Review of AAC interventions in persons with dementia

© 2019 Royal College of Speech and Language Therapists 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

The narrative self, distributed memory, and evocative objects

In this article, I outline various ways in which artifacts are interwoven with autobiographical memory systems and conceptualize what this implies for the self. I first sketch the narrative approach to the self, arguing that who we are as persons is essentially our (unfolding) life story, which, in turn, determines our present beliefs and desires, but also directs our future goals and actions. I then argue that our autobiographical memory is partly anchored in our embodied interactions with an ecology of artifacts in our environment. Lifelogs, photos, videos, journals, diaries, souvenirs, jewelry, books, works of art, and many other meaningful objects trigger and sometimes constitute emotionally-laden autobiographical memories. Autobiographical memory is thus distributed across embodied agents and various environmental structures. To defend this claim, I draw on and integrate distributed cognition theory and empirical research in human-technology interaction. Based on this, I conclude that the self is neither defined by psychological states realized by the brain nor by biological states realized by the organism, but should be seen as a distributed and relational construct

Supporting stimulation needs in dementia care through wall-sized displays

Beside reminiscing, the increasing cognitive decline in dementia can also be addressed through sensory stimulation allowing the immediate, nonverbal engagement with the world through one’s senses. Much HCI work has prioritized cognitive stimulation for reminiscing or personhood often on small screens, while less research has explored sensory stimulation like the one enabled by large displays. We describe a year-long deployment in a residential care home of a wall-sized display, and explored its domestication through 24 contextual interviews. Findings indicate strong engagement and attachment to the display which has inspired four psychosocial interventions using online generic content. We discuss the value of these findings for personhood through residents’ exercise of choices, the tension between generic/personal content and its public/private use, the importance of participatory research approach to domestication, and the infrastructure-based prototype, illustrated by the DementiaWall and its generative quality

Neurocognitive mechanisms of real‐world autobiographical memory retrieval: insights from studies using wearable camera technology

In recent years, investigation into the cognitive and neural mechanisms of autobiographical memory has been aided by the use of experimental paradigms incorporating wearable camera technology. By effortlessly capturing first-person images of one's life events, these cameras provide a rich set of naturalistic stimuli that can later be used to trigger the recall of specific episodes. Here, we chronicle the development and progression of such studies in behavioral and neuroimaging examinations of both clinical and nonclinical adult populations. Experiments examining the effects of periodic review of first-person images of life events have documented enhancements of autobiographical memory retrieval. Such benefits are most pronounced in patients with memory impairments, but there is mounting evidence that cognitively healthy individuals may benefit as well. Findings from functional magnetic resonance imaging experiments using wearable camera stimuli as retrieval probes have produced results that, although largely consistent with the broader episodic memory literature, have significantly extended prior findings concerning the underlying mnemonic processes and the neural representation of autobiographical information. Taken together, wearable camera technology provides a unique opportunity for studies of autobiographical memory to more closely approximate real-world conditions, thus offering enhanced ecological validity and opening up new avenues for experimental work

External details revisited – A new taxonomy for coding ‘non-episodic’ content during autobiographical memory retrieval

Autobiographical memory is typically held to comprise episodic and semantic elements, with the vast majority of studies to date focusing on profiles of episodic details in health and disease. In this context, ‘non-episodic’ elements are often considered to reflect semantic processing, or are discounted from analyses entirely. Mounting evidence suggests that rather than reflecting one unitary entity, semantic autobiographical information may contain discrete subcomponents, which vary in their relative degree of semantic or episodic content. The current study aimed to (i) review the existing literature to formally characterise the variability in analysis of ‘non-episodic’ content (i.e., external details) on the Autobiographical Interview and (ii) use these findings to create a theoretically-grounded framework for coding external details. Our review exposed discrepancies in the reporting and interpretation of external details across studies, reinforcing the need for a new, consistent approach. We validated our new external details scoring protocol (the ‘NExt’ taxonomy) in patients with Alzheimer’s disease (n = 18) and semantic dementia (n = 13), and 20 healthy older Control participants, and compared profiles of the NExt subcategories across groups and time periods. Our results revealed increased sensitivity of the NExt taxonomy in discriminating between autobiographical memory profiles of patient groups, when compared to traditionally used internal and external detail metrics. Further, remote and recent autobiographical memories displayed distinct compositions of the NExt detail types. This study is the first to provide a fine-grained and comprehensive taxonomy to parse external details into intuitive subcategories, and to validate this protocol in neurodegenerative disorders