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Verhoeks C, Bus B, Tendolkar I, Rijnen S. Cognitive communication disorders after brain injury: A systematic COSMIN review of measurement instruments. Ann Phys Rehabil Med 2024; 67:101870. [PMID: 39098162 DOI: 10.1016/j.rehab.2024.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 04/08/2024] [Accepted: 05/25/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND There is a lack of consensus on standardized measurement instruments (MIs) for the assessment of cognitive communication disorders in individuals with acquired brain injury (ABI). OBJECTIVES To identify and describe the currently available MIs for the assessment of cognitive communication disorders in individuals with ABI and to evaluate the psychometric properties of MIs. METHODS A search was conducted in 6 databases on March 12, 2024 using a validated methodological search filter. We included studies that evaluated psychometric properties of MIs used to assess cognitive communication disorders in individuals with ABI. We applied the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to evaluate the psychometric properties of the MIs. RESULTS We included 48 records reporting on 44 MIs. Of all MIs, the La Trobe Communication Questionnaire (LCQ) and the St Andrew's-Swansea Neurobehavioural Outcome Scale (SASNOS) were studied most extensively. No MIs had undergone exhaustive methodological evaluation. CONCLUSIONS Based on the COSMIN, only 1 of 44 MIs can be recommended as its results can be trusted. Most MIs have the potential to be recommended but require further research to assess their psychometric quality. The development of new tools is not necessary but further methodological studies should be conducted on promising tools. This review may help clinicians and researchers to select an MI for the assessment of cognitive communication disorders and may facilitate diagnosis and research. TRIAL REGISTRATION PROSPERO database (registration number: CRD42020196861). No funding.
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Affiliation(s)
- Carmen Verhoeks
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant. Kluisstraat 2 5427 EM Boekel, the Netherlands; Department of Psychiatry, Radboud University Medical Center, Post office box 9101 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior. P.O Box 9104 6500 HE Nijmegen, the Netherlands.
| | - Boudewijn Bus
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant. Kluisstraat 2 5427 EM Boekel, the Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Post office box 9101 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior. P.O Box 9104 6500 HE Nijmegen, the Netherlands
| | - Sophie Rijnen
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant. Kluisstraat 2 5427 EM Boekel, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands
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Ivanova O, Martínez-Nicolás I, Meilán JJG. Speech changes in old age: Methodological considerations for speech-based discrimination of healthy ageing and Alzheimer's disease. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:13-37. [PMID: 37140204 DOI: 10.1111/1460-6984.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023]
Abstract
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. WHAT THIS PAPER ADDS What is already known on the subject Societal aging goes hand in hand with the rising incidence of ageing-related neurodegenerations, mainly Alzheimer's disease (AD). This is particularly noteworthy in countries with longer life expectancies. Healthy ageing and early stages of AD share a set of cognitive and behavioural characteristics. Since there is no cure for dementias, developing methods for accurate discrimination of healthy ageing and early AD is currently a priority. Speech has been described as one of the most significantly impaired features in AD. Neuropathological alterations in motor and cognitive systems would underlie specific speech impairment in dementia. Since speech can be evaluated quickly, non-invasively and inexpensively, its value for the clinical assessment of ageing itineraries may be particularly high. What this paper adds to existing knowledge Theoretical and experimental advances in the assessment of speech as a marker of AD have developed rapidly over the last decade. Yet, they are not always known to clinicians. Furthermore, there is a need to provide an updated state-of-the-art on which speech features are discriminatory to AD, how they can be assessed, what kind of results they can yield, and how such results should be interpreted. This article provides an updated overview of speech profiling, methods of speech measurement and analysis, and the clinical power of speech assessment for early discrimination of AD as the most common cause of dementia. What are the potential or actual clinical implications of this work? This article provides an overview of the predictive potential of different speech parameters in relation to AD cognitive impairment. In addition, it discusses the effect that the cognitive state, the type of elicitation task and the type of assessment method may have on the results of the speech-based analysis in ageing.
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Affiliation(s)
- Olga Ivanova
- Spanish Language Department, Faculty of Philology, University of Salamanca, Salamanca, Spain
- Institute of Neuroscience of Castilla y León, Salamanca, Spain
| | - Israel Martínez-Nicolás
- Department of Basic Psychology, Psychobiology and Behavioral Science Methodology, Faculty of Psychology, University of Salamanca, Salamanca, Spain
- Institute of Neuroscience of Castilla y León, Salamanca, Spain
| | - Juan José García Meilán
- Department of Basic Psychology, Psychobiology and Behavioral Science Methodology, Faculty of Psychology, University of Salamanca, Salamanca, Spain
- Institute of Neuroscience of Castilla y León, Salamanca, Spain
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Powell KR, Popescu M, Lee S, Mehr DR, Alexander GL. Examining the Use of Text Messages Among Multidisciplinary Care Teams to Reduce Avoidable Hospitalization of Nursing Home Residents with Dementia: Protocol for a Secondary Analysis. JMIR Res Protoc 2023; 12:e50231. [PMID: 37556199 PMCID: PMC10448283 DOI: 10.2196/50231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Reducing avoidable nursing home (NH)-to-hospital transfers of residents with Alzheimer disease or a related dementia (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare and Medicaid. Technologies supporting the use of clinical text messages (TMs) could improve communication among health care team members and have considerable impact on reducing avoidable NH-to-hospital transfers. Although text messaging is a widely accepted mechanism of communication, clinical models of care using TMs are sparsely reported in the literature, especially in NHs. Protocols for assessing technologies that integrate TMs into care delivery models would be beneficial for end users of these systems. Without evidence to support clinical models of care using TMs, users are left to design their own methods and protocols for their use, which can create wide variability and potentially increase disparities in resident outcomes. OBJECTIVE Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using TMs and how salient and timely communication can be used to avert poor outcomes for NH residents with ADRD, including hospitalization. METHODS This project is a secondary analysis of data collected from a Centers for Medicare & Medicaid Services (CMS)-funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: (1) TMs exchanged among the multidisciplinary team across the 7-year CMS study period (August 2013-September 2020) and (2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. The study is guided by an age-friendly model of care called the 4Ms (What Matters, Medications, Mentation, and Mobility) framework. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in TMs occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD. RESULTS After accounting for inclusion and exclusion criteria, we will analyze over 30,000 TMs pertaining to over 3600 NH-to-hospital transfers. Development of the 4M ontology is in progress, and the 3-year project is expected to run until mid-2025. CONCLUSIONS To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding the future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50231.
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Affiliation(s)
- Kimberly R Powell
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
| | - Mihail Popescu
- School of Medicine, University of Missouri, Columbia, MO, United States
| | - Suhwon Lee
- College of Arts and Sciences, University of Missouri, Columbia, MO, United States
| | - David R Mehr
- School of Medicine, University of Missouri, Columbia, MO, United States
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Huang Y, Wang Y, Yang J, Johansson L, Ma B, Zhang X, Lu Q, Wang Y, Zhao Y. Application of the International Classification of Functioning, Disability and Health (ICF) in dementia research and practice: A scoping review. Aging Ment Health 2023; 27:357-371. [PMID: 35315703 DOI: 10.1080/13607863.2022.2053835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The International Classification of Functioning, Disability and Health (ICF) endorsed by the World Health Organization provides a conceptual framework for describing functioning and disability based on a biopsychosocial model. Although dementia is one of the leading causes of disability, yet little is known on the extent to how the ICF has been utilized in dementia research and practice. The study aimed to examine and map the current applications of the ICF with dementia from a body of earlier studies and to explore the potential use in person-centred dementia care. METHODS The Arksey and O'Malley framework was used to guide the searching, selecting, and synthesizing process. The scoping review was reported following The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines. RESULTS A total of 34 studies were included. The applications of ICF were classified into 4 themes: (1) in clinical practice and the education of health professionals (n = 20); (2) community support services and income support (n = 3); (3) population-based, census, or survey data (n = 10); (4) advocacy and empowerment purposes (n = 1). CONCLUSION The ICF has made a major impact on dementia in clinical settings. Findings strongly support applying the ICF to person-centered dementia care. In the future, more empirical studies are needed to expand the scope of ICF use in dementia research and practice.
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Affiliation(s)
- Yaqi Huang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yulu Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Jin Yang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Linda Johansson
- Institute of Gerontology, Aging Research Network-Jönköping, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Bingxin Ma
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaojun Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Qi Lu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
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Rathnayake S, Moyle W, Jones C, Calleja P. Family carers’ needs related to management of functional disability in dementia care and use of mHealth applications in health information seeking: An online survey. Collegian 2020. [DOI: 10.1016/j.colegn.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Krein L, Jeon YH, Miller Amberber A. Development of a new tool for the early identification of communication-support needs in people living with dementia: An Australian face-validation study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:544-554. [PMID: 31670440 DOI: 10.1111/hsc.12887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/30/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
Language and communication difficulties are common in dementia but limited tools are available for a timely assessment of those individuals who experience these difficulties. The Communication-Support Needs Assessment Tool in Dementia (CoSNAT-D) was developed to assist in (a) the early identification of communication difficulties among people with dementia in the community context; and (b) determining the level of their communication support needs to guide appropriate service access. The CoSNAT-D was developed based on a literature review. The face validity was tested with end-users (people with dementia and support persons of people with dementia) regarding relevance, wording, syntax, appropriateness and comprehensiveness of the items of the tool. Data were collected using semi-structured phone interviews. Seven people with dementia and 15 carers participated in the study. Feedback regarding items' appropriateness was largely positive and minor changes were made to improve comprehensiveness. A new item was added to the original item pool. The interviews highlighted the importance of including people with dementia in the assessment processes and person-centered approaches in this context. The CoSNAT-D presents a first step for the early identification of individual support needs of people living with dementia and communication difficulties who live in the community. Items of the CoSNAT-D have been determined face-valid by end-users. The face-validated version of the tool is currently undergoing further testing to determine additional relevant psychometric properties.
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Affiliation(s)
- Luisa Krein
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
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Prynn JE, Kuper H. Perspectives on Disability and Non-Communicable Diseases in Low- and Middle-Income Countries, with a Focus on Stroke and Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3488. [PMID: 31546803 PMCID: PMC6766001 DOI: 10.3390/ijerph16183488] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/04/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022]
Abstract
Non-communicable diseases (NCD) and disability are both common, and increasing in magnitude, as a result of population ageing and a shift in disease burden towards chronic conditions. Moreover, disability and NCDs are strongly linked in a two-way association. People living with NCDs may develop impairments, which can cause activity limitations and participation restriction in the absence of supportive personal and environmental factors. In other words, NCDs may lead to disabilities. At the same time, people with disabilities are more vulnerable to NCDs, because of their underlying health condition, and vulnerability to poverty and exclusion from healthcare services. NCD programmes must expand their focus beyond prevention and treatment to incorporate rehabilitation for people living with NCDs, in order to maximize their functioning and well-being. Additionally, access to healthcare needs to be improved for people with disabilities so that they can secure their right to preventive, curative and rehabilitation services. These changes may require new innovations to overcome existing gaps in healthcare capacity, such as an increasing role for mobile technology and task-sharing. This perspective paper discusses these issues, using a particular focus on stroke and dementia in order to clarify these relationships.
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Affiliation(s)
- Josephine E Prynn
- Faculty of Population Health, University College London, 62 Huntley Street, London WC1E 6DD, UK.
| | - Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Nasiri S, Zahedi G, Kuntz S, Fathi M. Knowledge representation and management based on an ontological CBR system for dementia caregiving. Neurocomputing 2019. [DOI: 10.1016/j.neucom.2019.04.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Krein L, Jeon YH, Amberber AM, Fethney J. The Assessment of Language and Communication in Dementia: A Synthesis of Evidence. Am J Geriatr Psychiatry 2019; 27:363-377. [PMID: 30581140 DOI: 10.1016/j.jagp.2018.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Without the current option of a dementia cure, there is an existing need to focus on rehabilitation intervention. This includes interventions that address language and communication impairment (LCI), found to be present early in most types of dementia. Assessment of LCI can occur in many contexts (e.g., speech pathology, neuropsychology, occupational therapy) and is a vital initial step in providing adequate support to people living with dementia and their families. However, no previous research has compared the psychometric properties and utility of currently available and suitable tools for this purpose. METHODS Eighteen tools with the potential to assess language and communication in dementia were identified through a two-stage process, and a synthesis of evidence is provided. RESULTS Three tools satisfied all selection criteria: the Arizona Battery for Communication Disorders of Dementia, the Sydney Language Battery, and the Addenbrooke's Cognitive Examination III. Main limitations of the 18 tools reviewed concern a lack of standardization, normative data, and criterion validity, as well as poor evidence of reliability of tools originally developed for non-neurodegenerative LCI (e.g., aphasia in the context of cerebrovascular accidents). Furthermore, no tool considers the perspectives of people with dementia regarding the impact of LCI on their daily lives. CONCLUSION Further research is needed to improve reliability and validity of currently available tools for the linguistic assessment of people living with dementia. Importantly, a tool to assess early identification of language and communication difficulties and associated needs among people with dementia is warranted to facilitate timely management and support.
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Affiliation(s)
- Luisa Krein
- Susan Wakil School of Nursing and Midwifery (LK, YJ, JF), University of Sydney, Sydney, Australia.
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery (LK, YJ, JF), University of Sydney, Sydney, Australia
| | | | - Judith Fethney
- Susan Wakil School of Nursing and Midwifery (LK, YJ, JF), University of Sydney, Sydney, Australia
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