"I felt like I had been put on the shelf and forgotten about" - lasting lessons about the impact of COVID-19 on people affected by rarer dementias.

BACKGROUND: The public health measures imposed in many countries to contain the spread of COVID-19 resulted in significant suspensions in the provision of support and care for people with dementia. The negative effects of these measures have been extensively reported. However, little is known about the specific impact on people with young onset, non-memory-led and inherited dementias. This group may have experienced different challenges compared to those with late onset dementia given their non-memory phenotypes and younger age. We explored the impact of the first COVID-19 lockdown on people living with familial Alzheimer's disease, behavioural variant frontotemporal dementia, familial frontotemporal dementia, dementia with Lewy bodies, posterior cortical atrophy and primary progressive aphasia and their carers in the UK and their self-reported strategies for coping. METHODS: This was a mixed methods study. An online survey was administered to people with dementia and family carers recruited via Rare Dementia Support. Free-text responses were analysed using framework analysis to identify key issues and themes. RESULTS: 184 carers and 24 people with dementia completed the survey. Overall, people with dementia experienced worsening of cognitive symptoms (70%), ability to do things (62%), well-being (57%) and changes to medication (26%) during lockdown. Carers reported a reduction in the support they received (55%) which impacted their own mental health negatively. Qualitative analysis of free-text responses shed light on how the disruption to routines, changes to roles and responsibilities, and widespread disconnection from friends, family and health and social care support varied according to phenotype. These impacts were exacerbated by a more general sense that precious time was being lost, given the progressive nature of dementia. Despite significant challenges, respondents demonstrated resilience and resourcefulness in reporting unexpected positives and strategies for adapting to confinement. CONCLUSIONS: This study has highlighted the specific impacts of the COVID-19 restrictions on people with young onset, non-memory-led and inherited dementias, including behavioural variant frontotemporal dementia, primary progressive aphasia and posterior cortical atrophy, and their carers. The specific challenges faced according to diagnosis and the self-reported strategies speak to the importance of - and may inform the development of - tailored support for these underrepresented groups more generally.

Adult-onset hearing loss and incident cognitive impairment and dementia - A systematic review and meta-analysis of cohort studies.

BACKGROUND: We comprehensively summarized the cohort evidence to date on adult-onset hearing loss as risk factor for incident cognitive impairment and dementia, and examined the evidence for dose-response, risk for various dementia subtypes, and other moderators. Previous meta-analyses were less comprehensive. METHODS: We included cohort studies with participants without dementia and with hearing assessments at baseline, minimum 2 years follow-up and incident cognitive outcomes. We used random-effect models and subgroup and meta-regression on moderator analyses. RESULTS: We identified fifty studies (N=1,548,754). Hearing loss (yes/no) was associated with incident dementia risk (HR=1.35 [95% CI = 1.26 - 1.45), mild cognitive impairment (MCI HR=1.29 [95% CI = 1.11 - 1.50]), cognitive decline not specified as MCI or dementia (HR=1.29 [95% CI = 1.17 - 1.42]), and Alzheimer's disease dementia (ADD, HR=1.56 [95% CI = 1.30 - 1.87]), but not with vascular dementia (HR, 1.30 [95% CI = 0.83 - 2.05]). Each 10-decibel worsening of hearing was associated with a 16% increase in dementia risk (95% CI = 1.07 - 1.27). The effect of hearing loss did not vary across potential moderators. CONCLUSIONS: Cohort studies consistently support that adult-onset hearing loss increases the risk of incident cognitive decline, dementia, MCI, and ADD.

Is Virtual Cognitive Stimulation Therapy the Future for People with Dementia? An Audit of UK NHS Memory Clinics During the COVID-19 Pandemic.

Access to psychosocial interventions for people with dementia, such as Cognitive Stimulation Therapy (CST), has been restricted during the COVID-19 pandemic. Some services have shifted to provision via videoconferencing, but the prevalence of this is unknown. This audit aimed to understand provision of virtual CST (vCST) within National Health Service (NHS) memory clinics throughout the UK and Channel Islands and investigate plans for ongoing CST provision. A cross-sectional survey was circulated to NHS memory clinics, which included closed and open-ended questions to generate quantitative and qualitative data. Thirty-three memory clinics responded to the survey. During the pandemic, 55% of respondents offered vCST, whereas 45% offered no CST. Of those offering vCST, 80% plan to continue with a hybrid model of separate face-to-face and vCST groups, whilst 20% intend to deliver face-to-face CST only. Reported positive aspects of vCST were participant and staff enjoyment, perceived improved digital confidence in participants, and improved accessibility for those who cannot attend face-to-face groups. Negative aspects related to digital poverty, limited digital literacy, support needed from carers, the impact of sensory impairment on engagement, and staff time commitment. Virtual CST has been a feasible alternative to face-to-face services during the pandemic but should not completely replace in-person groups. A hybrid approach would increase accessibility for all. Future research should explore efficacy of vCST and seek to understand patterns of exclusion from such digital interventions. Supplementary Information: The online version contains supplementary material available at 10.1007/s41347-023-00306-5.

Spatial Integration and the Underlying Mechanisms of Cross-Modality Interference.

Researchers have often utilized the classic Stroop task as a measure of selective attention processes. While it is largely agreed upon that semantic interference plays a role in the classic task, the role of attentional processes is less clear. The picture is further muddied when variations on the classic task are used. For example, the cross-modal Stroop task, in which one names the color of visual items while ignoring distracting auditory color words, typically leads to smaller sized interference effects and little or no facilitation when compared to the classic task. Furthermore, relationship(s) with working memory capacity have only been found in the classic version. We examined whether these differences are due to a methodological factor; namely, spatial integration versus separation of the target and distractor locations. We conducted four experiments manipulating the location of auditory distractors within the cross-modal Stroop task, and found that the location of the distractors had little to no impact on the size of the effect. This lack of an effect of location implies that the mechanisms contributing to the cross-modal Stroop effect are not the same as those of the classic Stroop effect, and that the role of spatial attention in cross-modal Stroop is limited. The implications of a unique role for auditory distractors is considered as well, and supports the conclusion that interference in the cross-modal Stroop effect is the result of a combination of semantic interference and modality-specific interference.

The Role of Visual Stimuli in Cross-Modal Stroop Interference.

It has long been known that naming the color of a color word leads to what is known as the Stroop effect (Stroop, 1935). In the traditional Stroop task, when compared to naming the color of a color-neutral stimulus (e.g. an X or color patch), the presence of an incongruent color word decreases performance (Stroop interference), and a congruent color word increases performance (Stroop facilitation). Research has also shown that auditory color words can impact the color naming performance of colored items in a similar way in a variation known as cross-modal Stroop (Cowan & Barron, 1987). However, whether the item that is colored interacts with the auditory distractor to affect cross-modal Stroop interference is unclear. Research with the traditional, visual Stroop task has suggested that the amount of color the visual item displays and the semantic and phonetic components of the colored word can affect the magnitude of the resulting Stroop interference; as such, it is possible the same components could play a role in cross-modal Stroop interference. We conducted two experiments to examine the impact of the composition of the colored visual item on cross-modal Stroop interference. However, across two different experiments, three test versions, and numerous sets of trials, we were only able to find a small effect of the visual stimulus. This finding suggests that while the impact of the auditory stimuli is consistent and robust, the influence of non-word visual stimuli is quite small and unreliable and, while occasionally being statistically significant, it is not practically so.