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Trends in Dementia Diagnosis

Written by \"\"Christine DaytonMedically reviewed by \"\"Shivani Kharod, Ph.D.

Published on · Updated on

Dementia, a condition characterized by problems with memory and thinking, is declining as a percentage of the population. However, while the proportion of older adults with dementia is lower compared to the past, the total number of dementia cases will likely rise due to a growing elderly population overall.

Recognizing the nuances of the latest trends in dementia diagnosis is essential for understanding both the progress in prevention and the challenges that lie ahead.

\"A

Key takeaways

  • Some studies show declining dementia rates among older adults even as population aging increases the total number of cases.
  • Improved cardiovascular health, education, and healthier lifestyles may contribute to lower individual risk.
  • Growing demand still requires accessible diagnosis, care, and continued prevention research.

Population Aging and Dementia

To address how dementia rates are changing, it is beneficial to consider the topic of population aging. Beginning in 2030, people aged 65 and older are projected to make up approximately 21% of the U.S. population, a notable increase from 17% in 2020⁠[1]. This shift reflects the aging of the Baby Boomer generation and improvements in life expectancy.

As the population continues to age, the demographic structure of the United States will undergo a historic transformation. By 2034, older adults are expected to outnumber children under the age of 18 for the first time in the nation’s history⁠[1]. 

Despite falling rates of dementia among older adults as a proportion of the population, the absolute number of people living with dementia is forecasted to rise sharply. In 2020, more than seven million Americans aged 65 and older had dementia. Projections indicate this number could exceed nine million by 2030 and nearly 12 million by 2040⁠[2]. 

While aging remains the strongest risk factor for dementia, it is not the only one. Lifestyle factors and advances in science are also shaping the trajectory of dementia diagnoses, offering new opportunities for prevention and early intervention.

Subject matter expert

\"\"

Natalie Staats Reiss Ph.D.

Older adults and caregivers

The proportion of adults aged 70 and older with dementia declined from 13% in 2011 to 10% in 2019⁠[2]. This trend suggests that a smaller percentage of older adults are developing dementia compared to previous decades.

Advances in healthcare and overall well-being have likely played a role in this decline. However, as life expectancy increases and more people live longer, the total number of dementia cases continues to rise, even though the rate of diagnosis is decreasing.

Reasons for the Decline in Dementia Rates

Lifestyle improvements, improved vascular health, higher educational achievements, and healthier lifestyle choices may contribute to the falling dementia rates observed in North America and Europe. 

Smoking Cessation

Improvements in lifestyle factors are contributing to encouraging trends in cognitive health. One significant shift is the reduction in smoking rates, especially among men. Smoking is a major risk factor for dementia, and sharp declines in smoking prevalence have likely played a substantial role in decreasing the rate of new dementia cases⁠[3]. 

Improved Heart Health

Maintaining healthy blood pressure, managing cholesterol, and reducing heart disease risk also help lower dementia risk. Studies suggest that improvements in cardiovascular health have contributed to fewer dementia cases related to stroke, atrial fibrillation, and heart failure⁠[4].

Education Protects the Brain

Higher educational attainment is linked to lower dementia risk in developed regions. Education may build \"cognitive reserve,\" which allows the brain to better compensate for aging or damage. Increasing numbers of people completing high school or higher education over the past decades correlate with a reduced rate of people developing dementia⁠[5].

Healthy Lifestyle Choices

Other lifestyle factors contribute to brain health and may help lower the risk of developing dementia. These include drinking alcohol within recommended limits and eating a balanced diet, which reduces the risk of obesity and may offer cognitive protection⁠[3]. People are also staying physically active and engaging in mentally stimulating activities later into life.

To further explore and quantify declines in dementia diagnosis, researchers have conducted large-scale, long-term studies that track changes over time. A landmark 2016 National Institutes of Health (NIH) study in Framingham, Massachusetts, provides detailed evidence on declining dementia rates, in which researchers followed 5,205 volunteers aged 60 and older over several decades, assessing cognitive function every five years from the 1970s through the 2000s⁠[6].

Some key findings of this study include⁠[6]:

    \n
  • Fewer new dementia cases: Dementia cases decreased by an average of 20% across the entire study period.
    • \n
  • Education impact: Among volunteers with at least a high school diploma, dementia incidence dropped by 22% in the 1980s, 38% in the 1990s, and 44% by the 2000s compared to rates in the 1970s.
    • \n
  • Older age at diagnosis: The average age of dementia diagnosis rose from 80 years in the 1970s to 85 years in the 1980s, indicating an older average age of onset.
    • \n
  • Decline in vascular risk factors: Most vascular risk factors, or health issues connected to blood flow and the heart, declined in parallel with the decrease in dementia cases. The number of dementia cases linked to cardiovascular issues like stroke and heart failure also declined.
    • \n

While these findings emphasize the positive impact of lifestyle and education on dementia risk, researchers note that these factors are not definitive explanations⁠[6]. Continued research is necessary to fully understand all elements contributing to trends in dementia diagnosis. 

Though falling dementia rates per capita are encouraging, the expected rise in total dementia cases presents significant challenges. An aging population means more people will live into ages where dementia risk is highest, which will likely increase demands on healthcare, social services, and families.

Preparing for the increased needs of an aging population includes:

    \n
  • Expanding specialized healthcare, memory clinics, and community support services.
    • \n
  • Encouraging lifestyle changes that reduce dementia risk from an earlier age.
    • \n
  • Providing resources, training, and respite for family members caring for loved ones with dementia.
    • \n
  • Continuing to investigate causes, treatments, and strategies to further delay or prevent dementia onset.
    • \n

These realities underscore the need to adapt systems and strategies to meet evolving needs. As we look to the path ahead, the focus moves toward increased innovation, equity, and long-term planning in dementia care.

The Road Ahead for Dementia Diagnosis

While progress continues, these trends serve as a call to action rather than a reason for complacency. Addressing the evolving landscape of dementia care requires forward-thinking diagnosis strategies grounded in science and compassion.

Future Direction for Research

The future of dementia research centers on improving diagnostic accuracy by uncovering more precise causes, risk factors, and early detection strategies. Scientists continue to investigate the complex interactions between dementia and genetics, lifestyle, environment, and brain aging.

There is a growing emphasis on identifying biological markers, or measurable indicators of a condition, when diagnosing dementia. These can signal the earliest changes in brain health, allowing for earlier detection⁠[7].

Innovations in imaging, artificial intelligence, and personalized medicine hold promise for diagnosing dementia. At the same time, researchers are working to understand why certain communities experience higher dementia rates and how social determinants of health, such as income and access to care, influence risk and outcomes⁠[2].

Timely Interventions and Equitable Access

In light of growing awareness about dementia's impact on mental health, advancing early and accurate diagnosis is a priority, helping to identify the condition sooner. Emerging research also suggests that certain medications may increase the risk of developing dementia, underscoring the importance of early and frequent medication reviews throughout the diagnostic process⁠[8].

Efforts are also underway to ensure that advancements in dementia diagnosis reach all communities equitably. Reducing disparities in education, healthcare access, and socioeconomic status ensures that early detection and diagnostic tools benefit every segment of the population.

Making Progress and Meeting Demands

Dementia diagnosis trends reflect a nuanced reality: while the rate of dementia in older adults is declining due to improved lifestyle and educational factors, the overall number of people living with dementia is increasing because of population aging. This dual trend emphasizes the progress made in reducing dementia risk, as well as the urgent need to prepare for future healthcare demands.

Understanding these trends enables policymakers, healthcare providers, researchers, and families to make informed decisions that support the growing population of older adults.

The encouraging decline in dementia rates shows that progress is possible, driven by healthier lifestyles, better education, and advances in preventive care. With continued investment in research, communities can help more people age with dignity, independence, and a higher quality of life.

References

  1. Vespa, J., Medina, L., & Armstrong, D. M. (2020). Demographic turning points for the United States: Population projections for 2020 to 2060. (Current Population Reports, P25-1144). U.S. Census Bureau. U.S. Census Bureau. Accessed October 10 2026.
  2. PRB. (n.d.). Fact sheet: U.S. dementia trends. prb.org. Accessed October 10 2026.
  3. Peters, R., Poulter, R., Warner, J., Beckett, N., Burch, L., & Bulpitt, C. (2008). Smoking, dementia and cognitive decline in the elderly: A systematic review. BMC Geriatrics, 8, 36. Springer. Accessed October 10 2026.
  4. Yang, J., Ding, H., Li, Y., Ang, T. F. A., Devine, S., Liu, Y., Qiu, W., Au, R., Ma, J., & Liu, C. (2025). Association of mid-age Life’s Essential 8 score with digital cognitive performance and incident Alzheimer’s disease: The Framingham Heart Study. Journal of Alzheimer’s Disease, 104(2), 498–508. SAGE Journals. Accessed October 10 2026.
  5. Sharp, E. S., & Gatz, M. (2011). The relationship between education and dementia: An updated systematic review. Alzheimer Disease and Associated Disorders, 25(4), 289–304. ovid.com. Accessed October 10 2026.
  6. Satizabal, C. L., Beiser, A. S., Chouraki, V., Chêne, G., Dufouil, C., & Seshadri, S. (2016). Incidence of dementia over three decades in the Framingham Heart Study. The New England Journal of Medicine, 374(6), 523–532. na01.safelinks.protection.outlook.com. Accessed May 30 2025.
  7. López-Antón, R. (2024). Recent advances in Alzheimer's disease research: From biomarkers to therapeutic frontiers. Biomedicines, 12(12), 2816. MDPI. Accessed October 10 2026.
  8. Gray, S. L., Anderson, M. L., Dublin, S., Hanlon, J. T., Hubbard, R. A., Walker, R. L., Yu, O., Crane, P. K., & Larson, E. B. (2015). Cumulative use of strong anticholinergics and incident dementia: A prospective cohort study. JAMA Internal Medicine, 175(3), 401–407. JAMA Network. Accessed October 10 2026.

Medical Content

The Clinical Affairs Team at MentalHealth.com is a dedicated group of medical professionals with diverse and extensive clinical experience. They actively contribute to the development of content, products, and services, and meticulously review all medical material before publication to ensure accuracy and alignment with current research and conversations in mental health. For more information, please visit the Editorial Policy.

About MentalHealth.com

MentalHealth.com helps people understand themselves, build healthier relationships, and access the right care. We bring together mental health education, diagnostics, and care management to support well-being throughout every phase of life.

\"\"

Author

Christine Dayton, B.S.W.

BSW

Christine Dayton is a professional health writer with over a decade of experience in geriatric care and wellness, mental health, end-of-life support, and bereavement care.

Published
Updated
\"\"

Medical Reviewer

Shivani Kharod, Ph.D.

Ph.D.

Shivani Kharod, Ph.D. is a medical reviewer with over 10 years of experience in delivering scientifically accurate health content.

Reviewed
\"\"

Related community

Assessments & Diagnosis

Explore questions about mental health assessments, diagnostic language, and the evaluation process.

","text":"Home Library Medical Conditions Trends in Dementia Diagnosis Trends in Dementia Diagnosis Written by Christine DaytonMedically reviewed by Shivani Kharod, Ph.D. Published on June 5, 2025 · Updated on May 12, 2026 Dementia, a condition characterized by problems with memory and thinking, is declining as a percentage of the population. However, while the proportion of older adults with dementia is lower compared to the past, the total number of dementia cases will likely rise due to a growing elderly population overall. Recognizing the nuances of the latest trends in dementia diagnosis is essential for understanding both the progress in prevention and the challenges that lie ahead. Key takeaways Some studies show declining dementia rates among older adults even as population aging increases the total number of cases. Improved cardiovascular health, education, and healthier lifestyles may contribute to lower individual risk. Growing demand still requires accessible diagnosis, care, and continued prevention research. Population Aging and Dementia To address how dementia rates are changing, it is beneficial to consider the topic of population aging. Beginning in 2030, people aged 65 and older are projected to make up approximately 21% of the U.S. population, a notable increase from 17% in 2020⁠[1]. This shift reflects the aging of the Baby Boomer generation and improvements in life expectancy. As the population continues to age, the demographic structure of the United States will undergo a historic transformation. By 2034, older adults are expected to outnumber children under the age of 18 for the first time in the nation’s history⁠[1]. Despite falling rates of dementia among older adults as a proportion of the population, the absolute number of people living with dementia is forecasted to rise sharply. In 2020, more than seven million Americans aged 65 and older had dementia. Projections indicate this number could exceed nine million by 2030 and nearly 12 million by 2040⁠[2]. While aging remains the strongest risk factor for dementia, it is not the only one. Lifestyle factors and advances in science are also shaping the trajectory of dementia diagnoses, offering new opportunities for prevention and early intervention. Subject matter expert Natalie Staats Reiss Ph.D. Older adults and caregivers Recent Trends in Dementia Rates The proportion of adults aged 70 and older with dementia declined from 13% in 2011 to 10% in 2019⁠[2]. This trend suggests that a smaller percentage of older adults are developing dementia compared to previous decades. Advances in healthcare and overall well-being have likely played a role in this decline. However, as life expectancy increases and more people live longer, the total number of dementia cases continues to rise, even though the rate of diagnosis is decreasing. Reasons for the Decline in Dementia Rates Lifestyle improvements, improved vascular health, higher educational achievements, and healthier lifestyle choices may contribute to the falling dementia rates observed in North America and Europe. Smoking Cessation Improvements in lifestyle factors are contributing to encouraging trends in cognitive health. One significant shift is the reduction in smoking rates, especially among men. Smoking is a major risk factor for dementia, and sharp declines in smoking prevalence have likely played a substantial role in decreasing the rate of new dementia cases⁠[3]. Improved Heart Health Maintaining healthy blood pressure, managing cholesterol, and reducing heart disease risk also help lower dementia risk. Studies suggest that improvements in cardiovascular health have contributed to fewer dementia cases related to stroke, atrial fibrillation, and heart failure⁠[4]. Education Protects the Brain Higher educational attainment is linked to lower dementia risk in developed regions. Education may build \"cognitive reserve,\" which allows the brain to better compensate for aging or damage. Increasing numbers of people completing high school or higher education over the past decades correlate with a reduced rate of people developing dementia⁠[5]. Healthy Lifestyle Choices Other lifestyle factors contribute to brain health and may help lower the risk of developing dementia. These include drinking alcohol within recommended limits and eating a balanced diet, which reduces the risk of obesity and may offer cognitive protection⁠[3]. People are also staying physically active and engaging in mentally stimulating activities later into life. Insights on Dementia Trends from Long-Term Research To further explore and quantify declines in dementia diagnosis, researchers have conducted large-scale, long-term studies that track changes over time. A landmark 2016 National Institutes of Health (NIH) study in Framingham, Massachusetts, provides detailed evidence on declining dementia rates, in which researchers followed 5,205 volunteers aged 60 and older over several decades, assessing cognitive function every five years from the 1970s through the 2000s⁠[6]. Some key findings of this study include⁠[6]: Fewer new dementia cases: Dementia cases decreased by an average of 20% across the entire study period. Education impact: Among volunteers with at least a high school diploma, dementia incidence dropped by 22% in the 1980s, 38% in the 1990s, and 44% by the 2000s compared to rates in the 1970s. Older age at diagnosis: The average age of dementia diagnosis rose from 80 years in the 1970s to 85 years in the 1980s, indicating an older average age of onset. Decline in vascular risk factors: Most vascular risk factors, or health issues connected to blood flow and the heart, declined in parallel with the decrease in dementia cases. The number of dementia cases linked to cardiovascular issues like stroke and heart failure also declined. While these findings emphasize the positive impact of lifestyle and education on dementia risk, researchers note that these factors are not definitive explanations⁠[6]. Continued research is necessary to fully understand all elements contributing to trends in dementia diagnosis. What Dementia Trends Mean for Society Though falling dementia rates per capita are encouraging, the expected rise in total dementia cases presents significant challenges. An aging population means more people will live into ages where dementia risk is highest, which will likely increase demands on healthcare, social services, and families. Preparing for the increased needs of an aging population includes: Expanding specialized healthcare, memory clinics, and community support services. Encouraging lifestyle changes that reduce dementia risk from an earlier age. Providing resources, training, and respite for family members caring for loved ones with dementia. Continuing to investigate causes, treatments, and strategies to further delay or prevent dementia onset. These realities underscore the need to adapt systems and strategies to meet evolving needs. As we look to the path ahead, the focus moves toward increased innovation, equity, and long-term planning in dementia care. The Road Ahead for Dementia Diagnosis While progress continues, these trends serve as a call to action rather than a reason for complacency. Addressing the evolving landscape of dementia care requires forward-thinking diagnosis strategies grounded in science and compassion. Future Direction for Research The future of dementia research centers on improving diagnostic accuracy by uncovering more precise causes, risk factors, and early detection strategies. Scientists continue to investigate the complex interactions between dementia and genetics, lifestyle, environment, and brain aging. There is a growing emphasis on identifying biological markers, or measurable indicators of a condition, when diagnosing dementia. These can signal the earliest changes in brain health, allowing for earlier detection⁠[7]. Innovations in imaging, artificial intelligence, and personalized medicine hold promise for diagnosing dementia. At the same time, researchers are working to understand why certain communities experience higher dementia rates and how social determinants of health, such as income and access to care, influence risk and outcomes⁠[2]. Timely Interventions and Equitable Access In light of growing awareness about dementia's impact on mental health, advancing early and accurate diagnosis is a priority, helping to identify the condition sooner. Emerging research also suggests that certain medications may increase the risk of developing dementia, underscoring the importance of early and frequent medication reviews throughout the diagnostic process⁠[8]. Efforts are also underway to ensure that advancements in dementia diagnosis reach all communities equitably. Reducing disparities in education, healthcare access, and socioeconomic status ensures that early detection and diagnostic tools benefit every segment of the population. Making Progress and Meeting Demands Dementia diagnosis trends reflect a nuanced reality: while the rate of dementia in older adults is declining due to improved lifestyle and educational factors, the overall number of people living with dementia is increasing because of population aging. This dual trend emphasizes the progress made in reducing dementia risk, as well as the urgent need to prepare for future healthcare demands. Understanding these trends enables policymakers, healthcare providers, researchers, and families to make informed decisions that support the growing population of older adults. The encouraging decline in dementia rates shows that progress is possible, driven by healthier lifestyles, better education, and advances in preventive care. With continued investment in research, communities can help more people age with dignity, independence, and a higher quality of life. References Vespa, J., Medina, L., & Armstrong, D. M. (2020). Demographic turning points for the United States: Population projections for 2020 to 2060. (Current Population Reports, P25-1144). U.S. Census Bureau. U.S. Census Bureau. Accessed October 10 2026. PRB. (n.d.). Fact sheet: U.S. dementia trends. prb.org. Accessed October 10 2026. Peters, R., Poulter, R., Warner, J., Beckett, N., Burch, L., & Bulpitt, C. (2008). Smoking, dementia and cognitive decline in the elderly: A systematic review. BMC Geriatrics, 8, 36. Springer. Accessed October 10 2026. Yang, J., Ding, H., Li, Y., Ang, T. F. A., Devine, S., Liu, Y., Qiu, W., Au, R., Ma, J., & Liu, C. (2025). Association of mid-age Life’s Essential 8 score with digital cognitive performance and incident Alzheimer’s disease: The Framingham Heart Study. Journal of Alzheimer’s Disease, 104(2), 498–508. SAGE Journals. Accessed October 10 2026. Sharp, E. S., & Gatz, M. (2011). The relationship between education and dementia: An updated systematic review. Alzheimer Disease and Associated Disorders, 25(4), 289–304. ovid.com. Accessed October 10 2026. Satizabal, C. L., Beiser, A. S., Chouraki, V., Chêne, G., Dufouil, C., & Seshadri, S. (2016). Incidence of dementia over three decades in the Framingham Heart Study. The New England Journal of Medicine, 374(6), 523–532. na01.safelinks.protection.outlook.com. Accessed May 30 2025. López-Antón, R. (2024). Recent advances in Alzheimer's disease research: From biomarkers to therapeutic frontiers. Biomedicines, 12(12), 2816. MDPI. Accessed October 10 2026. Gray, S. L., Anderson, M. L., Dublin, S., Hanlon, J. T., Hubbard, R. A., Walker, R. L., Yu, O., Crane, P. K., & Larson, E. B. (2015). Cumulative use of strong anticholinergics and incident dementia: A prospective cohort study. JAMA Internal Medicine, 175(3), 401–407. JAMA Network. Accessed October 10 2026. Medical Content The Clinical Affairs Team at MentalHealth.com is a dedicated group of medical professionals with diverse and extensive clinical experience. They actively contribute to the development of content, products, and services, and meticulously review all medical material before publication to ensure accuracy and alignment with current research and conversations in mental health. For more information, please visit the Editorial Policy. About MentalHealth.com MentalHealth.com helps people understand themselves, build healthier relationships, and access the right care. We bring together mental health education, diagnostics, and care management to support well-being throughout every phase of life. Author Christine Dayton, B.S.W. BSW Christine Dayton is a professional health writer with over a decade of experience in geriatric care and wellness, mental health, end-of-life support, and bereavement care. Published June 5, 2025 Updated May 12, 2026 Medical Reviewer Shivani Kharod, Ph.D. Ph.D. Shivani Kharod, Ph.D. is a medical reviewer with over 10 years of experience in delivering scientifically accurate health content. Reviewed June 5, 2025 Related community Assessments & Diagnosis Explore questions about mental health assessments, diagnostic language, and the evaluation process. Table of contentsChoose a section Population Aging and Dementia Recent Trends in Dementia Rates Reasons for the Decline in Dementia Rates Insights on Dementia Trends from Long-Term Research What Dementia Trends Mean for Society The Road Ahead for Dementia Diagnosis Making Progress and Meeting Demands View more","wordCount":1945},"schema":{"@context":"https://schema.org","@graph":[{"@type":"Organization","@id":"https://www.mentalhealth.com/#organization","name":"MentalHealth.com","url":"https://www.mentalhealth.com/","publishingPrinciples":"https://www.mentalhealth.com/publishing/editorial-policy"},{"@type":"WebSite","@id":"https://www.mentalhealth.com/#website","url":"https://www.mentalhealth.com/","name":"MentalHealth.com","inLanguage":"en-US","publisher":{"@id":"https://www.mentalhealth.com/#organization"}},{"@type":"BreadcrumbList","@id":"https://www.mentalhealth.com/library/are-dementia-rates-increasing#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.mentalhealth.com/"},{"@type":"ListItem","position":2,"name":"Library","item":"https://www.mentalhealth.com/library"},{"@type":"ListItem","position":3,"name":"Medical Conditions","item":"https://www.mentalhealth.com/library/medical-conditions"},{"@type":"ListItem","position":4,"name":"Trends in Dementia Diagnosis","item":"https://www.mentalhealth.com/library/are-dementia-rates-increasing"}]},{"@type":"ImageObject","@id":"https://www.mentalhealth.com/library/are-dementia-rates-increasing#primaryimage","url":"https://www.mentalhealth.com/assets/optimized/43578f951fc39ce047adb586.webp","contentUrl":"https://www.mentalhealth.com/assets/optimized/43578f951fc39ce047adb586.webp","width":1200,"height":675,"encodingFormat":"image/webp","caption":"A healthcare professional gently supports an older adult's hands."},{"@type":"Person","@id":"https://www.mentalhealth.com/people/christine-dayton#person","name":"Christine Dayton","url":"https://www.mentalhealth.com/people/christine-dayton","jobTitle":"BSW","image":"https://www.mentalhealth.com/assets/optimized/7839d88c5b37ea22d8f827d1.jpg","sameAs":["https://www.linkedin.com/in/christine-dayton/"],"memberOf":[{"@id":"https://www.mentalhealth.com/publishing#department"}]},{"@type":"Person","@id":"https://www.mentalhealth.com/people/shivani-kharod#person","name":"Shivani Kharod, Ph.D.","url":"https://www.mentalhealth.com/people/shivani-kharod","jobTitle":"Ph.D.","image":"https://www.mentalhealth.com/assets/optimized/d298e1ab0221c766e22a9fce.jpg","sameAs":["https://www.linkedin.com/in/shivanikharod"],"memberOf":[{"@id":"https://www.mentalhealth.com/clinical-affairs#department"}]},{"@type":"Article","@id":"https://www.mentalhealth.com/library/are-dementia-rates-increasing#article","url":"https://www.mentalhealth.com/library/are-dementia-rates-increasing","headline":"Trends in Dementia Diagnosis","description":"Explore dementia diagnosis trends that show how aging populations, lifestyle choices, and education shape future healthcare and research.","wordCount":1402,"mainEntityOfPage":{"@id":"https://www.mentalhealth.com/library/are-dementia-rates-increasing#webpage"},"publisher":{"@id":"https://www.mentalhealth.com/#organization"},"articleSection":"Medical Conditions","citation":[{"@type":"CreativeWork","name":"Vespa, J., Medina, L., & Armstrong, D. 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