The Language of Life

Researchers examine the effects of aging-related disorders and how to counter them.

As the global population ages, the number of people living with dementia is growing rapidly, along with the need for improvements in care for them. Adelphi faculty members are studying ways to give a better quality of life to patients with dementia and ease the emotional burdens of family caregivers. Here are ways that three Adelphi professors are doing that.

Examining—and improving—social services for older adults with dementia

Daniel Kaplan, PhD, assistant professor in the School of Social Work, specializes in promoting geriatric mental health. He works with a mentor, Barbara Silverstone, PhD, to create workforce-enhancement programs for social work supervisors, helping them gain skills to effectively support social service providers serving older adults, including those living with dementia. Dr. Kaplan was co-investigator for the pilot study of a multistate implementation of their training model and reported the results in “NASW’s Supervisory Leaders in Aging: An Acceptable and Feasible Model for Training and Supporting Social Work Supervisors” published in the December 2018 issue of Clinical Social Work Journal. Their latest work includes Adelphi’s own social work supervision training initiative, Social Work Practice Fellows, which was recently tested in four regions across the Northeast.

Dr. Kaplan is the principal investigator in two studies of the Alzheimer’s Poetry Project (APP), an intervention focused on creativity, joy, humor and personhood. APP facilitators engage groups of people with dementia who recite famous poems and express themselves through the co-creation and performance of original poetry. Dr. Kaplan and poet Gary Glazner, who founded APP, collaborate to study Poetry for Life—a program for middle and high school students who receive instruction in APP methods and visit local elder care settings to facilitate APP workshops—to measure how poetry-based intergenerational experiences impact students’ views on aging, dementia, the arts and careers in healthcare. They are also studying the implementation of APP in 20 nursing homes throughout Wisconsin, evaluating impacts among the staff trained to deliver the intervention. They published an overview of their work, “The Alzheimer’s Poetry Project,” in the December 2018 issue of JAMA: The Journal of the American Medical Association.

Daniel B. Kaplan, PhD, collaborated on the Alzheimer’s Poetry Project (APP).

Exploring language impairment in older adults

Establishing connections using a 128 electrode sensor net for electroencephalographic (EEG) research

Melissa A. Randazzo, PhD, assistant professor of communication sciences and disorders in the College of Education and Health Sciences, is investigating how aging-related disorders affect patients’ understanding of speech. “We know very little about how the clinical populations we serve interpret visual mouth cues,” she said.

Conducted in Adelphi’s Neurocognition of Communication Disorders (NCCD) Lab, her research uses electroencephalography (EEG) to examine audiovisual integration—how the brain processes what we see, such as mouth movements, and what we hear when someone is talking. Research in audiovisual integration is particularly important for aging-related disorders such as presbycusis (aging-related hearing loss) and aphasia (language impairment following stroke or other brain damage).

Older adults losing their hearing come to rely on looking at a speaker’s mouth movements, especially in noisy environments, Dr. Randazzo notes. While people with aphasia tend to have poor auditory processing for speech sounds, it’s unclear if looking at the speaker’s mouth helps them understand speech better, or if that simply constitutes information overload. “For both disorders, we tend to use these mouth movements as cues during treatment, yet we don’t know how the brain processes this information and integrates it with what is heard,” she explained. “This is an important line of inquiry for developing new and better treatments.”

Dr. Randazzo wrote the entry on audiovisual integration in the Encyclopedia of Human Communication Sciences and Disorders (2017) and presented “Neural Correlates of Audiovisual Integration in Presbycusis” at the Fall 2018 conference of the Society for Psychophysiological Research in Quebec City, Canada. As a complement to her own work, Dr. Randazzo, along with senior department colleagues, oversaw the dissertation written by doctoral student Susan DeMetropolis, “Word Associations in Early-Stage Alzheimer’s Disease: EEG Evidence,” which was developed in the NCCD lab and stemmed from DeMetropolis’ clinical work as a speech-language pathologist.

DeMetropolis observed that individuals in the early stages of dementia did not use adjectives when describing an object, but relied instead on verbs and nouns. Because the subtle cognitive and language changes associated with incipient dementia tend to go undetected, the findings can be used to develop more effective assessment and treatment tools.

Focusing on the swallowing issues that afflict patients with dementia

In addition to language impairment, swallowing impairment can also affect quality of life for patients with dementia and create challenges for caregivers. As a graduate student, Ashwini Namasivayam-MacDonald, PhD, assistant professor of communication sciences and disorders, pursued a clinical placement working with dementia patients, which sparked her interest in finding ways to help maintain their quality of life for as long as possible. The lead author of “Quantifying Airway Invasion and Pharyngeal Residue in Patients with Dementia,” published in Geriatrics in January 2019, Dr. Namasivayam-MacDonald focuses on understanding the swallowing difficulties that ensue from dementia. Recent research has suggested that up to 93 percent of people with dementia have some type of swallowing impairment, which puts them at risk for malnutrition, dehydration, pneumonia and even death. “Many people with dementia are put on modified diets or feeding tubes due to swallowing difficulties. However, many do not receive comprehensive swallowing assessments. My lab is focusing on teasing apart exactly what parts of the swallow are affected,” Dr. Namasivayam-MacDonald said. She hopes to develop treatment solutions that can be implemented in the early stages of dementia to preserve swallowing function. Her work also informs clinicians of the common swallowing impairments found in people with dementia so they can better assess these deficits. Dr. Namasivayam-MacDonald is one of the few researchers in her field to bridge the gap between swallowing impairments and nutrition (including hydration) as well as caregiver burden. As a clinically trained speech-language pathologist, she stresses the importance of partnering with other healthcare professionals on a comprehensive approach to optimizing care for dementia patients. “All of the systems in our body are connected, so it would be naïve to assume that when one is not functioning the others are,” she said.