Conversational cohesion patterns in men and women with Alzheimer's disease: a longitudinal study.

The use of cohesion devices in conversations was examined in 60 individuals (31 women, 29 men) with early to midstage Alzheimer's disease (AD) and 47 non-demented elderly (NE) (27 women, 20 men). AD individuals produced more referent errors than NE, although AD and NE subjects otherwise demonstrated similar use of cohesion devices. AD women showed more frequent use of two elliptical devices (clause omission and word omission) compared with AD men and NE men and women. A subset of 23 AD subjects (13 women, 10 men) who completed four data collections (entry, 6, 12 and 18 months) was followed longitudinally. They demonstrated a significant decline in the number of ellipses and conjunctions at 18 months post-entry. As AD subjects produced fewer and shorter utterances across time, their use of all cohesive devices declined. No gender differences were found over time. Although referencing errors differentiated early to midstage AD from NE, conversational discourse tasks alone may have limited clinical value to assess and monitor communication competence.

Comparison of African-American and white persons with Alzheimer's disease on language measures.

We assessed 11 African-American and 32 white subjects with early to midstage AD using seven measures (the Boston Naming Test, Peabody Picture Vocabulary Test-Revised, Shortened Token Test, a modified Reporter's Test, two subtests of a shortened Rey Auditory Verbal Learning Test, and selected stimuli from the Test of Problem Solving). There were no ethnic differences, with Mini-Mental State Examination score and education accounting for most of the variance between ethnic groups. However, white subjects tended to score higher than African-Americans on five of the seven measures. African-Americans tended to perform better on the Test of Problem Solving, a measure of the pragmatic use of language. Although these preliminary findings suggest no test bias for ethnicity, the trends indicate that language measures should continue to be examined for ethnic differences in larger samples.

Gender differences in language of AD patients: a longitudinal study.

We examined gender differences in probable Alzheimer's disease (AD) patients on language measures at four data collections (entry, 6, 12, and 18 months) and a normal elderly (NE) comparison group at entry and 18 months. Comparison of gender differences in language abilities of 60 (29 men, 31 women) early (Clinical Dementia Ratings I and II) AD subjects at entry revealed significant effects for gender on the Boston Naming Test (BNT) and Peabody Picture Vocabulary Test-Revised (PPVT-R) but not on the Word Fluency Test, shortened Token Test, or modified Reporter's Test. The 37 subjects (18 men, 19 women) who completed less than four data collection sessions compared with the 23 subjects (11 men, 12 women) who completed all four sessions differed on education and Reporter's Test scores. Longitudinal analysis of measures showed that gender differences persisted for the BNT and PPVT-R and that time differences were found on all measures. Gender differences remained after correcting for age, education, duration of illness, and mental status. We found no differences for the NE comparison group for gender or time. All AD subject trends were downward, suggesting that (1) language is affected over time in AD, (2) both men and women decline at similar rates, and (3) language abilities of women are more severely impaired at all time points.

Functional communication with AD patients: a caregiver training program.

The loss of functional communication in Alzheimer disease (AD) results from the disproportionate breakdowns in the pragmatic and semantic areas of language in these patients. Communication breakdown is regularly listed among the top four stressors in measures of stress and burden of AD caregivers. A caregiver training program designed around seven specific communication strategies can be used to alter communication interactions. As a pilot program, the acronym FOCUSED organized the seven strategies for easy recall (Face-to-face, Orientation, Continuity, Unsticking, Structure, Exchanges, and Direct). Significant differences in both attitude toward AD patients, knowledge of AD, and knowledge of communication strategies were shown in comparisons of pre- and posttraining assessments.

Turn-taking and speech act patterns in the discourse of senile dementia of the Alzheimer's type patients.

Conversational discourse patterns of 11 normal elderly and 11 senile dementia of the Alzheimer's type (SDAT) patients engaged in dyadic interaction with an examiner were examined. Differences in word usage, turn taking, and speech act production were investigated both for the two-subject groups and for the examiner's conversations with each group. Compensatory shifts in discourse by participants are identified. For the subject, differences were shown on words per turn with SDAT subjects speaking in shorter turns and in nonverbal responses with SDAT subjects using this strategy more frequently. Speech act categories of Requestives and Assertives also differed with SDAT subjects using more Requestives and fewer Assertives. The SDAT subjects had significantly more occurrences of unintelligible utterances. For the examiner, words per turn differed with the examiner using shorter turns with SDAT subjects. No differences were shown in the examiner's patterns of speech act usage, nonverbal responses, or intelligibility. In general, these results indicate significant discourse differences in the words per turn level for all participants and speech act levels of conversation for SDAT subjects. They also indicate generally maintained interaction patterns by speakers so that the discourse genre of conversation is sustained. The pattern of compensatory shifts in discourse suggests retained flexibility in the communication system of early and mid stage SDAT patients.

Narrative abilities in hearing-impaired children: propositions and cohesion.

Two linguistic microstructures, propositions and cohesive devices, were analyzed in story recalls by 11 primary and intermediate level hearing-impaired students. The students were enrolled in total communication, public day classes, and had severe-to-profound hearing losses. Four story conditions were presented: (1) easy structure--T.C.; (2) complex structure--T.C.; (3) complex structure with pictures--T.C.; and (4) create-a-story--pictures. Students watched and then retold or made up a story to a friend. Recalls were videotaped and transcribed by a deaf adult and the first investigator. Recalls of hearing-impaired students were significantly shorter than those found earlier for hearing students. When stories are very simple, hearing-impaired students generate mostly complete propositions, however as complexity increases, semantic errors result in fewer complete propositions.

Patterns of discourse cohesion and coherence in Alzheimer's disease.

Patterns of discourse--as reflected in the use of propositions, cohesion devices, and in judgments of coherence--in the speech of 6 well elderly and 6 patients with senile dementia of the Alzheimer type (SDAT) during topic-centered interviews were compared. Compared to the well elderly, SDAT patients used significantly more words and conversational turns. The interviewer also used more words and turns when interviewing SDAT patients, making those interviews more lengthy and more interactive than those of the elderly comparison group. Although significant differences in propositional form and cohesion devices were not found, a pattern of cohesion disruptions in SDAT patients was identified that appears consistent with previously noted patterns of language dissolution. Coherence judgements by four listeners showed significant differences between the two groups. The breakdowns in coherence were related to one subtype of cohesion disruption, missing element. This suggests that incoherence may result in part from a loss of the ability to take the listener's perspective in developing thematic structure during conversation. It is argued that SDAT results not only in the impairment of linguistic abilities but also in the impairment of discourse abilities that contribute to Alzheimer patients' incoherent speech.

Accessing children's knowledge of sociolinguistic rules for speech therapy lessons.

Eight dyads of misarticulating school children (M = 7:9 years) enrolled in clinical programs were videotaped while they role-played 5-min remedial articulation lessons. Analysis of lesson transcripts was carried out at selected levels (lesson management, roles, discourse contexts, communicative acts, discourse sequences, and topic introduction). The "clinicians" controlled the lesson tasks and topics and used communicative acts in a manner typical of adult clinicians. The "clients" role-played cooperatively and displayed the response patterns of children receiving remedial lessons. Hierarchical relationships among the selected levels of analysis suggested the use of a cohesive register appropriate for clinical teaching. It is suggested that children's sociolinguistic perspectives on remedial speech and language lessons should be taken into account when intervention lessons are planned and implemented.