The role of pragmatics in the diagnosis of dementia

Louise Cummings

Abstract

Dementia is a large and growing public health problem that poses considerable economic and social challenges to many countries around the world. The emphasis of clinical intervention is to delay the onset of severe functional limitations that are associated with poor outcomes and large health and social care costs. For this to be possible, however, clinicians must achieve earlier diagnosis of the condition than is currently the case. I argue that pragmatic language abilities hold promise as early behavioural markers of cognitive impairment. This article describes some empirical work on the search for pragmatic markers of early cognitive impairment in 27 English-speaking participants with neurodegenerative disorders. With one exception, none of the participants had received a diagnosis of mild cognitive impairment or dementia. Yet, their performance in discourse production tasks suggested they were experiencing early disruption of pragmatic language skills that had been masked in some cases by compensatory strategies.

Keywords: 

DEMENTIA, COGNITIVE IMPAIRMENT, PRAGMATICS

Article Summary

It has been argued in this article that the pragmatics of language is a potentially rich source of behavioural markers that can be used in the early diagnosis of cognitive impairment in the neurodegenerative dementias. Dementia poses a global public health challenge, with even well-funded healthcare systems inadequately equipped to address it. This burgeoning health and social-care problem could be substantially alleviated if earlier diagnosis were possible. It was argued, however, that our current diagnostic methods lead to high rates of misdiagnosis and that many affected individuals are already in a state of advanced disease progression before a diagnosis is made. Behavioural markers rooted in the pragmatics of language, it was contended, have the potential to improve diagnostic accuracy and to contribute to an earlier diagnosis of affected individuals. The article examined some pragmatic aspects of language that could serve as behavioural markers of cognitive impairment in the neurodegenerative dementias and considered a model that may be used to characterise these markers.

About the author

Louise Cummings is Professor in the Department of English at The Hong Kong Polytechnic University. She teaches and conducts research in pragmatics, clinical linguistics, and public health reasoning.

Pathological verbal repetition by Chinese elders with Dementia of Alzheimer’s Type:  A functional perspective

Lin Zhu & Lihe Huang

Abstract

Verbal repetition has been acknowledged as one of the most common symptoms in early Dementia of Alzheimer’s Type (DAT). Despite previous attempts, the applicability of verbal repetition as an essential linguistic marker indicating this disease remains unexplored for Chinese DAT patients. This study collects Chinese DAT Patients’ daily conversation data to investigate both structural and functional aspects of pathological verbal repetition. Three major types are set regarding the cases of pathological repetition, respectively ‘unconscious concept repetition’, ‘perseveration’, and ‘involuntary word repetition’. The analysis focuses on what features these repetitions have from the perspective of ‘ideational function’, ‘interpersonal function’, and ‘textual function’ within the framework of Systemic Functional Linguistics. A better understanding of pathological verbal repetition by DAT elders as the linguistic markers of cognitive impairment promotes effective communication between patients, nursing staff, and family members.

keywords:

ALZHEIMER’S DISEASE, VERBAL BEHAVIOUR, PATHOLOGICAL REPETITION, METAFUNCTION, LANGUAGE AGING

Article Conclusion

The present study focuses on DATs’ verbal repetition in daily conversation. This phenomenon stands out among various language disorders found in DATs’ utterances. The analysis was conducted specifically on the type of ‘pathological repetition’, discussing three metafunctions and their respective features.

Three major types of pathological repetition were categorised, namely ‘unconscious concept repetition’, ‘perseveration’, and ‘involuntary word repetition’. Repetition of a certain sort of concept, inappropriate and excessive repetition of oneself or others, or simply a stuttering-like involuntary repetition of certain words all concern cases preventing discourse from flowing smoothly to some extent.

DATs’ cases of pathological repetition are found mostly embodied in the material process, and most examples of repetition are in the middle voice. From the perspective of interpersonal function, the findings suggest that DATs’ pathological repetition is, for the most part, embedded in the declarative mood with ‘polarity’ taking the lead. For the textual function, DATs repeat old information in the rheme position of the whole sentence by the interviewer; the analysis of ‘cohesion’ within DATs’ repetition shows that lexical repetition is of high frequency in achieving textual cohesion.

The above description and analysis of DATs’ pathological repetition uncover their cognitive impairment. Among various possible reasons, memory distortion, difficulty in finding words, and difficulty in bringing forth new information are the three major ones. DATs’ weak intermediate-term episodic memory and their impaired long-term memory take effect in DATs’ repetition. In addition, difficulty in retrieving the exact words drives DATs to repeat certain parts in a sentence to spare time for the right words. At times, the conversations will stop. Moreover, difficulty in bringing forth new information usually happens when it is time for DATs to respond or to initiate another talk turn. As the progressive dementing condition becomes severer than before, DATs may only repeat previous utterances of others or of themselves. This prevents the whole interaction process from proceeding smoothly.

Previous researchers are inclined to claim that DAT “can be more sensitively detected with the help of a linguistic analysis than with other cognitive examinations” (Szatloczki et al., 2015). In general, therefore, this study further suggests that a better understanding of pathological verbal repetition from DAT elders in daily interaction provides an essential and early sign of dementia in the pre-clinical setting. Additionally, it also promotes effective communication between patients, nursing staff, and family members. In this sense, this article shows that it is necessary to extend the linguistic items in current Alzheimer’s disease-related scales that currently focus on the semantic and (memory) naming dimensions (Huang, Wang, & Li, 2019).  

About the author

Lihe Huang（corresponding author）is Associate Professor of Linguistics and General Secretary of Research Center for Aging, Language and Care in Tongji University, China.

由中国逻辑学会语用学专业委员会会长、南京大学陈新仁教授主编的East Asian Pragmatics（《东亚语用学》）为ESCI（Emerging Sources Citation Index）检索期刊。该刊由陈新仁教授与匈牙利国家科学院语用学研究部主任Daniel Z. Kádár教授联合创办，英国Equinox Publishing Ltd编辑、出版。

期刊创刊宗旨是增进对亚洲文化背景下语言使用与人际互动的理解，通过聚焦来自东亚国家或地区的语用语料，对语用学学科的理论建构做出贡献，为东亚语用学研究者与西方研究者的学术交流搭建一个重要的沟通平台。

在过去的四年中，该刊得到国际、国内同行认可，23位国际语用学名家及7位国内语用学专家担任顾问编辑、副主编或编委，吸引了一批高端作者和优秀的审稿人。

《东亚语用学》投稿与订阅系统：https://journal.equinoxpub.com/EAP