Interaction and language test performance involving persons with dementia
A comparison between test conversation and informal conversation
DOI:
https://doi.org/10.1558/jircd.20366Keywords:
dementia, language assessment, informal conversation, repair, topic initiation, requests for clarification/confirmationAbstract
Purpose: Dementia has a significant impact on language and communication. In this study, the aim was to compare the organization of interaction between persons with dementia (PWDs) and speech and language pathologists (SLPs) in two types of conversation, a test conversation and an informal conversation. A further aim was to relate interactional abilities to the PWDs’ performance on an aphasia test battery.
Method: Ten PWDs participated in the two types of conversations. In the test conversation, a standardized aphasia test battery was used. All dyads were audio- and video-recorded. Analyses were informed by interaction analytical approaches, such as conversation analysis (CA), combined with quantitative measurements.
Results: The results demonstrated that there was a larger number of turns, words, and topic initiations made by the PWDs in the informal conversations. The frequency of occurrence of repair instances was the same in the two conditions, but repairs in the test conversations were mostly resolved within one turn, whereas repairs stretching over several turns were more frequent in the informal conversations. Many of the repairs were initiated with a clarification request or a request for confirmation. Even though a majority of the PWDs demonstrated a rather robust turn-taking ability in the informal conversations, several of them struggled with the aphasia test assignments, in some cases due to visual perception problems.
Discussion and conclusion: The results indicate that a thorough analysis of informal conversations is important in assessing language in PWDs. The ecological validity of standardized language tests needs to be discussed, and the results of such tests should be handled carefully.
References
Arkin, S. (2001). Alzheimer rehabilitation by students: Interventions and outcomes. Neuropsychological Rehabilitation, 11(3), 273–317. https://doi.org/10.1080/09602010143000059
Baddeley, A., and Della Sala, S. (1996). Working memory and executive control. Philosophical Transactions of the Royal Society of London B: Biological Sciences, 351, 1397–1403. https://doi.org/10.1098/rstb.1996.0123
Barnes, S., and Bloch, S. (2019). Why is measuring communication difficult? A critical review of current speech pathology concepts and measures. Clinical Linguistics and Phonetics, 33(3), 219–236. https://doi.org/10.1080/02699206.2018.1498541
Barnes, S., Candlin, C., and Ferguson, A. (2013). Aphasia and topic initiation in conversation: A case study. International Journal of Language and Communication Disorders, 48(1), 102–114. https://doi.org/10.1111/j.1460-6984.2012.00186.x
Beckett, T. G. (2004). Language and dementia in bilingual settings: Evidence from two studies. Cape Town: PRAESA.
Bloch, S., Saldert, C., and Ferm, U. (2015). Problematic topic transitions in dysarthric conversation, International Journal of Speech-Language Pathology, 17(4), 373–383. https://doi.org/10.3109/17549507.2014.979879
Blom Johansson, M., Carlsson, M., and Sonnander, K. (2011). Svenska logopeders insatser till personer med afasi. Logopednytt, 3, 18–22. http://www.dik.se/media/126582/logopednytt_3_2011_ webb_0.pdf
Bowie, P., and Mountain, G. (1993). Using direct observation to record the behavior of long-stay patients with dementia. International Journal of Geriatric Psychiatry, 8(10), 857–864. https://doi.org/10.1002/gps.930081009
Brown, G., and Yule, G. (1983). Discourse analysis. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511805226
Button, G., and Casey, N. (1985). Topic nomination and topic pursuit. Human Studies, 8, 3–55. https://doi.org/10.1007/BF00143022
Carlsson, M., and Eriksson, H. (2008). Aspekter på afasibedömning i ett ICF-perspektiv. Master’s thesis, Department of Speech and Language Pathology, Sahlgrenska Academy, University of Gothenburg, Sweden.
Caspari, I., and Parkinson, C. (2000). Effects of memory impairment on discourse. Journal of Neurolinguistics, 13(1), 15–36. https://doi.org/10.1016/S0911-6044(99)00009-3
Chatwin, J. (2014). Conversation analysis as a method for investigating interaction in care home environments. Dementia, 13, 737–746. https://doi.org/10.1177/1471301213485231
De Lira, J., Ortiz, K. Z., Campanha, A. C., Bertolucci, P. H. F., and Minett, T. S. C. (2011). Microlinguistic aspects of the oral narrative in patients with Alzheimer’s disease. International Psychogeriatrics, 23(3), 404–412. https://doi.org/10.1017/S1041610210001092
Dijkstra, K., Bourgeois, M. S., Allen, R. S., and Burgio, L. D. (2004). Conversational coherence: Discourse analysis of older adults with and without dementia. Journal of Neurolinguistics, 17, 263–283. https://doi.org/10.1016/S0911-6044(03)00048-4
Drew, P., and Heritage, J. (1992). Analyzing talk at work: An introduction. In P. Drew and J. Heritage (Eds.), Talk at work (pp. 3–65). Cambridge: Cambridge University Press.
Ellis, M., and Astell, A. (2017). Communicating with people living with dementia who are nonverbal: The creation of adaptive interaction. PLoS ONE, 12(8). https://doi.org/10.1371/journal.pone.0180395
Fagius, T., and Söderman, E. (2009). Friska äldres prestationer på afasitestet A-ning, (master’s thesis). Division of speech and language pathology, Karolinska Institute.
Fischer, C. E., Qian, W., Schweizer, T. A., Ismail, Z., Milikin, C. P., and Munoz, D. G. (2017). Determining the impact of psychosis on rates of false-positive and false-negative diagnosis in Alzheimer’s disease. Alzheimer’s & Dementia, 3(3), 385–392. https://doi.org/10.1016/j.trci.2017.06.001
Fonseca, J., Ferreira, J. J., and Martin, I. P. (2017). Cognitive performance in aphasia due to stroke: A systematic review. International Journal of Disability and Human Development, 16(2), 127–140. https://doi.org/10.1515/ijdhd-2016-0011
Goodwin, C., and Goodwin, M. H. (1992). Context, activity and participation. In P. Auer and A. Di Luzio (Eds.), The contextualization of language (pp. 77–99). Amsterdam: John Benjamins Publishing Company. https://doi.org/10.1075/pbns.22.07goo
Goodwin, C., and Heritage, J. (1990). Conversation analysis. Annual Review of Anthropology, 19, 283–307. https://doi.org/10.1146/annurev.an.19.100190.001435
Guendouzi, J., and Muller, N. (2002). Defining trouble-sources in dementia: Repair strategies and conversational satisfaction in interactions with an alzheimer’s patient. In F. Windsor, M. L. Kelly, and N. Hewlett (Eds.), Investigations in clinical linguistics (pp. 15–30). Mahwah, NJ: Lawrence Erlbaum Associates.
Hall, K., Lind, C., Young, J. A., Okell, E., and van Steenbrugge, W. (2017). Familiar communication partners’ facilitation of topic management in conversations with individuals with dementia. International Journal of Language and Communication Disorders, 3(53), 564–575. https://doi.org/10.1111/1460-6984.12369
Holland, A. L. (1982). Observing functional communication of aphasic adults. Journal of Speech and Hearing Disorders, 47, 50–56. https://doi.org/10.1044/jshd.4701.50
Hydén, L.-C. (2011). Non-verbal vocalizations, dementia and social interaction. Communication and Medicine, 8(2), 135–144. https://doi.org/10.1558/cam.v8i2.135
Kempler, D., and Goral, M. (2008). Language and dementia: Neuropsychological aspects. Annual Review of Applied Linguistics, 1(28), 73–90. https://doi.org/10.1017/S0267190508080045
Kempler, D., and Zelinski, E. (1994). Language in dementia and normal aging. In F. A. Huppert, C. Brayne, and D. W. O’Connor (Eds.), Dementia and normal aging (pp. 331–365). Cambridge: Cambridge University Press.
Kindell, J., Keady, J., Sage, K., and Wilkinson, R. (2017). Everyday conversation in dementia: A review of the literature to inform research and practice. International Journal of Language and Communication Disorders, 52, 392–406. https://doi.org/10.1111/1460-6984.12369
König, A., Satt, A., Sotin, A., Hoory, R., Toledo-Ronen, O., Derreumax, A., Manera, V., Verhey, F., Aalten, P., Robert, P. H., and David., R. (2015). Automatic speech analysis for the assessment of patients with predementia and Alzheimer’s disease. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 1(1), 112–124. https://doi.org/10.1016/j.dadm.2014.11.012
Laakso, M., and Klippi, A. (1999). A closer look at the ‘hint and guess’ sequences in aphasic conversation. Aphasiology, 13, 345–363. https://doi.org/10.1080/026870399402136
Lindeberg, S., Samuelsson, C., and Müller, N. (2019). Swedish clinical professionals’ perspectives on evaluating cognitive and communicative function in dementia. Clinical Gerontologist (advance online publication), 1–15. https://doi.org/10.1080/07317115.2019.1701168
Lindström, E., and Werner, C. (1995). Test manual: A-ning, neurolingvistisk afasiundersökning. Stockholm: Ersta utbildningsinstitut.
Linell, P. (1998). Approaching dialogue: Talk, interaction and contexts in dialogical perspectives. Amsterdam, Philadelphia: John Benjamins. https://doi.org/10.1075/impact.3
Linell, P., and Luckmann, T. (1991). Asymmetries in dialogue: Some conceptual preliminaries. In I. Markova and K. Foppa (Eds.), Asymmetries in dialogue (pp. 1–20). Hemel Hempstead: Harvester Wheatsheaf.
Luzzi, S., Baldinelli, S., Ranaldi, V., Fabi, K., Cafazzo, V., Fringueli, F., Silvestrini, M., Provinciali, L., Reverberi, C., and Gainotti, G. (2017). Famous faces and voices: Differential profiles in early right and left semantic dementia and in Alzheimer’s disease. Neuropsychologia, 94, 118–128. https://doi.org/10.1016/j.neuropsychologia.2016.11.020
Marshall, R. C. (2002). Having the courage to be competent: Persons and families living with aphasia. Journal of Communication Disorders, 35, 139–152. https://doi.org/10.1016/S0021-9924(02)00061-8
McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack Jr., C. R., Kawas, C. H., et al. (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging–Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7(3), 263–269. https://doi.org/10.1016/j.jalz.2011.03.005
Milroy, L., and Perkins, L. (1992). Repair strategies in aphasic discourse; towards a collaborative model. Clinical Linguistics and Phonetics, 6(1–2), 27–40. https://doi.org/10.3109/02699209208985517
Myrberg, K., Hydén, L.-C., and Samuelsson, C. (2018). Different approaches in aphasia assessments: A comparison between test and everyday conversations. Aphasiology, 32(4), 417–435. https://doi.org/10.1080/02687038.2017.1366416
Norberg, A. (2001). Communication in the care of people with severe dementia. In M. L. Hummert and J. F. Nussbaum (Eds.), Aging, communication and health (pp. 157–173). New Jersey: Lawrence Erlbaum Associates.
Orange, J. B., Lubinski, R. B., and Higginbotham, J. (1996). Conversational repair by individuals with dementia of the Alzheimer’s type. Journal of Speech and Hearing Research, 39(4), 881–895. https://doi.org/10.1044/jshr.3904.881
Sabat, S. R. (1991). Facilitating conversation via indirect repair: A case study of Alzheimer’s disease. Georgetown Journal of Languages and Linguistics, 2, 284–296.
Sacks, H., Schegloff, E. A., and Jefferson, G. (1974). A simplest systematics for the organization of turntaking for conversation. Language, 50, 696–735. https://doi.org/10.1353/lan.1974.0010
Saldert, C., Ferm, U., and Bloch, S. (2014). Semantic trouble sources and their repair in conversations affected by Parkinson’s disease. International Journal of Language and Communication Disorders, 49(6), 710–721. https://doi.org/10.1111/1460-6984.12105
Samuelsson, C., and Hydén, L.-C. (2017). Collaboration, trouble and repair in multiparty interaction involving couples with dementia or aphasia. International Journal of Speech-Language Pathology, 19(5), 454–464. https://doi.org/10.1080/17549507.2016.1221448
Schegloff, E. A. (1996). Confirming allusions: Toward an empirical account of action. American Journal of Sociology, 102(1), 161–216. https://doi.org/10.1086/230911
Schegloff, E. A., Jefferson, G., and Sacks, H. (1977). The preference for self-correction in the organization of repair in conversation. Language, 53, 361–382. https://doi.org/10.1353/lan.1977.0041
Simmons-Mackie, N., Raymer, A., Armstrong, E., Holland, A., and Cherney, L. R. (2010). Communication partner training in aphasia: A systematic review. Archives of Physical and Medical Rehabilitation, 91, 1814–1836. https://doi.org/10.1016/j.apmr.2010.08.026
Wilkinson, R. (2010). Conversation analysis. In M. J. Ball, N. Müller, and R. L. Nelson (Eds.), Handbook of qualitative research in communication disorders (pp. 79–82). New York: Taylor & Francis.
