8) engaged in a 3D-platform video game training over a period of 6 months. Additionally, an active control group took a series of self-directed, computerized music (piano) lessons (MUS; n = 12), while a no-contact control group did not engage in any intervention (CON; n = 13). After training, a within-subject increase in grey matter within the hippocampus was significant only in the VID training group, replicating results observed in younger adults. Active control MUS training did, however, lead to a within-subject increase in the DLPFC, while both the VID and MUS training produced growth in the cerebellum. In contrast, the CON group displayed significant grey matter loss in the hippocampus, cerebellum and the DLPFC.

The impact of attentional training on event-related potentials in older adults.

Attentional control declines in older adults and is paralleled by changes in event-related brain potentials (ERPs). The N200 is associated with attentional control, thus training-related improvements in attentional control should be paralleled by enhancements to the N200. Older participants were randomly assigned to 1 of 3 groups, which focused on training different levels of attentional control: (1) single-task training (single), where participants trained on 2 tasks in isolation; (2) fixed divided attention training (fixed), where participants trained on 2 tasks simultaneously; and (3) variable divided attention training (variable), where participants trained on 2 tasks simultaneously but were instructed to alternatively prioritize each of the 2 tasks. After training, the amplitude of the N200 wave increased in dual-task conditions for the variable group, and this enhancement was correlated with improved dual-task performance. Participants in the variable group also had the greatest improvement in the ability to modulate their allocation of attention in accordance with task instructions to the less salient and less complex of the 2 tasks. Training older adults to modulate their division of attention between tasks improves neural functions associated with attentional control of the trained tasks.

Activation in the Right Inferior Parietal Lobule Reflects the Representation of Musical Structure beyond Simple Pitch Discrimination.

Pitch discrimination tasks typically engage the superior temporal gyrus and the right inferior frontal gyrus. It is currently unclear whether these regions are equally involved in the processing of incongruous notes in melodies, which requires the representation of musical structure (tonality) in addition to pitch discrimination. To this aim, 14 participants completed two tasks while undergoing functional magnetic resonance imaging, one in which they had to identify a pitch change in a series of non-melodic repeating tones and a second in which they had to identify an incongruous note in a tonal melody. In both tasks, the deviants activated the right superior temporal gyrus. A contrast between deviants in the melodic task and deviants in the non-melodic task (melodic > non-melodic) revealed additional activity in the right inferior parietal lobule. Activation in the inferior parietal lobule likely represents processes related to the maintenance of tonal pitch structure in working memory during pitch discrimination.

Attending to pitch information inhibits processing of pitch information: the curious case of amusia.

In normal listeners, the tonal rules of music guide musical expectancy. In a minority of individuals, known as amusics, the processing of tonality is disordered, which results in severe musical deficits. It has been shown that the tonal rules of music are neurally encoded, but not consciously available in amusics. Previous neurophysiological studies have not explicitly controlled the level of attention in tasks where participants ignored the tonal structure of the stimuli. Here, we test whether access to tonal knowledge can be demonstrated in congenital amusia when attention is controlled. Electric brain responses were recorded while asking participants to detect an individually adjusted near-threshold click in a melody. In half the melodies, a note was inserted that violated the tonal rules of music. In a second task, participants were presented with the same melodies but were required to detect the tonal deviation. Both tasks required sustained attention, thus conscious access to the rules of tonality was manipulated. In the click-detection task, the pitch deviants evoked an early right anterior negativity (ERAN) in both groups. In the pitch-detection task, the pitch deviants evoked an ERAN and P600 in controls but not in amusics. These results indicate that pitch regularities are represented in the cortex of amusics, but are not consciously available. Moreover, performing a pitch-judgment task eliminated the ERAN in amusics, suggesting that attending to pitch information interferes with perception of pitch. We propose that an impaired top-down frontotemporal projection is responsible for this disorder.