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Suárez-González A, Savage SA, Alladi S, Amaral-Carvalho V, Arshad F, Camino J, Caramelli P, Comas-Herrera A, Cook J, Cooper C, García Díaz L, Grasso SM, Jokel R, Lavoie M, León T, Priya T, Ramos Franco T, Taylor-Rubin C, Townsend R, Thöne-Otto A, Slachevsky A, Volkmer A, Weidner W, O’Connor CMC. Rehabilitation Services for Young-Onset Dementia: Examples from High- and Low-Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:790. [PMID: 38929036 PMCID: PMC11203756 DOI: 10.3390/ijerph21060790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/05/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
The WHO Dementia Global Action Plan states that rehabilitation services for dementia are required to promote health, reduce disability, and maintain quality of life for those living with dementia. Current services, however, are scarce, particularly for people with young-onset dementia (YOD). This article, written by an international group of multidisciplinary dementia specialists, offers a three-part overview to promote the development of rehabilitation services for YOD. Firstly, we provide a synthesis of knowledge on current evidence-based rehabilitative therapies for early-onset Alzheimer's disease (EOAD), behavioural variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and posterior cortical atrophy (PCA). Secondly, we discuss the characteristics of rehabilitation services for YOD, providing examples across three continents for how these services can be embedded in existing settings and the different roles of the rehabilitation multidisciplinary team. Lastly, we conclude by highlighting the potential of telehealth in making rehabilitation services more accessible for people with YOD. Overall, with this paper, we aim to encourage clinical leads to begin introducing at least some rehabilitation into their services, leveraging existing resources and finding support in the collective expertise of the broader multidisciplinary dementia professional community.
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Affiliation(s)
- Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London (UCL), London WC1N 3BG, UK
| | - Sharon A Savage
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560030, India
| | - Viviane Amaral-Carvalho
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560030, India
| | - Julieta Camino
- Institute of Health and Social Care, London South Bank University, London SE1 0AA, UK
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TQ, UK
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London WC2A 2AZ, UK
| | - Julia Cook
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester WR5 1JR, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK
| | - Laura García Díaz
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Stephanie M. Grasso
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78712-1069, USA
| | - Regina Jokel
- Rotman Research Institute, Toronto, ON M6A 2X8, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada
| | - Monica Lavoie
- Chaire de Recherche sur les Aphasies Primaires Progressives—Fondation de la Famille LEMAIRE, CHU de Québec-Université Laval, Québec, QC G1V 0A6, Canada;
| | - Tomás León
- Memory Unit, Neurology Department, Memory and Neuropsychiatric Center (CMYN), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago 7500922, Chile
- Department of Psychiatry and Global Brain Health Institute, Trinity College, D02 K104 Dublin, Ireland
| | - Thomas Priya
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India;
| | - Teresita Ramos Franco
- Memory Unit, Neurology Department, Memory and Neuropsychiatric Center (CMYN), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago 7500922, Chile
| | - Cathleen Taylor-Rubin
- Speech Pathology Department, War Memorial Hospital, Sydney, NSW 2024, Australia
- School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | | | - Angelika Thöne-Otto
- Clinic for Cognitive Neurology, University Hospital Leipzig, 04103 Leipzig, Germany
- Max-Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
| | - Andrea Slachevsky
- Memory Unit, Neurology Department, Memory and Neuropsychiatric Center (CMYN), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago 7500922, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago 7500922, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopatology Program—Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago 7500922, Chile
- Neurology and Psychiatry Department, Clínica Alemana-Universidad Desarrollo, Santiago 7650568, Chile
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London (UCL), London WC1H 0AP, UK
| | - Wendy Weidner
- Alzheimer’s Disease International, London SE1 4PU, UK
| | - Claire MC O’Connor
- Centre for Positive Ageing, HammondCare, Sydney, NSW 2170, Australia
- School of Psychology, Faculty of Sciences, University of New South Wales, Sydney, NSW 2052, Australia
- Neuroscience Research Australia, Sydney, NSW 2031, Australia
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Kertesz A, Finger E, Munoz DG. Progress in Primary Progressive Aphasia: A Review. Cogn Behav Neurol 2024; 37:3-12. [PMID: 38498721 DOI: 10.1097/wnn.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/07/2023] [Indexed: 03/20/2024]
Abstract
We present a review of the definition, classification, and epidemiology of primary progressive aphasia (PPA); an update of the taxonomy of the clinical syndrome of PPA; and recent advances in the neuroanatomy, pathology, and genetics of PPA, as well as the search for biomarkers and treatment. PPA studies that have contributed to concepts of language organization and disease propagation in neurodegeneration are also reviewed. In addition, the issues of heterogeneity versus the relationships of the clinical phenotypes and their relationship to biological, pathological, and genetic advances are discussed, as is PPA's relationship to other conditions such as frontotemporal dementia, corticobasal degeneration, progressive supranuclear palsy, Pick disease, and amyotrophic lateral sclerosis. Arguments are presented in favor of considering these conditions as one entity versus many.
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Affiliation(s)
- Andrew Kertesz
- Department of Clinical Neurosciences, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurosciences, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - David G Munoz
- Department of Pathology, St Michael's Hospital, Toronto, Ontario, Canada
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Suárez-González A, John A, Brotherhood E, Camic PM, McKee-Jackson R, Melville M, Sullivan MP, Tudor-Edwards R, Windle G, Crutch S, Hoare Z, Stott J. "Better Living with Non-memory-led Dementia": protocol for a feasibility randomised controlled trial of a web-based caregiver educational programme. Pilot Feasibility Stud 2023; 9:172. [PMID: 37821924 PMCID: PMC10566043 DOI: 10.1186/s40814-023-01403-1] [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: 05/18/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Non-memory-led dementias such as posterior cortical atrophy (PCA), primary progressive aphasia (PPA) and behavioural variant frontotemporal dementia (bvFTD) are low prevalent and often affect individuals under the age of 65. Tailored educational and support resources for caregivers of people living with these dementia phenotypes are scarce and unevenly distributed geographically. Web-based educational programmes are emerging as promising alternatives to improve caregiver self-efficacy and well-being. Here, we present the protocol of a study aiming to assess the feasibility of a co-produced online educational programme for caregivers of people living PCA, PPA and bvFTD: the Better Living with Non-memory-led Dementia programme. METHODS A randomised controlled feasibility trial will be conducted on a sample of 30 caregivers of people living with PCA, PPA and bvFTD. Participants will be recruited among members of the support organisation Rare Dementia Support (based at UCL in the UK). The intervention group will be given access to an 8-week co-produced web-based educational programme consisting of 6 modules addressing education about PCA, PPA and bvFTD and support strategies for the person with dementia and for the caregiver. The control group will receive treatment as usual (TAU). Feasibility will be measured through feasibility of recruitment, clinical measurement tools and acceptability. Clinical measures will be used to assess preliminary efficacy and data on completion rates, missing data and variability used to decide on measures to be included in a full-scale trial. Allocation ratio will be 2:1 (intervention:control) stratified by diagnosis. Feasibility of recruitment and acceptability will be assessed. Clinical measures will be administered at baseline and 8-week and 3-month post-randomisation. The control group will be offered access to the intervention at the completion of data collection. Participants will be unblinded, and all measures will be self-reported online. DISCUSSION Online-delivered educational programmes show potential for improving care competency of caregivers and may contribute to overcoming geographical inequalities in local provision of support services. This pilot study will inform a fully powered international trial to determine the effectiveness of Better Living with Non-memory-led Dementia. TRIAL REGISTRATION This trial has been registered prospectively on the Clinical Trials Registry on 1st September 2022, registration number NCT05525377.
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Affiliation(s)
- Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK.
| | - Amber John
- Psychology and Language Sciences, University College London, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Paul M Camic
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Roberta McKee-Jackson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Mel Melville
- Psychology and Language Sciences, University College London, London, UK
| | - Mary Pat Sullivan
- Faculty of Education and Professional Studies, School of Social Work, Nipissing University, North Bay, ON, Canada
| | | | - Gill Windle
- Dementia Services Development Centre, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Sebastian Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Zoe Hoare
- School of Health Sciences, Bangor University, Bangor, UK
| | - Joshua Stott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
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Wauters LD, Croot K, Dial HR, Duffy JR, Grasso SM, Kim E, Schaffer Mendez K, Ballard KJ, Clark HM, Kohley L, Murray LL, Rogalski EJ, Figeys M, Milman L, Henry ML. Behavioral Treatment for Speech and Language in Primary Progressive Aphasia and Primary Progressive Apraxia of Speech: A Systematic Review. Neuropsychol Rev 2023:10.1007/s11065-023-09607-1. [PMID: 37792075 DOI: 10.1007/s11065-023-09607-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/13/2023] [Indexed: 10/05/2023]
Abstract
Primary progressive aphasia (PPA) and primary progressive apraxia of speech (PPAOS) are neurodegenerative syndromes characterized by progressive decline in language or speech. There is a growing number of studies investigating speech-language interventions for PPA/PPAOS. An updated systematic evaluation of the treatment evidence is warranted to inform best clinical practice and guide future treatment research. We systematically reviewed the evidence for behavioral treatment for speech and language in this population. Reviewed articles were published in peer-reviewed journals through 31 May 2021. We evaluated level of evidence, reporting quality, and risk of bias using a modified version of the American Speech-Language Hearing Association (ASHA) Levels of Evidence, an appraisal point system, additional reporting quality and internal/external validity items, and, as appropriate, the Single Case Experimental Design Scale or the Physiotherapy Evidence Database - PsycBITE Rating Scale for Randomized and Non-Randomized Controlled Trials. Results were synthesized using quantitative summaries and narrative review. A total of 103 studies reported treatment outcomes for 626 individuals with PPA; no studies used the diagnostic label PPAOS. Most studies evaluated interventions for word retrieval. The highest-quality evidence was provided by 45 experimental and quasi-experimental studies (16 controlled group studies, 29 single-subject designs). All (k = 45/45) reported improvement on a primary outcome measure; most reported generalization (k = 34/43), maintenance (k = 34/39), or social validity (k = 17/19) of treatment for at least one participant. The available evidence supports speech-language intervention for persons with PPA; however, treatment for PPAOS awaits systematic investigation. Implications and limitations of the evidence and the review are discussed.
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Affiliation(s)
- Lisa D Wauters
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA
| | - Karen Croot
- School of Psychology, University of Sydney, 2006, Sydney, NSW, Australia
| | - Heather R Dial
- Department of Communication Sciences and Disorders, University of Houston, Houston, TX, 77204, USA
| | - Joseph R Duffy
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Stephanie M Grasso
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA
| | - Esther Kim
- US Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, T6G 2R3, Edmonton, AB, Canada
| | | | - Kirrie J Ballard
- Faculty of Medicine & Health and Brain & Mind Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Heather M Clark
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Leeah Kohley
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, ON, N6A 3K7, Canada
| | - Emily J Rogalski
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, 60611, Chicago, IL, USA
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, Feinberg School of Medicine, 60611, Chicago, IL, USA
| | - Mathieu Figeys
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Lisa Milman
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan, UT, 84322, USA
| | - Maya L Henry
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA.
- Department of Neurology, Dell Medical School, University of Texas at Austin, 78712, Austin, TX, USA.
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Lindauer A, Smith S, Gothard S, Mattek N, Tran L, Mooney A. 'There's no straight line…' a consumer-informed intervention for FTD family care partners: the STELLA-FTD pilot study. Aging Ment Health 2023; 27:2000-2010. [PMID: 37655616 PMCID: PMC10518812 DOI: 10.1080/13607863.2023.2250741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES Behavioral symptoms and communication challenges are particularly apparent in frontotemporal degenerative (FTD) dementias. There is a paucity of psychoeducation programming specifically tailored to the needs of families with FTD. We revised an existing intervention to meet the needs of these families. METHODS We used a quasi-experimental approach. In Phase 1, we sought consumer input about an existing intervention. In Phase 2, we modified the intervention based on the qualitative findings from Phase 1 and tested the revised intervention (STELLA-FTD) for feasibility, acceptability and early-stage efficacy. Outcome for Phase 2 included feasibility data and care partner reactivity to upsetting behaviors. Secondary outcomes included data from unobtrusive sleep monitoring. An inductive analysis of transcripts from the Phase 2 STELLA-FTD focus group provides guidance for future revisions. RESULTS Fifteen family care partners participated in the Phase 1 focus groups; sixteen care partners enrolled in Phase 2. Testing in Phase 2 revealed that the care partners found our consumer-informed revised intervention both feasible and acceptable. The post-intervention findings suggest STELLA-FTD has the potential to reduce care partner reactivity to upsetting behaviors and to decrease care partner burden. Sleep did not change over the 8-week intervention. CONCLUSIONS The revised STELLA-FTD intervention was found to be feasible and acceptable, and has potential to improve care partner burden for families living with FTD. Providing the intervention via telehealth maximized access and engaged rehabilitation specialists in providing disease management content. Future revisions will include examination of efficacy and mechanism of action (OHSU IRB # 00022721, ClinicalTrials.gov NCT05338710).
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Affiliation(s)
- Allison Lindauer
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Samantha Smith
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Sarah Gothard
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Nora Mattek
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Leslie Tran
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Aimee Mooney
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
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Fegter O, Santos H, Rademaker AW, Roberts AC, Rogalski E. Suitability of Goal Attainment Scaling in Older Adult Populations with Neurodegenerative Disease Experiencing Cognitive Impairment: A Systematic Review and Meta-Analysis. Gerontology 2023; 69:1002-1013. [PMID: 36966524 PMCID: PMC11214152 DOI: 10.1159/000529984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/01/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Identifying responsive outcome measures for assessing functional change related to cognition, communication, and quality of life for individuals with neurodegenerative disease is important for intervention design and clinical care. Goal Attainment Scaling (GAS) has been used as an outcome measure to formally develop and systematically measure incremental progress toward functional, patient-centered goals in clinical settings. Evidence suggests that GAS is reliable and feasible for use in older adult populations and in adult populations with cognitive impairment, but no review has assessed the suitability of GAS in older adults with neurodegenerative disease experiencing dementia or cognitive impairment, based on responsiveness. This study conducted a systematic review to evaluate the suitability of GAS as an outcome measure for older adult populations with neurodegenerative disease experiencing dementia or cognitive impairment, based on responsiveness. METHODS The review was registered with PROSPERO and performed by searching ten electronic scientific databases (PubMed, Medline OVID, CINAHL, Cochrane, Embase, Web of Science, PsycINFO, Scopus, OTSeeker, REHABDATA) and four registries (Clinicaltrials.gov, Grey Literature Report, Mednar, OpenGrey). A summary measure of responsiveness (post-intervention minus pre-intervention mean GAS T-score) was compared across eligible studies using a random-effects meta-analysis. Risk of bias in included studies was assessed using the NIH Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group. RESULTS 882 eligible articles were identified and screened by two independent reviewers. Ten studies met inclusion criteria for the final analysis. Of the ten included reports, 3 focus on all-cause dementia, 3 on multiple sclerosis, 1 on Parkinson's disease, 1 on mild cognitive impairment, 1 on Alzheimer's disease, and 1 on primary progressive aphasia. Responsiveness analyses showed pre- and post-intervention GAS goals were significantly different from zero (Z = 7.48, p < 0.001), with post-intervention GAS scores being higher than pre-intervention GAS scores. Three included studies showed a high risk of bias, 3 showed a moderate risk of bias, and 4 showed a low risk of bias. Overall risk of bias of included studies was rated as moderate. CONCLUSION GAS showed an improvement in goal attainment across different dementia patient populations and intervention types. The overall moderate risk of bias suggests that while bias is present across included studies (e.g., small sample size, unblinded assessors), the observed effect likely represents the true effect. This suggests that GAS is responsive to functional change and may be suitable for use in older adult populations with neurodegenerative disease experiencing dementia or cognitive impairment.
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Affiliation(s)
- Ollie Fegter
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Haylie Santos
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Alfred W. Rademaker
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Angela C. Roberts
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
- Department of Computer Science, Western University, London, ON, Canada
- Canadian Centre for Activity and Aging, Western University, London, ON, Canada
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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7
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Mooney AR, Bravo M, Roberts A, Salley E, Blaze E, Esparza M, Fried-Oken M, Khayum B, Rao L, Rademaker A, Rogalski E. Use and Perceived Effectiveness of Communication Modes Reported by Persons With Primary Progressive Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:298-305. [PMID: 36472941 PMCID: PMC10023145 DOI: 10.1044/2022_ajslp-21-00386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/22/2022] [Accepted: 08/11/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Primary progressive aphasia (PPA) is a clinical neurodegenerative dementia syndrome characterized by early, selective, and progressive language impairment. PPA onset is gradual, providing time to potentially identify additional or alternative expressive communication modes; however, reports of communication mode use and effectiveness by persons with PPA have not been described. This study characterized the use, frequency, and perceived effectiveness of communication modes reported by individuals with PPA. METHOD Forty-one participants with mild-to-moderate PPA completed a structured interview detailing the type, frequency, and perceived effectiveness of 12 potential communication modes, categorized by technology required (no-tech, low-tech, and high-tech). The ratio of modes used was compared across technology categories with a repeated-measures generalized linear model assuming a binomial distribution with an overall Wald chi-square statistic, followed by pairwise post hoc t-test comparisons. RESULTS Of the 12 communication modes assessed, participants reported using a median of eight (range: 5-10). All participants affirmed using speech, facial expressions, and talking on the phone. Frequency and perceived effectiveness ratings for these three modes were endorsed at the "some/most of the time" level for more than 80% of the participants. No-tech mode use was significantly higher than reported high-tech and low-tech modes (p = .004 and p < .0001, respectively). Even so, while some high-tech modes (apps) and some low-tech modes (nonelectronic augmentative and alternative communication) had fewer users, effectiveness ratings were moderate to high for all but one user. CONCLUSIONS Persons with mild-to-moderate language impairment due to PPA report using a range of communication modes with moderate-to-high frequency and perceived effectiveness. These outcomes provide practical information when considering mode refinement or expansion during intervention to maximize communication participation. Barriers to modality use may include low awareness or access, which could be queried by future studies and supported by speech and language interventions. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21614262.
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Affiliation(s)
| | - Megan Bravo
- Oregon Health & Science University, Portland
| | - Angela Roberts
- School of Communication Sciences and Disorders and Department of Computer Science, Western University, London, Ontario, Canada
| | - Elizabeth Salley
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Erin Blaze
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marissa Esparza
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Becky Khayum
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leela Rao
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alfred Rademaker
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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