One-Minute Speech Test Could Help Assess Dementia Risk

Medscape / By Sara Freeman

BUDAPEST — Analyzing temporal changes in people's speech could be a simple way of detecting mild cognitive impairment to see whether there is a risk of developing dementia in the future, suggests research.

János Kálmán, MD, PhD, and colleagues at the University of Szeged in Hungary have developed an automated speech analysis approach called the Speech-Gap Test (S-GAP Test) that is unique because it focuses on the temporal changes made when someone talks. This means it does not overcomplicate matters by also assessing the phonetics and semantics of speech, Kálmán told Medscape Medical News. 

Kálmán presented his findings at the 32nd European Congress of Psychiatry. 

Temporal Speech Parameters

The test analyzes parameters such as how quickly someone speaks, whether they hesitate when they talk, how long the hesitation lasts, and how many silent pauses they make. This can be done with a mere 60-second sample of speech, Kálmán said, noting that other automated speech and language tools currently in development need much longer audio samples. 

"We tried different approaches and we finally ended up with the temporal speech parameters because these are not culture-dependent, not education-dependent, and could be more reliable than the semantic parts of [speech] analysis," he explained.

The analysis of temporal speech parameters is also not language-dependent. Although the S-GAP Test was developed using audio samples from native Hungarian speakers, Kálmán and his collaborators have shown that it works just as well with samples from native English and German speakers. They now plan to validate the test further using samples from native Spanish speakers. 

For Screening, Not Diagnosis

Currently, "the only purpose of this tool would be initial screening," Kálmán said at the congress. It is not for diagnosis, and there is no intention to get it registered as a medical device. 

A national survey of primary care physicians conducted by Kálmán and collaborators showed that there was little time for performing standard cognitive tests during the average consultation. Thus, the original idea was that the S-GAP Test would be an aid to help primary care physicians quickly flag whether a patient might have cognitive problems that needed further assessment at a memory clinic or by more specialist neurology services. 

The goalposts have since been moved, from developing a pure telemedicine solution to a more widespread application that perhaps anyone could buy and download from the internet or using a smartphone. 

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Lack of Retroactive Coverage for HCBS Pushes Seniors into Institutional Care: MACPAC

McKnight’s Home Care / By Adam Healy
 
Determining a beneficiary’s eligibility for Medicaid home- and community-based services can be a lengthy ordeal. And while states have options to streamline the process, most lack options for retroactive coverage, which can allow for the quickest access to HCBS, experts at the Medicaid and CHIP Payment and Access Commission discussed during a meeting Thursday.
 
“Timely access to HCBS is essential to ensure individuals receive care in the setting of their choice,” Asmaa Albaroudi, a senior analyst at MACPAC, said during the meeting. “States have several options to streamline Medicaid enrollment for people who need HCBS.”
 
Eligibility offerings
 
The most common way states streamline Medicaid eligibility processes is through presumptive eligibility. This system allows beneficiaries to begin receiving HCBS immediately as their eligibility is determined over a two-month period. Nine states use presumptive eligibility. 
 
Four states use expedited eligibility when making Medicaid HCBS determinations. While there is no uniform definition for expedited eligibility, it typically involves fast-tracking beneficiaries’ applications for HCBS so that they may begin receiving services sooner.
Only one state, Connecticut, offers retroactive coverage for Medicaid HCBS. This method allows people who are eligible for services, but not yet enrolled, to get coverage for care received up to three months prior to the start of their enrollment. This type of coverage is commonplace for nursing home care, but not for Medicaid HCBS, in other states, according to Patti Killingsworth, senior vice president of long term services and supports strategy at CareBridge and MACPAC commissioner.
 
Institutional bias 
 
As a result, nursing home care is often more financially viable for older adults as they can be reimbursed for care received before they enrolled in Medicaid. On the other hand, if one chose to receive Medicaid home care, they are fully responsible for the bill until they become enrolled.
 
“That is the reason why so many people end up in nursing homes that don’t need to,” Killingsworth said. “And I think it is a fundamental institutional bias — one of many in the federal regulations — that results in people being institutionalized when they don’t want to be and need to be.”
 
And while other tools including presumptive eligibility can still help beneficiaries receive HCBS, without retroactive coverage, many are still forced to rely on institutional care.
“I appreciate the fact that presumptive eligibility is available to states,” Killingsworth said. “I do not appreciate the fact that retroactive coverage of nursing facility benefits is available to people, while home- and community-based services are not.”

Adjusting After Our Person Has Died

By Barbara Karnes

We think of grief as mourning, of our emotional reaction to a loss. The tears, the “I miss her so much,” the sadness she is no longer with you. Grief is sadness. For some, it may be a relief that someone or something is no longer a part of our life.  We don’t just grieve for those we care about. We grieve for people we are challenged by also.

Another component when experiencing the death of someone close to us is learning how to live without that person. The component that extends beyond the emotional and into the physical, day to day life experiences. The adjusting to a new way of living, of figuring out how to be productive with this person no longer in our life.

For husband and wife, partners, or any other people living together like a parents and child or friends, our entire daily routine changes. Adjustments have to be made. Habits changed. How do I cook for just one? What do I do with all this time that I used to fill with caregiving? The "you mean I really get to watch the show I want?"

If the person we lost lived somewhere other than with us, the forced change is still there, it's just not as intense. There will still be the “we always phoned each other on Wednesday,” and the “He didn’t get to know about ______.” Thoughts and habits are displaced. We react to those changes, those habits that are missing. Our person is gone.

It is a challenging part of life, both emotionally and physically, to figure out how to live productively when this person is no longer with us.

How do we learn to adjust to living without our special person? Grief is so individualized that there really aren’t specific outlines, no step one, step two, step three, to adjust to a new way of living. We will each find our own way, or not. Our personality and how we have dealt with other life challenges will determine how we adjust to the new path life has put us on.

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