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

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

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

Background: Light verbs are highly frequent and semantically impoverished words. It is currently not known whether light verb production in discourse tasks differs by age or for people with dementia of the Alzheimer's type (DAT). Aims: The purpose of the current study was two-fold: (1) to determine whether there is a relationship between age and the proportion of light verbs produce during a narrative discourse task; and (2) to determine whether people with DAT produce a different proportion of light verbs compared with neurotypical adults. Methods & Procedures: A total of 469 neurotypical adults and 12 participants with DAT produced narratives from a wordless picture book. Outcome & Results: The results indicated that light verb production increases as a function of age, even when controlling for education, and people with DAT produced a higher light verb--word ratio compared with neurotypical adults when matched for age and education. Conclusion & Implication: Light verb use may increase as a function of age due to declines in retrieval ability. These declines are not only more pronounced in people with DAT, but also semantic knowledge deficits may contribute to a reliance on light verbs. What this paper adds: Light verbs are typically some of the first verbs learned due to their simple semantic construction and high frequency. However, two things are unknown: (1) how light verbs changed across the adult lifespan; and (2) whether cognitive impairment changes light verb production. The study found that light verb production increases as a function of age, and that people with DAT used a higher ratio of light verbs to words in a narrative task compared with neurotypical adults. However, despite the findings, more research is needed to determine their clinical utility. Future research may wish to investigate whether light verbs (1) facilitate comprehension in older adults or (2) may be used in cognitive-linguistic assessments for cognitive impairments.

Background: Cognitive–communication difficulties are often associated with dementia and can impact a person's ability to participate in meaningful conversations. This can create challenges to families, reflecting the reality that people living with dementia rarely have just one regular conversation partner, but interact with multiple family members. To date, there is limited evidence of the impact of changes in communication patterns in families. A family systems approach, with foundations in psychology, can be used to explore the impact of communication difficulties on multiple different family members, including the person living with dementia and potential coping strategies used by individuals, together with the family as a whole. Methods & Procedures: A systematic review of primary qualitative research was conducted to identify and examine research exploring communication and interaction within families living with dementia. Studies were identified through a comprehensive search of major databases and the full‐text articles were subject to a quality appraisal. We conducted a thematic analysis on the literature identified to consider the role of families in supporting communication for people with dementia. Outcomes & Results: The searches identified 814 possible articles for screening against the eligibility criteria. Nine articles were included in the final review. Three major themes emerged from the analysis of the included studies: (1) 'identities changing' reflected how interactions within the family systems impacted on identities; (2) 'loss' reflected the grief experienced by families due to changes in communication; and (3) 'developing communication strategies' highlighted strategies and approaches that families affected by dementia may use organically to engage in meaningful interactions and maintain connection. Only one study explicitly used a family systems approach to understand how families manage the changes in interaction resulting from dementia. Conclusions & Implications: The findings may usefully inform the clinical practice of speech and language therapists in terms of communication strategies and coping mechanisms that may be advised to facilitate connection in families living with dementia. Further research using a family systems approach to exploring communication in dementia may help to support the implementation of family‐centred practice as recommended in policy. What this paper adds: What is already known on the subject: There is increasing recognition of the impact of dementia on whole families and the need for family‐centred interventions to enhance quality of life. However, much of the research to date that explores communication within families affected by dementia examines interaction between dyads, largely overlooking the roles and skills of other familial communication partners. To the authors' knowledge, there has been no previous review of the literature using a family systems approach, which has the potential to inform clinical practice of those working in dementia care. What this paper adds to existing knowledge: The review examines and understands what is known about the approaches used by families affected by communication changes resulting from dementia to preserve connection. It collates the evidence from qualitative studies examining approaches and strategies used by individual conversation partners, including people with dementia, as well as the family system as a whole, to facilitate meaningful interactions, and proposes recommendations for clinicians working in this field. Furthermore, we consider the potential benefits of using a family systems approach to understand the context of people living with dementia and how this could enhance communication, personhood and well‐being. What are the potential or actual clinical implications of this work?: This review highlights practical conversation strategies and interactional approaches that may serve to enhance communication and preserve relationships between people with dementia and their family members. Such techniques have the potential to be advised by Speech and Language Therapists working in dementia care as part of tailored, relationship‐centred care and support that they provide. [ABSTRACT FROM AUTHOR]

Background Aim Methods & Procedures Outcomes & Results Conclusions & Implications WHAT THIS PAPER ADDS What is already known on the subject What this paper adds to existing knowledge What are the potential or actual clinical implications of this work? Speech and language therapists (SLTs) play an important role in assessing and rehabilitating communication disorders in people with dementia, but there is evidence to suggest that they do not receive appropriate training to provide management and support during their training.To investigate the level of awareness and knowledge that practising SLTs from Brazil have about dementia and their role in the care of dementia through an online survey.An online survey tool was developed to collect information from practising Brazilian SLTs regarding their knowledge about dementia, awareness about their role in the care of people with dementia, and opinions on how SLTs may be better prepared to work in the dementia field. The survey was disseminated via social media, websites, and e‐mail lists of researchers and stakeholders.A total of 227 SLTs completed the survey. Participants showed good knowledge of dementia in general, while their answers were less accurate on primary progressive aphasia. Regarding the awareness by SLTs of their role in the care of people with dementia, most agreed or strongly agreed that SLTs could help people in the diagnosis, treatment and prevention of dementia (> 80%). However, fewer participants agreed or strongly agreed that they felt confident in contributing to the treatment and diagnosis process of dementia (about 50%). To improve the training of SLTs in Brazil, most participants believed that it would be necessary to improve the teaching of dementia at the undergraduate speech and language therapy curriculum level and to develop recommendations or guidelines about speech and language therapy practice in dementia.The results of this survey point to a need for improvement in the knowledge and confidence of Brazilian SLTs about dementia. To reach this goal, targeted training courses and applied practice opportunities should be embedded within university curricula and training programmes. Many studies confirm the importance of speech and language therapy in the non‐pharmacological treatment of people with dementia. However, other evidence suggests to a possible lack of training for Brazilian SLTs, especially in the curriculum of undergraduate courses. This study reveals that Brazilian SLTs have substantial knowledge of dementia and recognize the significance of their role in treating people with dementia. However, a minority expressed confidence in their ability to assess and treat people with dementia. The findings of this research demonstrate that Brazilian SLTs have good knowledge of dementia and endorse their professional role in dementia care; however, they lack confidence in their own skills and expertise in diagnostic assessment and treatment of dementia. Interventions aimed at boosting the SLT's confidence level could lead to improved patients outcomes and overall quality of care within clinical settings. [ABSTRACT FROM AUTHOR]

Background: Dementia is a cognitive decline that leads to the progressive deterioration of an individual's ability to perform daily activities independently. As a result, a considerable amount of time and resources are spent on caretaking. Early detection of dementia can significantly reduce the effort and resources needed for caretaking. Aims: This research proposes an approach for assessing cognitive decline by analysing speech data, specifically focusing on speech relevance as a crucial indicator for memory recall. Methods & Procedures: This is a cross‐sectional, online, self‐administered. The proposed method used deep learning architecture based on transformers, with BERT (Bidirectional Encoder Representations from Transformers) and Sentence‐Transformer to derive encoded representations of speech transcripts. These representations provide contextually descriptive information that is used to analyse the relevance of sentences in their respective contexts. The encoded information is then compared using cosine similarity metrics to measure the relevance of uttered sequences of sentences. The study uses the Pitt Corpus Dementia dataset for experimentation, which consists of speech data from individuals with and without dementia. The accuracy of the proposed multi‐QA‐MPNet (Multi‐Query Maximum Inner Product Search Pretraining) model is compared with other pretrained transformer models of Sentence‐Transformer. Outcomes & Results: The results show that the proposed approach outperforms the other models in capturing context level information, particularly semantic memory. Additionally, the study explores the suitability of different similarity measures to evaluate the relevance of uttered sequences of sentences. The experimentation reveals that cosine similarity is the most appropriate measure for this task. Conclusions & Implications: This finding has significant implications for the early warning signs of dementia, as it suggests that cosine similarity metrics can effectively capture the semantic relevance of spoken language. The persistent cognitive decline over time acts as one of the indicators for prevalence of dementia. Additionally early dementia could be recognised by analysis on other modalities like speech and brain images. WHAT THIS PAPER ADDS: What is already known on this subject: It is already known that speech‐ and language‐based detection methods can be useful for dementia diagnosis, as language difficulties are often early signs of the disease. Additionally, deep learning algorithms have shown promise in detecting and diagnosing dementia through analysing large datasets, particularly in speech‐ and language‐based detection methods. However, further research is needed to validate the performance of these algorithms on larger and more diverse datasets and to address potential biases and limitations. What this paper adds to existing knowledge: This study presents a unique and effective approach for cognitive decline assessment through analysing speech data. The study provides valuable insights into the importance of context and semantic memory in accurately detecting the potential in dementia and demonstrates the applicability of deep learning models for this purpose. The findings of this study have important clinical implications and can inform future research and development in the field of dementia detection and care. What are the potential or actual clinical implications of this work?: The proposed approach for cognitive decline assessment using speech data and deep learning models has significant clinical implications. It has the potential to improve the accuracy and efficiency of dementia diagnosis, leading to earlier detection and more effective treatments, which can improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background Aims Methods Main Contribution Conclusions What this paper adds What is already known on this subject What this paper adds to existing knowledge What are the potential or actual clinical implications of this work? Primary progressive aphasia (PPA) is a neurodegenerative condition characterised by a prominent and progressive deterioration in language abilities, which significantly impacts quality of life and interpersonal relationships. Speech and language therapy plays a crucial role in offering interventions. Group intervention is one mode of delivery that could benefit communication functioning and overall wellbeing of people with PPA (pwPPA) and their care partners. Group interventions are also more efficient than one‐to‐one intervention and may facilitate peer support.The aim of this review was to systematically evaluate the current evidence for the effectiveness of speech and language therapy groups for pwPPA and their care partners. Specifically, this paper considered three questions: 1.What evidence‐based speech and language therapy groups for pwPPA and their care partners have been reported to date? 2.Are group communication interventions effective in improving quality of life and communication function for pwPPA and their care partners? 3.Are group communication interventions that are designed for people with communication difficulties of other aetiologies (such as stroke) effective for pwPPA? In addition, this review aimed to describe the structure and content of groups, including aims, disciplines involved, size and frequency of group meetings, and outcome measures.MEDLINE, CINAHL and PsycINFO were used to retrieve articles of interest. A total of 10 studies published between 2009 and 2022 met the eligibility criteria and therefore were included in this study. Data were extracted from the articles regarding the structure and content of groups.Although evidence is currently limited, results suggest that speech and language therapy group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well‐being. The importance of multidisciplinary input and care partners’ involvement in groups was highlighted, along with the benefits of creative non‐verbal activities as tools for self‐expression. There is also initial evidence that telehealth group provision and one‐off group sessions may be feasible and can benefit psychosocial well‐being. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses.The literature on speech and language therapy group interventions for PPA shows promise of positive effects on communication function and psychosocial well‐being of both pwPPA and their care partners. Speech and language therapists can consider these published interventions when designing and implementing similar groups, but more robust evidence is required to confirm the relative effectiveness of this approach. Speech pathology led group intervention shows some promise in benefitting communication functioning and overall well‐being of pwPPA and their carers, but there has been no systematic evaluation of all the evidence regarding the efficacy of speech and language therapy led groups. Establishing feasibility, acceptability and efficacy of speech and language therapy group interventions for pwPPA and their carers may present a valuable addition for managing this progressive language disability. Although evidence is currently limited, results from this systematic review suggest that speech and language therapy led group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well‐being for pwPPA and their carers. The importance of multidisciplinary input and carers’ involvement in groups was highlighted, along with the benefits of creative non‐verbal activities as tools for self‐expression. There is also initial evidence that telehealth group provision for carers may be feasible and can benefit psychosocial wellbeing. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. A synthesis of the evidence base for speech and language therapy led PPA groups, as well as a description of the group components and formats, will be valuable for clinical service planning, and will guide future examination of group options for pwPPA and their carers. Speech and language therapists can also consider the research findings from this systematic review when designing and implementing similar groups in their local context. [ABSTRACT FROM AUTHOR]

Background: Eating, drinking and swallowing (EDS) difficulties are important to identify early. Awareness of EDS changes starts with those living with dementia or their family carers. However, little is known about early identification from the perspective of people with dementia. Aim: The aim of this study was to understand the experience of EDS by people living with dementia in their own home. Methods: Published evidence pertaining to EDS difficulties in dementia was used to inform an online semi‐structured interview guide. Four people living with dementia and a third‐sector Empowerment Lead were invited to become co‐researchers. People living with dementia and their carers were invited to be interviewed. We enquired about their past and present experiences, and future expected changes in EDS, information needs, opinions on early problem identification, and lifestyle modifications following onset of EDS difficulty. Narrative concepts of heroes and villains in their 'stories' were identified. Responses were subjected to framework analysis informed by narrative enquiry. Results: Seven people living with dementia and five family carers were interviewed. The overarching theme was a 'missed connection' between EDS difficulty and dementia. Where EDS difficulties were identified, 'compensatory changes' and a need for 'access to information' were noted. Conclusions: The connection between potential EDS difficulties and a dementia diagnosis may not be made, even though EDS changes were recognised by people living with dementia and their family carers. This may be explained by behaviours that mask problems or allow individuals to cope or compensate. Reduced awareness may also be due to inadequate access to information and lack of specialist services. If the connection between dementia and EDS difficulty is missed it could further delay access to support services. WHAT THIS PAPER ADDS: What is already known on the subject: The prevalence of dementia is increasing and is expected to affect 9% of the population by 2040. EDS difficulties are common in people living with dementia and predispose to poorer outcomes. Better awareness of EDS changes early in the disease process of dementia or at preclinical stages can identify individuals at risk and allow for intervention prior to advanced EDS difficulties developing. What this paper adds to existing knowledge: This paper reports the perspective of people living with dementia and family carers and provides insights into experiences of EDS and the challenges faced and identifies commonalities. The connection between potential EDS difficulties and dementia is missed despite various changes reported by both people living with dementia and their family carers, who tend to make compensatory lifestyle changes without support. What are the potential or actual clinical implications of this work?: Lack of awareness of the connection between potential EDS difficulties and dementia may arise due to inadequate access to information to support people living with dementia and their family carers. Access to such information is needed and the quality assurance of information from reputable sources is important to people living with dementia. There is a need for greater service user awareness of signs of EDS difficulty and how to access specialist services. [ABSTRACT FROM AUTHOR]

Background and Objectives: In Italy, approximately 650 individuals receive a diagnosis of primary progressive aphasia (PPA) every year. Unfortunately, the frequency with which patients are referred to speech‐language services is suboptimal, likely due to skepticism regarding the value of speech‐language therapy in the context of neurodegeneration. Materials and Methods: We conducted a virtual survey of speech and language therapists (SLTs) across Italy, to collect information about the assessment, intervention and management of patients with PPA. To ensure that as many SLTs as possible received the survey, the Italian Federation of SLTs (Federazione Logopedisti Italiani, FLI) aided in disseminating the survey. Results: In total, 336 respondents participated in the online survey, 140 of whom had previous experience with PPA patients. Respondents indicated having seen a total of 428 PPA patients in the previous 24 months (three patients on average, range: 0–40). SLTs who reported never working with PPA identified underdiagnoses, low referral rates and the rarity of the clinical syndrome as major reasons for their lack of experience with PPA. SLTs with experience working with PPA indicated that patients may not have accessed services because of service dysfunction and geographical barriers. Respondents reported using informal interviews during assessments and tests developed for post‐stroke aphasia, while impairment‐based/restitutive interventions were utilised most often. Conclusion: Findings may serve to inform health policy organisations regarding the current shortcomings and needed recommendations for improving the care of individuals with PPA in Italy. Improving awareness of the utility of rehabilitation among SLTs and other clinical service providers may serve to facilitate access to intervention, which in turn will serve to better support individuals living with PPA. What This Paper Adds: What is already known on the subject: Speech and language therapists (SLTs) play a crucial role in the assessment, diagnosis and treatment of people with primary progressive aphasia (PPA). However, the frequency with which individuals with PPA are referred for speech and language services is suboptimal due to skepticism regarding the value of speech and language therapy in the context of neurodegeneration, the scarcity of SLTs with expertise in the treatment of PPA and the lack of awareness of the SLT role amongst referrers. What this paper adds to existing knowledge: In recognition of the lack of published information on the provision of speech and language therapy services and clinicians' approaches to the assessment and treatment of individuals with PPA in Italy, we conducted an online survey to evaluate the current referral patterns for speech and language therapy services and to examine the current barriers to access these services for individuals with PPA in Italy. What are the potential or actual clinical implications of this work?: The data presented here support that SLTs view treatment as useful for individuals with PPA and other professional figures and may serve to improve access to intervention, which in turn will serve to better support individuals living with PPA. The results highlight the need to inform health policy organisations about current gaps and aid in developing recommendations for improving the care of individuals with PPA, in order to understand how SLTs can best support individuals with PPA and their families. [ABSTRACT FROM AUTHOR]

Background: Age is a key factor when dealing with language and speech disorders, as it entails a progressive loss of neuroplasticity even in healthy individuals. Apart from this, ageing also affects our word‐retrieval abilities, and thus, our discursive skills, particularly in people suffering from neurodegenerative diseases. Therefore, descriptions and/or measures of communicative performance always need to be interpreted through the lens of variation across the lifespan. Aim: This paper's main objective is to create a general tutorial for researchers willing to start delving into discourse analysis, both in healthy and pathological ageing. Methods: An eight‐step tutorial on discourse analysis in the elderly is presented. Each of these steps starts with general recommendations and progresses to more specific topics that may be relevant when conducting this type of research. All of the steps have been extrapolated from an extensive literature review on discourse analysis. Main Contributions: This work presents an easy‐to‐follow, step‐by‐step tutorial on discourse analysis in the elderly. It is aimed at clinical researchers who are taking their first steps in discourse analysis.It may also be useful for those who are already familiar with the methodology but may be interested in reading a general overview on the topic. Moreover, it offers new insights into the following topics: types of research questions, advantages and disadvantages of the different research methodologies and ethical considerations for data production in clinical linguistics. Conclusions: Discourse analysis in the elderly is a highly complex issue that may require researching from different approaches and disciplines. This implies following a well‐planned and thorough process, which we have detailed through the following eight steps: (i) reviewing literature; (ii) formulating the research question; (iii) designing the study; (iv) producing data; (v) selecting technological tools for data treatment; (vi) transcribing the corpus; (vii) annotating the corpus and (viii) analysing and interpreting the results. What This Paper Adds: What is already known on the subject: Approaches in discourse analysis in elderly adults, and particularly, in people suffering from dementia have already been analysed by previous researchers and categorised into three main trends: the quantitative‐experimental approach, the qualitative‐naturalistic approach and an in‐between path, the quantitative‐naturalistic approach. Also, several handbooks on general discourse analysis have presented comprehensive revisions on potential resources and methodologies that can be applied to researching discourse in elderly populations. What this paper adds to existing knowledge: This paper takes these three main approaches and analyses how the most recent research on language in ageing and dementia fits into them. Furthermore, it reviews the advantages and disadvantages each of them may bring for beginners in the field of discourse analysis. Moreover, it adds some studies that may fit into a fourth approach: the qualitative‐experimental. This article also presents information about several of the main steps when analysing data from the pragmatic perspective: the formulation of the research question, data production and the transcription/annotation process. What are the potential or actual clinical implications of this work?: This work has been devised for linguists who may want to read a systematization of the steps for analysing discourse in elderly populations. It may also be of interest to specialists from different fields such as speech therapy, psychology, gerontology or neurology who desire to start applying methods from discourse analysis in their work and aim to have a comprehensive scope of the main research trends within the field of clinical pragmatics. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: In the past few years there has been a growing interest in the employment of verbal productions as digital biomarkers, namely objective, quantifiable behavioural data that can be collected and measured by means of digital devices, allowing for a low‐cost pathology detection, classification and monitoring. Numerous research papers have been published on the automatic detection of subtle verbal alteration, starting from written texts, raw speech recordings and transcripts, and such linguistic analysis has been singled out as a cost‐effective method for diagnosing dementia and other medical conditions common among elderly patients (e.g., cognitive dysfunctions associated with metabolic disorders, dysarthria). Aims: To provide a critical appraisal and synthesis of evidence concerning the application of natural language processing (NLP) techniques for clinical purposes in the geriatric population. In particular, we discuss the state of the art on studying language in healthy and pathological ageing, focusing on the latest research efforts to build non‐intrusive language‐based tools for the early identification of cognitive frailty due to dementia. We also discuss some challenges and open problems raised by this approach. Methods & Procedures: We performed a scoping review to examine emerging evidence about this novel domain. Potentially relevant studies published up to November 2021 were identified from the databases of MEDLINE, Cochrane and Web of Science. We also browsed the proceedings of leading international conferences (e.g., ACL, COLING, Interspeech, LREC) from 2017 to 2021, and checked the reference lists of relevant studies and reviews. Main Contribution: The paper provides an introductory, but complete, overview of the application of NLP techniques for studying language disruption due to dementia. We also suggest that this technique can be fruitfully applied to other medical conditions (e.g., cognitive dysfunctions associated with dysarthria, cerebrovascular disease and mood disorders). Conclusions & Implications: Despite several critical points need to be addressed by the scientific community, a growing body of empirical evidence shows that NLP techniques can represent a promising tool for studying language changes in pathological aging, with a high potential to lead a significant shift in clinical practice. WHAT THIS PAPER ADDS: What is already known on this subject: Speech and languages abilities change due to non‐pathological neurocognitive ageing and neurodegenerative processes. These subtle verbal modifications can be measured through NLP techniques and used as biomarkers for screening/diagnostic purposes in the geriatric population (i.e., digital linguistic biomarkers—DLBs). What this paper adds to existing knowledge: The review shows that DLBs can represent a promising clinical tool, with a high potential to spark a major shift to dementia assessment in the elderly. Some challenges and open problems are also discussed. What are the potential or actual clinical implications of this work?: This methodological review represents a starting point for clinicians approaching the DLB research field for studying language in healthy and pathological ageing. It summarizes the state of the art and future research directions of this novel approach. [ABSTRACT FROM AUTHOR]

Background: Word retrieval skills change across the lifespan. Permanent alterations in the form of decreased accuracy or increased response time can be a consequence of both normal ageing processes or the presence of acquired and neurodegenerative disorders (e.g., aphasia and dementia). Despite the extensive literature exploring the neuroanatomical underpinnings of word retrieval, psycholinguistic, biolinguistic and theoretical explanations, and the vast amount of evidence from primary and secondary language disorders, the best approach to consistently capture these changes is yet to be discovered. Aims: The goal of this paper is to determine which method(s) stand(s) as the most suitable candidate(s) to provide an accurate picture of word retrieval in the oral production of different groups of adult speakers, including cases of healthy ageing, preclinical Alzheimer's disease (AD), mild cognitive impairment (MCI), aphasia and dementia. Methods & Procedures: Using an integrative review of recent peer‐reviewed journal articles, we provide an overview of the different behavioural methods traditionally used to measure oral naming skills in research‐oriented and clinical protocols and discuss their main advantages and limitations. Main Contribution: Most existing studies are based on the results of people with diagnosed language disorders. Despite the growing interest, the reliability of the majority of the tasks to detect subtle changes associated with healthy ageing, MCI and preclinical AD are yet to be demonstrated, and the delicate balance between informativeness and efficiency (especially in terms of administration time and variable control) in experimental protocols is yet to be achieved. In this article we propose the pursuit of an integrative overarching methodology to characterize all naming deficits (from anecdotal to permanent) and all adult populations (from healthy to pathological ageing). Conclusions & Implications: A combination of spontaneous speech data and results from structured tasks stands as the best approach to capture changes in word retrieval skills of adult speakers with and without observable deficits. This review can guide future reflections on the necessary prerequisites of purpose‐oriented, sensitive and reliable protocols for the detection of incipient word retrieval problems, thus contributing to the early diagnosis and the design of personalized multicomponent treatments. WHAT THIS PAPER ADDS: What is already known on this subject: Word retrieval skills change during adulthood as a consequence of the neurological degradation associated with ageing. These changes are more dramatic in the event of acquired and neurodegenerative disorders. Numerous studies based on people with observable language disorders have addressed the multiplicity of factors involved in word retrieval and provided evidence of potential loci of impairment from a neuroanatomical, cognitive and/or (psycho‐)linguistic perspective. What this paper adds to existing knowledge: This study focuses on methodological strategies to assess naming skills and provides a reflection on generally accepted good practices and unresolved challenges to inform task selection, emphasizing the necessity for a combination of methods to best capture the actual problems and needs of people confronting word retrieval difficulties in their daily lives. Task selection, variable control and administration time stand as key concepts to adjust to the requirements of research and clinical contexts. What are the potential or actual clinical implications of this work?: The results of this review can orient future research towards the creation of sensitive, reliable and (ecologically) valid materials for the (early) detection of word retrieval deficits and for the customization of treatment protocols to alleviate or palliate their effects. [ABSTRACT FROM AUTHOR]

Background: Communication difficulties are common in people with dementia, and often present from an early stage. However, direct treatment options for people with dementia that positively influence their daily communication are scarce. Aims: To evaluate the potential impact and feasibility of a personalized logopaedic intervention. Methods & Procedures: A total of 40 community‐dwelling persons with dementia and their caregivers were recruited. Five experienced speech and language therapists (SLTs) delivered the six‐session Com‐mens intervention at home. Com‐mens aims to improve positive communication between people with dementia and their primary caregivers and comprises five elements: interactive history‐taking, dynamic observational assessment, education about the consequences of dementia on communication, development and use of personalized communication tools, use motivational, and person‐centred strategies by the SLT. We conducted a single‐group mixed‐methods pilot study with five measurements: baseline, directly after intervention, and at 3, 6 and 9 months follow‐up. Semi‐structured interviews and questionnaires for Experienced Communication in Dementia, quality of life, psychological well‐being and caregiver burden were conducted. Process evaluation was performed by interviewing participants, drop‐outs, SLTs and other stakeholders. Outcomes & Results: A total of 32 dyads completed the intervention. Repeated measures analyses revealed no significant changes over time. In the interviews, participants reported a positive impact on their feelings, increased communication skills and better coping with the diagnosis. Participants would recommend the intervention to others. Facilitators were timely delivery, personalized content and adequate reimbursement. Barriers were unfamiliarity with Com‐mens among referrers, an overburdened caregiver or disrupted family relationships. Conclusions & Implications: This newly developed logopaedic intervention is feasible and has a perceived positive impact on both people with dementia and their caregivers, which is confirmed by a stable pattern over a period of 1 year. Future comparative studies are needed to test the effectiveness of personalized interventions in this patient population. What this paper adds: What is already known on the subject?: SLTs are experts in the field of communication, but even though communication problems are common between people with dementia and their caregivers, there is a lack of logopaedic guidelines and materials for the direct treatment for this population. Interventions that are available either focus on (professional) caregivers only or aim to enhance cognitive functioning and do not target on joined communication. What this paper adds to the existing knowledge?: A newly developed intervention called Com‐mens can be provided by trained SLTs and takes an average of six 1‐h sessions. The intervention is perceived to be valuable and feasible for people with dementia and their caregivers, by the participants themselves, as well as by healthcare professionals and other stakeholders. What are the potential or actual clinical implications of this work?: Dissemination of this intervention will give SLTs skills, tools and materials to provide meaningful care to home‐dwelling persons with dementia and their caregivers. Also, persons with dementia and their caregivers will receive education and materials that can help them increase their understanding of communication problems, enhance their communication skills and better cope with the communication problems that result from dementia. We consider the Com‐mens intervention to be a valuable addition to the field of speech language therapy and dementia. [ABSTRACT FROM AUTHOR]

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

Background: Core lexicon (CL) analysis is a time efficient and possibly reliable measure that captures discourse production abilities. For people with aphasia, CL scores have demonstrated correlations with aphasia severity, as well as other discourse and linguistic measures. It was also found to be clinician‐friendly and clinically sensitive enough to capture longitudinal changes in aphasia. To our knowledge, CL has never been investigated in individuals with neurologically progressive disease. Aims: As a preliminary investigation, we sought to investigate (1) whether CL scores correlate with dementia severity, (2) whether CL scores correlate with measures of discourse quality, and (3) whether CL scores correlate with other measures of lexical/semantic access. Methods & Procedures: Twelve participants with a cognitive impairment associated with dementia of the Alzheimer's type (DAT) completed several measures of language and cognitive ability, as well as provide a language sample from the wordless picture book, Picnic. Results & Conclusion: Results are informative, as they provide insight into characteristics of CL and provide support for potential use of CL in individuals with neurologically progressive disease. The results indicated that CL scores do correlate with dementia severity and several measures of language ability, indicating they may provide a useful measure of language abilities in DAT, but more research is needed. WHAT THIS PAPER ADDS: What is already known on the subject: Core lexicon (CL) analysis is an assessment measure of discourse ability, most closely related to informativeness or productivity, used in aphasiology that is easier to use and less time consuming than previous measures of informativeness, such as correct information units or type‐token ratio (TTR). For people with aphasia, CL analysis correlates with aphasia severity, measures of informativeness, as well as other measures of discourse quality. It has also been shown to be faster and more reliable between scorers than other informativeness measures. What this study adds: Core lexicon analysis is a new simple and online method for assessing the informativeness of a discourse sample without the need to record or transcribe the language sample. CL is receiving a lot of attention in aphasia, correlating with everything from aphasia severity to measures of productivity and lexical access, as well as measures of informativeness. Unfortunately, no one has investigated CL analysis in dementia. The study demonstrates the first evidence that CL analysis may be a useful measure for determining dementia severity and language quality in people with dementia. What are the clinical implications of this work?: Core lexicon analysis may provide clinicians and researchers with an easy method for assessing the discourse of people with a cognitive impairment associated with dementia of the Alzheimer's type. This will improve initial assessment, as well as improve ongoing language assessment that may provide clues into their functional ability to communicate effectively. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is a progressive neurodegenerative disease. Cognitive functions and communication skills worsen as the disease progresses, thereby reducing patients' independence levels. Therefore, recommending software that can be used at home may be a useful means of slowing down the cognitive and communicative decline in AD. Aims: To develop software that can be used at home to slow down the cognitive and communicative decline and increase independence in individuals with AD; and to examine the effect of this software on the cognitive communication skills of individuals with AD. Methods & Procedures: The study was completed in four stages: the development of the application; the evaluation of the participants and their training for the application; their use of the application at home; and the re‐evaluation of the participants. A total of 32 individuals who met the inclusion criteria were included in the study. These individuals were randomly divided into study and control groups, each consisting of a total of 16 participants, including six in the mild stage, six in the moderate stage, and four in the severe stages. The developed software was loaded on tablets and given to the participants in the study group. The participants in the control group only received their pharmacological treatment, while those in the study group received both their pharmacological treatment and used the developed application. All participants were evaluated with the Mini‐Mental State Examination (MMSE) and Language Assessment Test for Aphasia (LATA) before and after application use. A survey was administered to the caregivers of the participants in the study group after the use of the application. Outcomes & Results: The results revealed a positive change in the cognitive–communication skills of the individuals in the study group, even if they were in the severe stage, according to the LATA and MMSE, as well as the survey. The application led to the greatest improvements in grammar on the LATA and orientation on the MMSE. No rapid cognitive decline was seen in individuals at all stages in the control group. Conclusions & Implications: In this study, software was developed in Turkish that can be used in every stage of AD as part of a holistic cognitive‐communication intervention programme offering alternative and supportive communication for individuals with AD, even those in the severe stage. Results prove the effectiveness of the developed software on the cognitive–communication skills of individuals with AD. What This Paper Adds: What is already known on the subject: There are a few (as far as is known, three) applications developed in English for cognitive–communication disorders due to dementia. What this study adds to the existing literature: In this study, for the first time in Turkish, mobile‐compatible software has been developed for both cognitive and communication disorders that is specific to individuals with AD and can be used by individuals at all stages of the disease. The effects of the application we developed on the cognitive–communication skills of individuals with AD were shown in a randomised controlled trial. What are the potential or actual clinical implications of this work?: Using the app can help people with all stages of AD keep their cognitive and communication skills and have a better prognosis in terms of cognitive–communication skills, especially grammar and orientation. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals without specialist training in communication disorders may not know how to identify and support patients with communication disabilities during mental capacity assessments. To meet this need, a novel communication screening tool was developed and tested as part of a mental capacity assessment support toolkit. Aims: To provide an initial evaluation of the communication screening tool's usability, interrater reliability and criterion validity. Methods & Procedures: A prototype communication screening tool was developed iteratively using co‐production and user‐centred design principles. A mixed‐methods case series design was used to explore how multidisciplinary healthcare professionals used the tool to test patients in acute hospital and intermediate care settings. Usability data were collected in an electronic survey and from a documentary analysis. Screening test outcomes obtained by pairs of professionals were compared to measure the tool's interrater reliability. Outcomes obtained by professionals were compared with the outcomes of a speech and language therapist's communication assessment to measure criterion validity. Quantitative data were analysed using frequency counts and inferential statistics. Qualitative data were analysed using framework analysis. Outcomes & Results: A total of 21 professionals, including physicians, nurses, occupational therapists, physiotherapists, and speech and language therapists, and 17 patients with diagnoses of stroke or cognitive impairment took part. Professionals reported they found the tool easy to use, useful and that its use increased their understanding of communication support methods and the speech and language therapist role in relation to mental capacity assessment. However, not all used it consistently or accurately. Professionals reported they chose not to use the tool when they perceived patients' communication to be intact. Four of eight patients with a diagnosis of dementia or memory impairment, who professionals elected not to screen, were found to have significant communication needs. Screening outcome data for nine patients suggest the tool's interrater reliability is currently moderate, whilst its criterion validity is poor. Conclusions & Implications: This study highlights that non‐speech and language therapist health professionals have difficulty identifying and screening for communication difficulties. This confirms existing evidence that people with communication disabilities may not receive the decision‐making support they require during mental capacity assessments when speech and language therapists are not involved. Greater understanding of health professionals' thought processes regarding communication is required to further develop this unique communication screening tool so that it can effectively enable healthcare professionals to identify and use communicative adaptations to support decision‐making. What this paper addsWhat is already known on this subjectLimited previous research suggests that assessing the mental capacity of people with communication disabilities is complex. Practice needs to be improved to ensure this group is adequately supported to make decisions, in line with legal requirements.What this paper adds to existing knowledgeThis paper describes the development and testing of a novel communication screening tool for use by healthcare professionals preparing to undertake mental capacity assessments. It increases our understanding of how healthcare professionals without specialist training understand communication disability and the role of the speech and language therapist in relation to mental capacity assessment.What are the potential or actual clinical implications of this work?Healthcare professionals without specialist training require support to understand and respond to the needs of people with communication disabilities during mental capacity assessments. With further development and testing, in response to initial evaluation, this novel communication screening tool may be able to provide this support. [ABSTRACT FROM AUTHOR]

Background: Due to dementia‐related communication difficulties, speech–language pathologists (SLPs) play a significant role in supporting individuals with dementia and their caregivers. Nevertheless, SLP practitioners may not have received adequate dementia training during their undergraduate programme and skills updating post‐qualification. Investigating the knowledge, attitudes and training needs of SLP students and practitioners would provide evidence on the need of enhancing training in dementia care and management at both the undergraduate level and through continuous professional development programmes. Aims: To assess the levels of dementia knowledge, attitudes and training needs of SLP students and practitioners. Methods & Procedures: A countrywide survey was conducted with undergraduate students reading for a BSc degree in communication therapy and SLPs currently in practice. Dementia knowledge and attitudes were assessed using the Alzheimer's Disease Knowledge Scale (ADKS) and the Dementia Attitude Scale (DAS). Training needs were measured using a three‐point Likert scale from a list of topics related to dementia management and care. Quantitative methods were used to analyse the collected data. Outcomes & Results: A total of 49 SLP students (94.2% response rate) and 113 practitioners (57.4% response rate) completed the survey. Although SLP practitioners scored significantly better than students on the ADKS and its constructs, both cohorts showed inadequate knowledge of dementia, in particular dementia risk factors. In general, both SLP students and practitioners showed positive attitudes towards individuals with dementia, even though significant differences were observed. With respect to training needs, SLP practitioners significantly scored less compared with students denoting that, in this cohort, there was the belief that less training in dementia was required. Conclusions & Implications: Although SLPs have an important role to play in the management and care of individuals with dementia, the findings of this study indicated a shortage of in‐depth knowledge in this area of practice. This continues to highlight the need of enhancing dementia training programmes through undergraduate curriculum development and continuous professional programmes for skills updating. What this paper addsWhat is already known on the subjectOne of the symptoms of dementia is that affected individuals progressively lose the ability to communicate effectively. With an increase in the number of people with dementia due to global ageing growth, SLPs are more likely to come into contact with such individuals and their caregivers. At present, there is little research on the levels of dementia knowledge, attitudes and training needs among individuals pursuing their career in this profession.What this paper adds to existing knowledgeThis study highlights a dearth of in‐depth knowledge among undergraduate students and practising SLPs in various aspects of dementia management and care and argues on the need of enhancing training in this field of study.What are the potential or actual clinical implications of this work?Improving SLPs' knowledge on dementia can enhance their professional role in several areas, including the provision of information on risk factors, disease progression and its effect on communication abilities, screening of cognitive communication difficulties and developing management plans aimed at maintaining communication abilities at the highest level. [ABSTRACT FROM AUTHOR]

Background: Light verbs are highly frequent and semantically impoverished words. It is currently not known whether light verb production in discourse tasks differs by age or for people with dementia of the Alzheimer's type (DAT). Aims: The purpose of the current study was two‐fold: (1) to determine whether there is a relationship between age and the proportion of light verbs produce during a narrative discourse task; and (2) to determine whether people with DAT produce a different proportion of light verbs compared with neurotypical adults. Methods & Procedures: A total of 469 neurotypical adults and 12 participants with DAT produced narratives from a wordless picture book. Outcome & Results: The results indicated that light verb production increases as a function of age, even when controlling for education, and people with DAT produced a higher light verb–word ratio compared with neurotypical adults when matched for age and education. Conclusion & Implication: Light verb use may increase as a function of age due to declines in retrieval ability. These declines are not only more pronounced in people with DAT, but also semantic knowledge deficits may contribute to a reliance on light verbs. What this paper adds: Light verbs are typically some of the first verbs learned due to their simple semantic construction and high frequency. However, two things are unknown: (1) how light verbs changed across the adult lifespan; and (2) whether cognitive impairment changes light verb production. The study found that light verb production increases as a function of age, and that people with DAT used a higher ratio of light verbs to words in a narrative task compared with neurotypical adults. However, despite the findings, more research is needed to determine their clinical utility. Future research may wish to investigate whether light verbs (1) facilitate comprehension in older adults or (2) may be used in cognitive–linguistic assessments for cognitive impairments. [ABSTRACT FROM AUTHOR]

Background: Picture‐naming tests (PNTs) evaluate linguistic impairment in dementia due to semantic memory impairment, impaired lexical retrieval or perceptual deficits. They also assess the decline in naming impairment at various stages of dementia and mild cognitive impairment (MCI) that occurs due to progressive cognitive impairment. With the increasing numbers of people with dementia globally, it is necessary to have validated naming tests and norms that are culturally and linguistically appropriate. Aims: In this cross‐sectional study we harmonized a set of 30 images applicable to the Indian context across five languages and investigated the picture‐naming performance in patients with MCI and dementia. Methods & Procedures: A multidisciplinary expert group formed by the Indian Council of Medical Research (ICMR) collaborated towards developing and adapting a picture naming test (PNT) known as the ICMR‐PNT in five Indian languages: Hindi, Bengali, Telugu, Kannada and Malayalam. Based on cross‐cultural adaptation guidelines and item‐wise factor analysis and correlations established separately across five languages, the final version of the ICMR‐PNT test was developed. A total of 368 controls, 123 dementia and 128 MCI patients were recruited for the study. Psychometric properties of the adapted version of the ICMR‐PNT were examined, and sensitivity and specificity were examined. Outcomes & Results: The ICMR‐PNT scores in all languages combined were higher in controls compared with patients with dementia and MCI (F2, 615 = 139.85; p < 0.001). Furthermore, PNT scores for MCI was higher in comparison with patients with dementia in all languages combined (p < 0.001). The area under the curve across the five languages ranged from 0.81 to 1.00 for detecting dementia. There was a negative correlation between Clinical Dementia Rating (CDR) and ICMR‐PNT scores and a positive correlation between Addenbrooke's Cognitive Examination—III (ACE‐III) and ICMR‐PNT scores in control and patient groups. Conclusions & Implications: The ICMR‐PNT was developed by following cross‐cultural adaptation guidelines and establishing correlations using item‐wise factor analysis across five languages. This adapted PNT was found to be a reliable tool when assessing naming abilities effectively in mild to moderate dementia in a linguistically diverse context. What this paper adds: What is already known on this subject: Picture‐naming evaluates language impairment linked to naming difficulties due to semantic memory, lexical retrieval or perceptual disturbances. As a result, picture naming tests (PNTs) play an important role in the diagnosis of dementia. In a heterogeneous population such as India, there is a need for a common PNT that can be used across the wide range of languages. What this study adds to existing knowledge: PNTs such as the Boston Naming Test (BNT) were developed for the educated, mostly English‐speaking, Western populations and are not appropriate for use in an Indian context. To overcome this challenge, a PNT was harmonized in five Indian languages (Hindi, Bengali, Telugu, Kannada and Malayalam) and we report the patterns of naming difficulty in patients with MCI and dementia. The ICMR‐PNT demonstrated good diagnostic accuracy when distinguishing patients with mild to moderate dementia from cognitively normal individuals. What are the potential or actual clinical implications of this work?: With the growing number of persons suffering from Alzheimer's disease and other forms of dementia around the world, its critical to have culturally and linguistically relevant naming tests and diagnosis. This validated ICMR‐PNT can be used widely as a clinical tool to diagnose dementia and harmonize research efforts across diverse populations. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well‐being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia‐related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. Aims: To establish the current practices of SLTs managing dementia‐related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. Methods & Procedures: An anonymous, cross‐sectional web‐based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open‐ended questions were analysed using conventional content analysis. Outcomes & Results: A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self‐rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. Conclusions & Implications: The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents' views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well‐being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential. What this paper addsWhat is already known on the subjectResearch indicates that people with dementia develop dysphagia and mealtime difficulties as dementia progresses. SLTs often manage these, but there is no research on the effective assessment and management procedures, or guidance on best practice.What this paper adds to existing knowledgeThis paper provides an understanding of the variation in practice across the UK and ROI. Respondents described barriers to delivering an effective service and frequently linked these to the SLTs' resources as well as service constraints.What are the potential or actual clinical implications of this work?These findings support the need for future research to develop guidelines for SLT practice in this area. They also support the need to examine resource allocation and workforce management to enable SLTs to manage dementia‐related dysphagia and mealtime difficulties effectively. [ABSTRACT FROM AUTHOR]

Background There has been increasing interest in dementia care in recent years, including how practitioners, service providers and society in general can help individuals to live well with the condition. An important aspect to this is provision of advice to ensure conversation partners effectively support the person with dementia in conversation. Aims To provide a descriptive review of the literature examining everyday conversation in dementia in order to inform practice and research. Methods & Procedures This review used a method specifically developed for reviewing conversation analytic and related literature. A range of databases were searched using key words and explicitly described inclusion criteria leading to a final corpus of 50 titles. Using this qualitative methodology, each paper was examined and data extracted. The contribution of each of these is described and the implications for practice and research are outlined. Main Contribution This review examined studies into conversation in Alzheimer's disease, vascular dementia and Lewy body dementia, grouping these into: early influential studies; work drawing on positioning theory; studies using social and linguistic approaches; collaborative storytelling; formulaic language; studies specifically using conversation analysis; and conversation as a target for individualized therapy. In addition, more recent work examining primary progressive aphasia and behavioural variant frontotemporal dementia was explored. Overall, this review indicates that research examining conversation in natural settings provides a rich source of data to explore not just the challenges within conversation for those taking part, but also the skills retained by the person with dementia. An important aspect of this understanding is the notion that these skills relate not only to information exchange but also aspects of social interaction. The role of others in scaffolding the conversation abilities of the person with dementia and the potential of this for developing interventions are discussed. Conclusions & Implications The review indicates that interventions targeting conversation in dementia are often advocated in the literature but currently such approaches remain to be systematically evaluated. In addition, many of the important insights arising from these studies have yet to inform multidisciplinary dementia care practice. [ABSTRACT FROM AUTHOR]

The traditional view of oral reading ability in patients with dementia holds that it is a preserved skill even if there is a general impairment to lexico-semantic processing ability. Recently, this view has been challenged by studies showing that the oral reading ability of patients with dementia can deteriorate over the course of the disease. These studies have found that the oral reading of irregular English words is more prone to error than the oral reading of regular words by patients with dementia suggesting that the oral reading of irregular words depends upon support from semantic memory. Relatively little is known about the oral reading abilities of Chinese-speaking dementia patients. This paper reports on the results of a study of the language processing and the oral reading ability of Chinese speakers with probable dementia of the Alzheimer's type (DAT). DAT patients displayed impairment on tests of oral reading as well as impairment on tests of semantic memory, confrontation naming and word comprehension. The results also show significant effects of regularity, frequency and imageability on the oral reading of DAT patients. It is argued that Chinesespeaking DAT patients display a pattern of language impairment similar to their English-speaking counterparts and, moreover, that normal oral reading of Chinese characters may depend critically upon the integrity of semantic memory. [ABSTRACT FROM AUTHOR]

Background: Communication is an important priority in dementia research. Communication strategies and scaffolds, specifically through augmentative and alternative communication (AAC), offer vital compensatory support for persons with dementia in an attempt to maintain the latter's quality of life and well‐being through participation with others. To date, no research review has been published that synthesizes the current research of AAC in the field of dementia. Aims: To provide an overview of current AAC strategies and techniques used for supporting communication in dementia by surveying the literature base in a systematic manner, synthesizing the findings and highlighting trends and gaps. Methods & Procedures: A multifaceted search strategy included nine electronic database searches, using specific keywords. Application of predefined selection criteria during screening procedures led to the inclusion of 39 studies. Data were extracted and studies synthesized according to communication partners; description of AAC strategies and techniques; outcome measures; and communication outcomes. Main Contribution: This review shows that the majority of the research to date has focused on supporting the interactions of persons with dementia of the Alzheimer's type (DAT) using non‐electronic memory and communication aids. Future research should focus on social participation and person‐centred communication to optimize functional communication with AAC. Training programmes targeting dyadic interaction and supporting persons with dementia from diverse ethnic backgrounds are avenues for further research. Conclusions: Research trends and, more importantly, the gaps highlighted in this research review present speech–language therapists and researchers with a set of current priorities that are necessary for the advancement of the knowledge base. [ABSTRACT FROM AUTHOR]

Background: Cognitive communication difficulties are a characteristic feature of dementia. These deficits have negative effects on all aspects of daily life. Yet, there are few options for standardized assessment of cognitive communication skills in people with dementia. Aims: To review published cognitive–communication assessments to determine what psychometrically sound assessments exist that are applicable to all people with dementia. Methods & Procedures: A scoping review of the literature was conducted using an established scoping review model. Cognitive–communication assessments validated in English with people with dementia were sought. A comprehensive search of eight relevant electronic databases was undertaken. Two reviewers independently analysed and assessed the psychometric quality of instruments that met inclusion criteria. Outcomes & Results: Four cognitive–communication assessments were included in the review. Although psychometrically sound, none was suitable for administration at all stages of dementia. Only one was validated for different dementia types. None included subtests for evaluation of conversation ability, and none involved the evaluation of communication partners' communication. Conclusions & Implications: There are limited options for standardized communication assessment for individuals with dementia and their communication partners. Directions for the development of new measures are provided to facilitate research and improve clinical practice. [ABSTRACT FROM AUTHOR]

Background: Communication partner training (CPT) programmes for health and care staff working with people with the neurologically based communication disorders associated with stroke, traumatic brain injury (TBI) and dementia are efficacious in improving communication. However, current programmes are lengthy and disorder specific, and therefore may not be suitable as staff training tools in environments with people with multiple communication disorders, and services with a variety of neurological populations. Aims: To identify common and distinct components of CPT programmes for stroke, TBI and dementia in order to determine whether there are common delivery methods and content that can be consolidated to improve implementation of CPT in health and care services. Methods & Procedures: A qualitative enquiry was used. Four CPT programmes targeting three disorders were identified from systematic reviews and literature searches. Programme data were recorded onto data sheets from manuals, study articles and supplementary materials, and were categorized using the Intervention Taxonomy (ITAX). Content analysis and elements of constant comparative analysis were employed to analyse the CPT programmes. Outcomes & Results: Delivery characteristics were similar across all four programmes. All were delivered face to face in either group or individual contexts. However, duration varied from 1 to 35 h. Six of the 12 categories of information provided were common across all programmes, including 'strategy' 'background to disorder', 'information about communication', 'information about program', 'negative behaviours to avoid' and 'purpose of program'. Programmes differed in the types of skill‐building techniques used, with the most common being videos (3/4 programmes), discussions (2/4 programmes) and trainer demonstrations (2/4 programmes). While strategies provided to trained partners targeted similar domains of communication, only 3/96 individual strategies were common to all programmes. Conclusions & Implications: There are both common and distinct components in content and delivery methods across CPT programmes. Further research is needed to evaluate the distinct components of the programmes, to determine which individual strategies are efficacious, and which approach to skill‐building techniques is most effective. The present study has contributed a comprehensive list of programme components, which can form a basis for describing and refining CPT programmes in future. [ABSTRACT FROM AUTHOR]

Abstract: Background: People with dementia and family carers often experience difficulties communicating together. These difficulties are considered to contribute significantly to the depression, anxiety and negative feelings such as guilt often reported by dementia family carers. Aims: To develop and contribute to the theory and evidence base for single‐component, psychosocial interventions that address these difficulties by evaluating the effectiveness of the Talking Sense programme which was designed to reflect existing best evidence. Methods & Procedures: Talking Sense was delivered as an individualized, one to one, cognitive behavioural approach for developing knowledge, skills, thinking and behaviour of dementia family carers in managing communication difficulties. In this study, a randomized controlled trial compared 27 carers who completed three one‐to‐one individualized sessions using Talking Sense with 25 carers who received a single, knowledge‐only, control discussion. Outcomes & Results: There were no significant differences for the primary outcome measure of carer anxiety and depression as well as carer quality of life and general self‐efficacy. Statistically significant results suggested carers receiving the Talking Sense intervention had fewer communication difficulties happening (p = 0.046) and felt more valued by their relatives (p = 0.046). A score close to significance (p = 0.052) suggested they perceived their relatives to be more communicatively competent. Conclusions & Implications: The intervention and research design were shown to be effective with low attrition and high adherence to treatment. A non‐significant finding for the primary outcome measure does not support the potential for this intervention to effect carer anxiety and depression. The potential for perceived change in the person with dementia, with statistically fewer communication difficulties happening and the carer feeling more valued by their relative, was the most significant finding from this programme of research. Recommendations for further research are made. [ABSTRACT FROM AUTHOR]

Abstract: Background: Language and memory impairments affect everyday interactions between individuals with dementia and their communication partners. Impaired topic management, which compromises individuals’ construction of relevant, meaningful discourse, is commonly reported amongst individuals with dementia. Currently, limited empirical evidence describes the sequential patterns of behaviour comprising topic‐management practices in everyday conversation between individuals with dementia and their communication partners. Aims: To describe the sequential patterns of behaviour relating to the manifestation of topic‐management impairments and facilitative behaviours in everyday interactions between individuals with dementia and their familiar communication partners (FCPs). Methods & Procedures: Three 20‐min conversations between individuals with moderate to severe dementia and their FCPs were recorded. Conversation Analysis was used to examine sequences in which topic‐management appeared to be impaired. Outcomes & Results: Conversational behaviours that reflected a difficulty in contributing on‐topic talk were pervasive in the talk of the three individuals with dementia. FCPs responded to these conversational difficulties by using two categories of facilitative behaviours. The first involved responding to an individual with dementia's explicit repair‐initiation by performing repair. In the second category, explicit repair‐initiation was absent; instead, the distance of the conversational difficulty from the prior topic‐shifting turn mediated the form and outcome of the FCPs’ facilitative behaviours. Each category successfully facilitated the individual with dementia to contribute on‐topic talk. Conclusions & Implications: The findings contribute to a growing understanding of topic‐management abilities in everyday interactions involving individuals with dementia. Individuals with dementia took a proactive role in eliciting topic‐management support. The FCPs responded with turns that facilitated the individuals with dementia to talk on‐topic. Clinically, the results support and extend the current topic‐management recommendations available in communication partner training programmes, and promote conversations which attend to the personhood of the individual with dementia. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although primary progressive aphasia (PPA) is characterized by progressive loss of language and communication skills, knowledge about the earliest emerging signs announcing the onset of this condition is limited. Aims: To explore spousal recollections regarding the earliest signs of PPA and to compare the nature of the earliest perceived symptoms across the three PPA variants. Methods & Procedures: In‐depth interviews focusing on the earliest signs of illness onset were conducted with 13 spouses whose partners were diagnosed with PPA. The earliest recollections and observations described by the spouses were analyzed and coded according to the DSM‐5 criteria for a mild neurocognitive disorder. These data were then compared across and within each of the three PPA variants. Outcomes & Results: Spousal retrospective accounts indicated the three PPA variants (semantic, logopenic and non‐fluent) had a signature profile announcing illness onset. Changes in social cognition presented in all three variants of PPA, but at different points in the illness trajectory. In particular, the findings suggest the possibility that PPA initially presents as subtle changes in social cognition for semantic variant PPA (svPPA) and logopenic variant PPA (IvPPA) rather than overt language impairments as defined in the current diagnostic criteria. Conclusions & Implications: : Understanding the nature of symptoms perceived in the earliest stages of PPA has potential to inform earlier and accurate diagnosis and interventions to assist those living with the illness. [ABSTRACT FROM AUTHOR]

Background Difficulty participating in conversation is commonly experienced by individuals with dementia, secondary to cognitive and language deficits. Frequent communication partners (FCPs), however, report being largely unaware of how to support their conversation partners with dementia during conversation. In particular, taking a turn appropriately may be difficult for either partner due to trouble predicting a partner's behaviour and, hence, difficulty with timing conversational turns appropriately, potentially resulting in overlapping talk. Aims To investigate the patterns of overlapping talk in the interaction between individuals with dementia and their FCPs. Methods & Procedures Three participants with moderate-severe dementia participated in conversation with an FCP. Ten minutes of 'casual' and 'task-oriented' conversation were audio- and video-recorded. Patterns of overlapping talk were investigated using conversation analytic methods. Outcomes & Results Overlapping talk was a consistent feature of all three dyadic interactions during both social and task-oriented talk. All participants exhibited competitive and non-competitive forms of overlapping talk. The data reveal that FCPs commonly yielded their own turns when overlapped by a partner in order to create opportunities for their partners with dementia to communicate. Participants with dementia demonstrated some retained pragmatic abilities, both using continuers and yielding the floor to their partner when competitively overlapped in order to encourage a speaker to continue. Conclusions & Implications These findings contribute to the understanding of the impact of dementia on the maintenance of sensitivity to the sequential aspects of everyday talk. From a clinical perspective, these findings can inform the training of FCPs about retained abilities and evidence-based support strategies, equipping them with knowledge and skills to structure and maintain fluent conversation. [ABSTRACT FROM AUTHOR]

Background Commissioners and providers require information relating to the number of people requiring a service in order to ensure provision is appropriate and equitable for the population they serve. There is little epidemiological evidence available regarding the prevalence of people who could benefit from augmentative and alternative communication (AAC) in the UK. Aim To determine the prevalence of people who could benefit from AAC in the UK. Methods & Procedures An epidemiological approach was taken to create a new estimate of need: the prevalence of the main medical conditions and specific symptoms leading to the requirement for AAC were identified from the literature and AAC specialists were consulted to estimate the number of people who may require AAC. Outcomes & Results A total of 97.8% of the total number of people who could benefit from AAC have nine medical conditions: dementia, Parkinson's disease, autism, learning disability, stroke, cerebral palsy, head injury, multiple sclerosis and motor neurone disease. The total expectation is that 536 people per 100 000 of the UK population (approximately 0.5%) could benefit from AAC. Conclusions & Implications To provide accurate figures on the potential need for and use of AAC, data need to be consistently and accurately recorded and regularly reviewed at a community level. The existing data suggest an urgent need for more accurate and up to date information to be captured about the need for AAC in the UK to provide better services and ensure access to AAC strategies, equipment and support. [ABSTRACT FROM AUTHOR]

Background: Global coherence is a metric of expressive language performance that represents the speaker's ability to initiate, plan and maintain a topic of discussion. Studies indicate that disruptions of global coherence can occur during the ageing process and following neurological disease or injury. However, little is known about the specific impact that the ageing process, disease or injury has on global coherence during discourse production. Aims: To review the literature on global coherence in adult populations and assess the impact that age, disease or injury has on global coherence during expressive language tasks. Methods & Procedures:We completed an in-depth search of Medline and PyschInfo (1990-2014) to identify studies of global coherence in adult populations. We identified studies that included a comparison group and utilized a measure of global coherence during expressive language production among adults. Outcomes & Results: Twenty studies comprised of 692 study participants who met inclusion criteria were identified for the review of the literature. Studies included participants without neurological impairments and individuals with aphasia, traumatic brain injury, dementia, generalizedmemory impairment and other neurological conditions. Study results indicated global coherence is an expressive language skill that is influenced by the ageing process and neurological disease or injury. Conclusions & Implications: Although evidence indicated that global coherence is negatively influenced by ageing and neurological disease/injury, the heterogeneity of study populations, measurement tools and study designs were limiting factors in determining the exact nature by which these factors impact the skill of global coherence. [ABSTRACT FROM AUTHOR]

Focuses on Speech and Language Therapy (SLT) services for people with dementia in Great Britain. Opportunities provided by the National Service Framework (NSF) for the profession to address the variability and quality in SLT service provision; Elimination of age discrimination; Provision of person-centered care; Promotion of older people's health and independence.