Podcast – Logopenic Progressive Aphasia and its characterisation

Voice Over:

Welcome to the NIHR Dementia Researcher Podcast, brought to you by dementiaresearcher.NIHR.ac.uk in association with Alzheimer’s Research UK and Alzheimer’s Society, supporting early career dementia researchers across the world.

Dr Anna Volkmer:

Hello, my name is Dr. Anna Volkmer and I’m delighted to be your host for this week’s show. I’m sure you’ve heard from me before, but if you’re new to our podcast, I’m a research fellow and lecturer at University College London, and I also work clinically as a speech and language therapist at the National Hospital for Neurology and Neurosurgery, helping people living with dementia, and language and communication difficulties. Now, this week’s topic is particularly close to my heart, I think I say that every time, but it focuses on one of the language-led dementias, namely logopenic variant primary progressive aphasia, and this is a relatively rare disease, often considered an atypical Alzheimer’s-type dementia, and has only really been recognized in the clinical and research literature fairly recently.

Dr Anna Volkmer:

Logopenic variant PPA affects specific aspects of a person’s ability to understand and communicate words and sentences, and due to its recent conceptualization, there’s still a fairly limited understanding about the breadth and behavioral difficulties that people with logopenic variant PPA face. Additionally, our understanding of any appropriate and effective treatments for this condition are very much under development. So this podcast is going to delve deeper into some of these issues in order to understand the history, the nature, and the treatments for logopenic variant PPA. So joining me today, I have two experts in the area, Shaz Henderson, another clinical academic speech and language therapist, and Siddharth Ramanan. Welcome to you both. Now, perhaps we could start off with some introductions, so Shaz, can you just tell the listeners a little bit about yourself?

Shalom Henderson:

Absolutely. Hi everyone, my name is Shalom Henderson. I go by my nickname, Shaz, and I’m a PhD student at the MRC Cognition and Brain Sciences Unit at the University of Cambridge. Like you mentioned, Anna, I’m also a speech and language pathologist in the US, which is equivalent to speech and language therapist here in the UK, and I’ve had the privilege of working with many patients and families living with dementia, primarily frontotemporal lobar degeneration, and it’s subtype, like primary progressive aphasia, at the MGH Frontotemporal Disorders Unit in Boston. Because the topic of today’s podcast is very near and dear to my heart as well, I’m very excited to be here today.

Dr Anna Volkmer:

Super. Thank you very much, Shaz. It’s interesting, we say speech and language therapist here, and then they say pathologist in America and pathologist in Australia as well. But now onto Sid. Siddharth, would you like to introduce yourself?

Dr Siddharth Ramanan:

Yes. Hi everyone, my name is Siddharth Ramanan. I’m a post-doc at the MRC Cognition and Brain Sciences Unit at the University of Cambridge. I am originally from Bangalore in India, and I recently finished my PhD at the University of Sydney, working with young onset dementia, such as frontotemporal dementia, and I did a lot of work on the logopenic variant of primary progressive aphasia. And I moved to the UK about five months ago, in the midst of the pandemic, but this topic, as Shaz said, it’s very near and close to my heart because I’ve done quite a lot of work on it, and I’m continuing to do some work in my ongoing growth.

Dr Anna Volkmer:

Brilliant. Well, welcome to the UK. I think it’s much better when it’s not in a pandemic, I’m afraid. So you’ve yet to see the best of the UK. So Siddharth, could you tell us a bit about the history of logopenic variant PPA? I keep saying PPA, which is short for primary progressive aphasia, but could you just tell us a little bit of the history of logopenic variant PPA as a dementia syndrome?

Dr Siddharth Ramanan:

Yeah, so it’s really interesting because before we understand where the logopenic variant of PPA came from, we have to really understand what actually constituted the definition of PPA back in the day and how did the syndrome of PPA come to evolution? In the last 15 to 20 years, there’s been a lot of active research in the field of PPA, but actually focal neurodegenerative disorders of language has been described even as early as 1892. In fact, Arnold Pick, who is famously known for their work on Pick’s disease, had mentioned a few patients who did show a lot of language difficulties, which started out focused on language but also evolved to eventually show a lot of behavior and other generalized cognitive impairment. And in fact, there’s been a lot of reports in the early 1900s as well of patients showing language difficulties. But again, these were not tracked well enough to understand whether the origin was actually just the language impairment per se or was it language impairment in the context of generalized dementia? But it’s not really until the 1980s where [Mesulam 00:05:41]-

Dr Anna Volkmer:

He’s kind of the guru, he’s the star, isn’t he, of PPA?

Dr Siddharth Ramanan:

Yeah, and it’s only in the ’80s when Mesulam described six cases of progressively declining language impairment in the absence of fairly … well, in the relative absence of other cognitive difficulties, that the concept of PPA actually … I mean it took quite a lot of importance. And I think what’s interesting about the LVPPA history is that I feel like when you track back into the older literature, you learn that it came out of a mixed bag of a mixed PPA syndrome. So it was once Mesulam had described PPA, there was a lot of work on PPA that started emerging, and I think people really were able to understand that there are definitely two types of PPA, which is the semantic variant and the nonfluent variant.

Dr Siddharth Ramanan:

These were quite clear, but there were always these other patients who showed a mixture of these difficulties or difficulties that did not fit the criteria for the semantic or the nonfluent variant PPA. And it’s only in that mixed bag that in about 2004, when the UCSF team led by [Marilu Gorno Tempini 00:07:06] found that there’s actually a systematic pattern of language difficulties within that mixed bag of patients. And revisiting some of the old Mesulam descriptions, I think it’s within this mixed bag that the idea of LVPPA came out.

Dr Anna Volkmer:

And I guess it’s worth now, as we started talking about there being three different variants, there’s this semantic variant, which is where people lose their understanding of word meanings, and then there’s the nonfluent variant, where people are considered to be apraxic, so they have this effort for difficulty in producing and articulating speech and/or innate grammatism, but people with logopenic variant, as Siddharth, you’ve mentioned, they experience very different difficulties with their language. And I wondered maybe Shaz, could you explain that in a bit more detail for us?

Shalom Henderson:

Absolutely. So just adding to what Sid was just describing and what you just mentioned, Anna, I think that there are three internationally recognized variants or subtypes of PPA, and one of which is logopenic PPA, and I think that it can be really contrasted from the other variants as well. And just to highlight the two core features of what constitutes or what characterizes LVPPA, those are word-finding difficulty as well as difficulty in repeating longer phrases and sentences. And a lot of neurologists, medical professionals would refer to this as Auditory Verbal Working Memory, I think speech and language therapists like to call this the phonological loop problem, where you have the phonological store, which is your ability to hold the words that you hear, and you have the articulatory process, which helps you repeat those words back in this loop fashion.

Shalom Henderson:

And I think we all can agree that many specialists as well as researchers all say, “Oh, it’s so imperative for LVPPA to be diagnosed early,” but as we may know, that there are many challenges to really look for these early signs in LVPPA, especially when the language symptoms are so mild and it’s so subtle, and it might take a while for patients and families to really understand that there is a problem with the individual, that language functions are perhaps changing, or I think some people even wonder is this normal aging or is this a pathologically driven language change? And I think some patients might really struggle in distinguishing between those two. And based on my experience as well, a lot of the patients actually come to us for a second or third opinion because previous doctors or medical staff had said, “Oh, it might be due to anxiety or depression.” So I think there is this problem while it’s so important to detect early signs and know what these early signs are, but there are also challenges in getting that early diagnosis as well.

Dr Anna Volkmer:

I was just reading a paper today actually, an Australian paper by a speech therapy academic, speech pathology academic, I should say. And it’s about quality of life. So it’s by [Leanne Ruggero 00:10:35], and she was saying that upwards of 20% of people are first diagnosed with anxiety before they’re diagnosed with a type of PPA. And I mean obviously we all know that happens commonly, but to see those data, it’s quite incredible. And I mean before we move on a little bit, I wondered what’s your feeling, Shaz, around the auditory perceptual skills? This question mark that’s arisen even more recently in the research literature that maybe people with PPA have difficulties in perceiving the difference between phonemes, so between sounds.

Dr Anna Volkmer:

So phonemes for the non-speech and language therapy folk are sounds like p and b. For example, it’s thought that people with logopenic variant may have difficulties understanding, I don’t know, the word pen and Ben, and this could also be associated with their output errors when they’re mixing up those sounds as well. And so it’s common for a person to vary … This is a bit of a simplistic example, but people often say, “I mix up sounds.” So people, rather than saying apple, they say papple. What would you say about those receptive issues?

Shalom Henderson:

Yeah, that’s a really interesting point, and to be honest, I don’t know if I’ve given a lot of thought to that yet, so I’m not sure if my response will be accurate, but I think that there is importance in the place and manner of articulation. And especially in my training, I think in the US in general, perhaps across the globe as well, a lot of speech therapists and pathologists get so much extensive training on maybe the phonological processes and the error patterns of children, and I think if we think about that, it could be really transferable to understanding LVPPA better as well, because if we think about the p versus be, and thinking about the place of articulation, how that’s similar. And ultimately, that could really transfer to this phonological loop process as well, if it’s the same manner or the same place, and the way it affects how you hear the words and how that transfers to how you articulate it. I find that fascinating and I would love to think more about that.

Dr Anna Volkmer:

Yeah, me too. I think patients, when I speak to people in my clinical life, they also find it fascinating that they can be diagnosed with this thing we don’t actually know that much about. And when I often try and explain it to them, explaining it is very tricky, as we’re discussing already, and I also find that, for people living with this, it’s not only language, is it? It’s also other thinking skills that are affected. So Sid, would you like to elaborate a little bit on those?

Dr Siddharth Ramanan:

Yeah, so I think one of the patterns that we’ve seen in the literature of late is that because LVPPA has been so heavily conceptualized within the PPA field and within the language field that initially there were very few investigations to try to understand whether these patients also show other difficulties to non-linguistic functions. I think of late in the last about 5 to 10 years, there’s been a lot of work on difficulties on non-linguistic aspects of cognition. And in particular, this has to do with two avenues of research. One is are these difficulties tied closely to language in the first place? So essentially does a person with LVPPA have difficulty on doing any aspect of cognition as long as there’s language involved, so as long as language is central to that function? And second is if this is just a result of advancing disease severity.

Dr Siddharth Ramanan:

So with the first question, I think initially there were some descriptions of LVPPA patients showing difficulties with memory, planning, their ability to multitask, do two things, understand something and translate it, and try to use their working memory to do other activities, but it was fairly clear maybe that a lot of these difficulties actually arise from the fact that they already have language difficulties, and they might not be able to comprehend and translate instructions in their mind as easily. But there’s been some new work showing that a lot of these individuals actually show difficulties even on nonverbal aspects of cognition, so spatial function, visual spatial function. We have done some work where we’ve been looking at nonverbal episodic memories, so looking at your ability to remember nonverbal content from the past, and actually we found that individuals with LVPPA are actually quite a bit … they do show difficulties on this front, so that’s quite interesting to see that they have these difficulties on these nonverbal fronts as well.

Dr Siddharth Ramanan:

Another avenue that has been coming up has been difficulties in calculation, which is quite interesting because these are not described typically in what you see as the reports in the classical LVPPA case studies. On the second point about disease severity, it’s really interesting that you mention Leanne’s study about these individuals showing these non-linguistic aspects of behavioral cognitive changes early on. There’s actually another paper that came out from an Australian team. I don’t remember who it was from actually LVPPA one-

Dr Anna Volkmer:

Margaret Pozzebon.

Dr Siddharth Ramanan:

Yes, that’s the one.

Dr Anna Volkmer:

I used to work with her clinically as a speech therapist.

Dr Siddharth Ramanan:

That’s such a good paper.

Dr Anna Volkmer:

Oh, she’s such a good researcher and clinician. She was the person who got me into PPA, actually. Yeah, it is. It’s a lovely paper about these spousal experiences. Absolutely.

Dr Siddharth Ramanan:

Yeah, it’s so insightful. I mean for our readers, or for the listeners rather, who aren’t familiar with this paper, this paper actually found that spouses of PPA patients, and especially LVPPA patients, find that their partners seem to show difficulties with social withdrawal, memory [inaudible 00:17:15], and these functions almost one to three years before the frank language impairment and language difficulty set in. So there are these changes that are happening in parallel, but I think there hasn’t been enough focus on those particular changes. We actually have a paper that is currently under review where we found LVPPA patients showing remote memory impairment, and this is something that is typically not expected of the PPA syndrome, or even LVPPA as such, and even when it’s statistically controlled for the overall level of language impairment and disease severity, this impairment seems to be pervasive and extends up to their childhood and teenage memories. So it says that there’s a lot more happening in the syndrome on the side that we really need to understand and investigate.

Dr Siddharth Ramanan:

And I think this onto the question which I think is now becoming … I think it’s a topic of contention in the literature, whether the description or the term LVPPA, logopenic variant PPA, is different from logopenic progressive aphasia, where some people tend to prefer the term logopenic progressive aphasia to refer to the syndrome of LVPPA plus these other non-linguistic cognitive difficulties, whereas the term LVPPA should maybe only be restricted to an individual who is showing purely language problems. So do you have anything to add onto this? I know this is becoming quite a … There was a paper actually by Mesulam that came out in neurology about five days ago where they investigate memory impairments in PPA patients with Alzheimer’s pathology. So it’s not specified if it’s LVPPA specifically, they have some PNFA and semantic dementia patients, but there they have an entire section saying that they prefer using the term logopenic progressive aphasia for patients who show the logopenic language symptoms plus these other non-linguistic difficulties, whereas the term LVPPA should maybe be served only for the patients who show just the pure language profile.

Dr Anna Volkmer:

I mean I think we probably have a bit of work to do anyway with all the terminology. When I started working particularly with people with PPA, the terminology was even more heterogeneous. I talked to people and they didn’t know what they … I mean it still happens now, people don’t know what they’ve been diagnosed with, and then we’re going to the research literature. And in the past, I’d speak to my colleague researcher or speech therapist at another organization, and they’d be using completely different terminology. So I think that paper that Shaz was highlighting by Gorno Tempini in 2011 was a first step to giving some kind of consensus, but I’m sure that this is going to be refined and refined. And we’ve got so much to learn from people, haven’t we?

Dr Anna Volkmer:

You were talking about Margaret Pozzebon’s work, and that was all from interviewing spouses, and that there’s some work going on at the Rare Dementia Support in the Research Center at UCL, and that’s led by Dr. Chris Hardy, where he’s doing surveys with people and their families, and understanding the stages, and what’s coming out there is exactly what you’re saying, Sid, that there’s so much more before the diagnosis is given and even as people progress that we aren’t actually getting to quite yet in the research literature. So as we’ve talked a bit about what logopenic variant PPA is, I think we’re coming to the good stuff, which is we want to know about your research, but before we talk about that, I think it would be remiss if we didn’t touch on what the available interventions are that are helpful for people with logopenic variant PPA. And I’m going to direct this at Shaz, but I might chip in, I’m afraid.

Shalom Henderson:

No, absolutely.

Dr Anna Volkmer:

This is where my research focuses in particular.

Shalom Henderson:

Absolutely, chip in any time.

Dr Anna Volkmer:

Thanks.

Shalom Henderson:

I think the topic of treatment and intervention in PPA is especially important because oftentimes people were diagnosed with dementia or sent home with a diagnosis, and the understanding is okay, I have a neurodegenerative disease, there is no cure for this, so I don’t know where to go from here. And I think that’s so detrimental in so many ways, and it affects the quality of life of the individual, not only the patient but also the family, and the support groups, and the systems around them. And so when we think about LVPPA, I think it’s actually really great because LVPPA is mostly caused by Alzheimer’s disease pathology, like we talked about, and there’s actually a lot of treatment available that people are probably not aware of, and these include pharmacological treatments for Alzheimer’s disease that can really help mitigate the cognitive decline. There’s also clinical trials that people might be eligible for.

Shalom Henderson:

And I think there are other forms of treatment as well, like transcranial magnetic stimulation. I think there’s a lot of research recently that are underway to investigate the effects of repetitive TMS, and sometimes coupled with interventions like naming treatment as well in a speech therapy setting. So coupled with those, I think there are many treatments available, but I think that because I’m coming from a clinical background, I often highlight the non-pharmacological treatment options that can really be helpful in managing symptoms and maximizing the quality of life in PPA, such as speech and language therapy, there are support groups, there are social work services, music therapy, even individual and couples counseling. I think a lot of times when a patient is newly diagnosed, the spouse as well is learning new ways to better communicate with their loved ones. So I think counseling can be really helpful, as well as community events.

Shalom Henderson:

And just to make one point about speech and language therapy, I think it’s helpful to know that unlike speech therapy that is targeted for aphasia due to a stroke or a traumatic brain injury, where the goal might be to regain the patient’s lost language abilities, so this is what we would call an impairment focused treatment approach, in PPA the goal is actually to really enhance the person’s functional communication and to use all available resources, whether that’s nonverbal communication or verbal communication, and with assistive technology as well, I think there is quite a lot of resource and they can all be used together to really work on not only the weaknesses, but maintain the strengths of the individual, and to compensate for the weaknesses that the patients are experiencing.

Dr Anna Volkmer:

Well, yeah. And to add to that a little bit in terms of speech and language therapy, this is hot off the press, there’s there’s about 16 clinical academic speech and language therapists across the UK, Australia, Canada, and America, including people like Margaret Pozzebon and Dave Cartwright, Leanne Ruggero, Maya Henry, Regina [Jokel 00:25:09], I’m just listing off speech and language therapy academics here, but we’ve all got together and we’ve done a piece of work to identify some best practice. We’ve done a piece of consensus work around interventions for speech therapists to deliver to people with PPA. So we’ll be looking at … In fact, we’ve spoken to Adam and we’re hoping to do a podcast on it later this year, just really focusing in and honing in on those non-pharmacologic interventions, because I think the research evidence there is actually also coming on leaps and bounds.

Dr Anna Volkmer:

And there are more and more interventions that are available that actually target a person’s ability to participate in conversations and identify strategies to maintain the flow of conversation for both them and their partner, equally interventions that aim to maintain vocabulary and script relevant to functional interactions, and conversation, and communication. And then, of course, there’s work under development around … There’s so many more potential interventions. I keep coming back around to what you and I were discussing about auditory perceptual work, Shaz, and I think there’s lots more opportunities to expand that stuff. So this is the bit I’ve been hanging out for, and I want to hear lots more about the research you’re both doing to advance our understanding of logopenic variant PPA. So maybe Siddharth, do you want to go first? I’d really like to hear about the work.

Dr Siddharth Ramanan:

Yeah, so a lot of my past research has been focused on understanding these non-linguistic aspects of LVPPA. So I have focused a lot on memory in the past. I have some data that I’ve collected back during my time in Sydney that I’m starting to … well, I should be starting to write it up now, but that’s actually looking at navigation difficulties in LVPPA patients. So we put them through a virtual supermarket and they had to navigate the supermarket, or you’d have a shopping cart, and the shopping cart would go around the supermarket and stop at a certain place. And then all they had to do is just point to which direction they started from with their hands. So did you start from back there? Did you start from here? And one of the things that we find is that individuals who have LVPPA actually show a lot of difficulty in egocentric or first person pointing out to where they started from. So they do have some navigation difficulties.

Dr Siddharth Ramanan:

Of course, I haven’t analyzed the data fully, this is just my preliminary, just when I was having a look at what the patterns look like. And so that is another avenue that seems to be advancing our understanding of the syndrome. I have some work that I’m planning on starting out where I’m trying to look at the difficulties that people with LVPPA show, how they line up with the other clinical variants of Alzheimer’s disease. So essentially trying to position all of these clinical variants of Alzheimer’s disease on a spectrum of difficulties, and therefore we’re able to understand how does one syndrome, for example LVPPA, how does one individual evolve to show difficulties from a different clinical variant of Alzheimer’s disease? And so this will allow us to have a unified understanding of these heterogeneous symptoms that these individuals show.

Dr Anna Volkmer:

And are you including posterior cortical atrophy in that? I find sometimes when I meet people clinically, I end up providing similar interventions, yet there’s hardly any research on PCA, so posterior cortical atrophy, and what interventions are appropriate. So yeah, do you include PCA?

Dr Siddharth Ramanan:

Yeah. So the idea is to include posterior cortical atrophy, typical Alzheimer’s disease, logopenic variant of PPA, and all other clinical data in terms of Alzheimer’s disease, because you’re right, Anna, because there has been some work showing that the language profile of PCA seems to evolve into one that looks like LVPPA, so we just wonder whether LVPPA patients also progress to show the same visual spatial difficulties that posterior cortical atrophy patients show. I know there has been some work that has happened on that front, but I don’t know if there’s more work that needs to be done, which does more detail, but it will be really interesting to explore that avenue. So some of the work that I’m proposing to do with my post-doc actually looks at all of these syndromes that are on a spectrum of cognitive difficulties so that we can achieve a comprehensive understanding of why some individuals seem to progress on to show symptoms of posterior cortical atrophy whereas others might show symptoms more resembling typical Alzheimer’s disease and so on.

Dr Anna Volkmer:

Makes sense. Thank you, Siddharth. That’s so exciting, and I think it will have direct clinical relevance as well. Thank you. What about you, Shaz? What have you been up to?

Shalom Henderson:

So if I’m being completely honest, I moved here as well during the pandemic, so I have [crosstalk 00:30:50], I had high hopes and dreams for our PhD project, but recruiting patients and interacting with patients might take a while, so I’m trying to be as flexible as I can, and perhaps working with existing data for now, but I’m happy to share the general idea for the PhD that I’m envisioning during my tenure here. And just going back to some of the points that we were talking about, when I was at the MGH FTD unit, one of the things that was really unfortunate was that when LVPPA patients come into clinic for the first time, a lot of them unfortunately had years of decline already happening, so by the time they’re being diagnosed with LVPPA, it’s not so clean. And as Sid was mentioning earlier, it’s a very heterogeneous syndrome, and there is a spectrum of not only linguistic or language based symptoms, but other cognitive deficits like executive functioning, for instance.

Shalom Henderson:

So I really want to better characterize the clinical features as well as the neuropsychological profile of LVPPA, because I think one of the gaps in the literature is the trajectory of decline in LVPPA. If we assume that it starts with a purely linguistic language base, word-finding and this phonological deficit, what happens in this trajectory of the client? And I think we can all agree that maybe that’s something that we’re in a way trying to investigate as well. And a particular area of interest to me, in the past as well as in the present, is semantic cognition. And when we think about semantic cognition, recently there has been a lot of research in understanding the framework of controlled semantic cognition that it’s constituted with not only our conceptual knowledge or semantic memory for words, objects, factual information about the world, but also the control aspect which lets us flexibly access and manipulate meaningful information for a specific task or a specific context.

Shalom Henderson:

So I think a canonical example is if we look at a piano, we recognize what a piano is because we have semantic memory or the conceptualization of what it is, but me playing the piano might require access to knowing the notes, the keys, how I position my fingers, my posture, the ability to read music, for instance. This situation might be very different and might require very different control from moving the piano, the keys, that notes, the musical components of it is not as important because what I need to know is that it’s very heavy, I perhaps can’t move it by myself, and I’m going to need help from other people. So this control aspect is so important, I think, when we think about the framework of semantic cognition, and it really hasn’t been investigated in logopenic PPA, even though there are reports that semantic control like or perhaps with executive functioning deficits occur across this rather vast spectrum of a syndrome.

Shalom Henderson:

So my hope is that I mean even though it could be small, but I think it could make a small but meaningful contribution to our greater understanding of what LVPPA is, and in doing so we can think more specifically about what types of interventions, whether it’s speech therapy, is appropriate for LVPPA patients, and also thinking about the disease severity as well, what is most effective when it’s purely language-based in the beginning versus maybe three or four years down the line, we see some of these semantic deficits starting to occur. Then the approaches to intervention will, of course, change. So that’s what I’m envisioning [crosstalk 00:34:52].

Dr Anna Volkmer:

Absolutely. And I mean you’ve hit on so many things, and I was just thinking in a study I’ve done, one of the biggest barriers to delivering interventions for speech and language therapists was the fact that people were referred in clinical setting so far along their disease journey. And I see that happen a lot, that there’s almost a barrier in terms of accessing anything until you have a diagnosis, and then it’s too late often to access lots of things. And then the other thing you were describing about this ability to participate in this semantic knowledge, and how valuable that is to participating in daily life, and it reminds me again, I think we’ve talked a lot today about speech therapy, but perhaps we’re a bit biased here, two to one speech therapist, and we’ve talked about things like TMS and pharmacy medications, but there’s other things that, for example, occupational therapists offer, and I’m often trying to liaise with occupational therapists in the clinical setting to try and help them understand the language components so that we can work together to provide that functional support so people can manage in their home settings for longer.

Dr Anna Volkmer:

So just as we come to the finish of our podcast, I wanted to highlight that the work in this field of dementia has a direct impact on the lived experience of people with logopenic variant PPA, as we’ve been saying throughout today’s discussions, as it influences the development of new and novel interventions. And as a speech and language therapist working clinically, this is what people often tell me they’re most concerned about. They want to know that research will help themselves and others into the future. So thank you so much, both of you, Shaz and Siddharth, for sharing your work today. And I wondered if there was anything else we haven’t touched on yet that you wanted to mention? No? And perhaps if you’d like to share your Twitter handle so people know where to find you, that would be really helpful too. So maybe Shaz, would you like to start?

Shalom Henderson:

Absolutely. Thank you so much for having me today. My Twitter handle is @hendersonshalom. And as a PhD student, I also consider myself an early career researcher. So if anyone is interested in chatting or have any questions, I’m more than happy to respond via Twitter.

Dr Anna Volkmer:

Super, thank you. And Siddharth.

Dr Siddharth Ramanan:

Yes, thanks again for having me. So much fun. My Twitter handle is @sidramanan. And just like Shaz said, I’ve just transitioned into a postdoc, so if anyone also has questions about moving trans-continentally, starting a post-doc during the pandemic, I’d be happy to chat about it along with chatting about some of the work that I’ve been up to.

Dr Anna Volkmer:

That’s a great idea. That sounds like another podcast unto itself, starting a PhD during a pandemic. So thank you for that. We have profiles on today’s panelists on the website, including details of their Twitter accounts if you would like to ask any up questions and didn’t catch what Sid and Shaz just said. So finally, please remember to like, subscribe, and leave a review of this podcast through our website, iTunes, Spotify, Stitcher, Podbean, and SoundCloud, and all the other places that you find podcasts. Thank you very much.

Voice Over:

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