Dementia in social interaction (conversational analysis and other techniques)

Question 1

What are the strengths of conversation analysis in dementia studies?

Answer 1

1. Provides insight into how dementia impacts on individuals in real-time
2. Allows some comparison with what is known about normal conversation
3. Highlights the contribution of all the participants to success or failure of communication conversation

Question 2

What are the weaknesses of conversation analysis in dementia studies?

Answer 2

1. The publications are largely single case studies, so questions about the generalisability of the findings to wider dementia population
   NB issues the different types of dementia and different severities

Question 3

Describe the normal time taking procedures.

Answer 3

• Speakers take turns are talking usually one at a time with little overlap BETWEEN speakers
• The speaker produces one or more actions in his turn
• Actions/turns are often produced together in sequences

Question 4

What is an adjacency pair?

Answer 4

An adjacency pair is a unit of conversation that contains an exchange of one turn each by two speakers. The turns are functionally related to each other in such a fashion that the first turn requires a certain type or range of types of second turn.

E.g. Question-answer; request-acceptance or decline

Question 5

Describe epistemic imbalance in question and answer adjacency pairs?

Answer 5

One feature question and answers are that they display an epistemic imbalance between speakers (e.g. The question of presents him self-esteem less important than the speaker who will answer).

A part of this epistemic activity maybe at the questioner may respond to the answer with the third turn which shows he or she is now being informed(E.g. ohhh)

Question 6

What did Jones (2013) find about question and answers with people with dementia (AD type)?

Answer 6

Jones 2013 - case study the person with dementia and her daughter and son-in-law on the telephone

• Findings -
• The biggest problems fro QA routies in people with AD are interactional (these arise as a result of deficits in episodic memory)
  
  • co-participants often ask questions that are ill fited to the peroson with AD cognitive abilitues- They rarley consider the persons limitations in episodic memory
• • Question and answer routines can cause distress and embarrassment -
    * Because they highlight impairments - in order to answer question you must have knowledge which relies memory. For her, her episodic memory impairment associated with Alzheimer’s disease means that she has difficulty answering simple routine questions. Question and answer routines often highlight memory deficits.This causes distress and embarrassment.
    * because they remind people of distressing life events - e.g the death of a loved one or the fact that they will not return home. This can cause social and interactional friction.
    
    • Collaboration from co-participantscan help dementia patients find the answers
    • Dementia patients often guess the answers -
      
      • This shows their interactional abilities are still in tact- although they have damaged episodic memory, they often can produce internationally appropriate responses in the form of guesses. They make up what they think is the most approporiate answer.
      • However… This can often backfire leading to more shame and embarrassment.

Question 7

What did Mikesell (2009, 2010) find about people with dementia and their question and answer routines?

Answer 7

What he did? - explored question-and-answer sequences in two patients with behavioural varient of frontotemporal dementia (apathetic varient), by natural observation (CA). Focusing on the type of:

1. ‘I don’t know’ responses
2. Repetition of some or all of just prior utterance

As a technique used to assert agency or epistemic authority.

What he found? -

Patients with FTD often find themselves:

• responding to obvious questions
• facing high rates of infantile directives and suggestions for children
• they often have to respond to questions that test knowledge and recall of information.

So…. he proposed that the ‘I don’t know’ and ‘repetitional responses were a technique used to exert some autonomy over the situation they found themselves and were not primarily a symptom of their biological impairment.

1. ‘I don’t know’- this is a uselful response as it allows FTD patients to respond to a wide range of questions and prehaps close down the topic that the question is part of. However, problems arise when this is not an appropriate response to a question.
2. Repetitiional responses- useful for asserting priomary epistemic rights over the conversation. This is a good technique becuse words are already there in the prior turn and alows speaker to claim understanding. However… can also backfire when lack of knowledge is eventually exposed.

Question 8

What did Kindell et al (2013) report in his study of questions and answers in semantic dementia?

Answer 8

• What did they do? Examined everyday conversation in semantic dementia, at home.
• What did they find?
  
  • Responses were “often on topic but not on answer” (I.e. His responses often start the way that asked the question and then veer off, albeit on related matters)
  • Doug responds by using enactment - he uses direct reported speech with paralinguistic features (such as pitch and loudness) and non-vocal communication (such as body posture, pointing and facial expression) as an adaptive strategy to communicate with others in conversation. This case shows that while severe difficulties may be present on neuropsychological assessment, relatively effective communicative strategies may be evident in conversation. This generated a greater level of meaningful communication than his limited vocabulary alone could achieve through

describing the events concerned.

Question 9

What did Joaquin (2010) report about co-participant talk of people with dementia?

Answer 9

• what he did? looked at how attitudes towards FTD patients are indexed through speech festures by thier interloculors. Focusing on three different speech fearures:
  
  • directives
  • let’s/we framed sequences
  • initiation-response-evaluation sequences
• What he found?The way in which the co-participants talk in conversation t to people with FTD is in a similar way to people talk to children. They are used sas startegies to guide the behaviour and reflect how patients with FTD are socially constructed as ‘child-like’ and in need of assistance and guidance though not necessarily warrented. Thus FTD patents may be subject to a diminished status through their impairments.
• co-participants:
  
  • use dirctives - to tell FTD patients what to do
  • Use ‘lets do’ formulation as a different way of using directives
  • initiation-evaluation-response sequences as test quiestions.

Question 10

Describe a typical turn taking in conversations.

Answer 10

• Speakers in conversations take turns to speak
• Gaps (silences/delays) overlaps are relatively rare (silences of one second or more seen as long and noticed and often acted upon by speakers)
• Once a speaker and has the floor, this is his/her turn space and she or he has the right an obligation to produce a complete turn (Overlapping talk by another speaker, or otherwise coming into the current speakers turn space, is noticeable to speakers and sometimes negatively viewed)

Question 11

Describe what was found about turn-taking in patients with dementia in the study by Perkins, Whitworth and lesser (1998).

Answer 11

• What they did?? - investigating conversations involving people with Alzheimer’s disease or people with dementia with Lewy bodies, Including particular patterns of terms and turn taking evident in their talk
• What they found? - turn taking abilities even when dementia is quite severe.
  
  • However…… some cognitive and/or linguistic deficits may negatively impact on the PWD’s ability to respond to another’s turn in the time expected. One result is that the conversation partner may speak again before the PWD has started their response. This means that the PWD can lose their chance to speak and, if repeated, can become passive in the conversation. This may result in long pauses within the PWD’s turn.
  • If the conversation partner provides the PWD with more time, they are able to produce their response themselves.
  • In the later stages of deIn the later stages of dementia the PWD will only produce minimal turns such as ‘mmhmm’, Head nods, etc. Such minimal turns may be teh best way in which PWD can take thier turn in conversastion

Question 12

Describe topic and topic initiation in normal speakers.

Answer 12

• Topic - what is talked about through a series of turns and sequences in conversation
• Topic initiation (i.e the start of a topic) - can sometimes occur almost imperceptibly over one or more turns. By many topic initiations are disjunctive. Sucessful dysjunctive topic change is a collaborative and mutual phenomenom (i.e one speaker anounces some news and otHERr speake aligns with this news)
• topic maintence - in peer conversation this is relitivley equal and apartcipants will alternate who takes the lead and who talks most at ceratin points in conversations.

Question 13

Describe the topic in dementia conversations as was described by Perkins et al (1998)

Answer 13

• They found??
  
  • Person with dementia may produce turns which appear topically incoherent prehaps attempting to start a new topic, but very abrupty (i.e too disjunctive for co-participant to follow)
  • Topics may be unequally shared - it may fall to the conversation partner to carry the topic. This is because PWD talks in such a way which put the burden on the conversational partner
  • Topic perseveration ( reported in people with both AD and LB dementia)

Question 14

Describe what was discussed about confabulations and their responses in Linolm (2015)

Answer 14

• Confabulations cause problems for the conversational partner:
  
  • Dilemma 1 - confabulations seem like PWD is socially able and allow pwd to initiate and develop topics. Confabulations in this sense seen as a compensational strategy. so do they go along with them? (with potential cost f joining in on untrue sutuations/ lying)
  • Dillema 2- Or challenging them? with the potential of upsetting PWD and challenging what is prehaps their social and personal resourse

Question 15

What is repair?

Answer 15

Interactional behaviours in which partcipants identify and deal with troubles in speaking, hearing and undersatnding. It can be self-initiated (i.e initated by the peroson that has made the mistake) or other initated (initiated by the other person who made the mistake)

Question 16

What did Perkins at al (1998) say about repair in dementia?

Answer 16

• Repair can be long and difficult to resolve and some evidence is that the ability to repair may deteriorate as the disease progresses - people with dementia have a range of cognitive deficits which make repair difficult to resolve (compromised linguistics and attentional processing.) These deficits also make interactional trouble more likely. They are often aware that they need to reapir bu cannot self-initiate repair. So……
  
  • It becomes more important for the conversational partner to initiate the repair. Tactics used inclide: paraphrasing, asking questions, or they may avoid repair altogether (pass over failed sequence) - may be related to low expectations of PWD abilities
  • it is important because it allows people with dementia and their conversational partner to have a shared referent
• other theory is that person with dementia may avoid repair if it highlights memory impairments/ comprehension failure.

Question 17

What conversational analysis studies look at Question and answers in dementia?

Answer 17

• Jones (2013) - A case study of someone with AD
• Mikesell (2009/2010) - explores QA in somebody with FTD
• Kindell et al (2013) - QA in somebody with semantic dementia
• Joaquin (2010) - FTD intearctions

Question 18

What conversational analysis studies looked at turn-taking in dementia?

Answer 18

• perkins, witworth and lesser (1998) -turn-taking in AD

Question 19

which conversational analysis studies talk about topic in dementia?

Answer 19

• Perkins et al (1998)

Question 20

Describe what has been said about confabulations for people with dementia ?

Answer 20

• people with dementia confabulate (they preset statements about facts in the world where those statements are inevitabley inccorect.)
• confabulations can be brought about by hallucinations or delusions
• confabulations can become the topic of PWD’s - this created problems
  
  • some CP challenge the PWD confabulations (seen in Perkins, 1998) involving a peroson with lewy body dementia
  • Some can aquiesence with the PWD confbulations (Lindholm, 2015)
  • common response is for CP to produce minimal response (these are non-comital resonses)

Question 21

Who talks about confabulations in people with dementia ?

Answer 21

• Perkins et al (1998)
• Lindolm (2015)

Question 22

What positive features of the dementia talk have been mentioned in the conversation analysis studies?

Answer 22

• ususally good conversational routines (jones, 2007)
• use of other verbal and non-verbal resources that are available (enactment) (kindell et al, 2013)

Question 23

What are the benefits of data driven approaches (i.e. conversation analysis)?

Answer 23

• strong ecological validity
• should be able to deal with almost any interactional data (however messy)

Question 24

What are the benefits of theory driven (e.g. systematic functional linguistics what interactional social linguistics) in studying talking dementia?

Answer 24

• fits within existing framework and can be quantified (used with reliability test)

Question 25

What is systemic functional lingusitics?

Answer 25

Systemic-Functional Linguistics (SFL) is a theory of language centred around the notion of language function. While SFL accounts for the syntactic structure of language, it places the function of language as central (what language does, and how it does it), in preference to more structural approaches, which place the elements of language and their combinations as central. SFL starts at social context, and looks at how language both acts upon, and is constrained by, this social context.

Question 26

What did Ellis et al (2016) say about global coherence?

Answer 26

• Adults with dementia (AD, FTD and vascular) had worse global coherence than normal speakers

Question 27

What did Glosser and Deser (1990) say about people with AD and global coherence?

Answer 27

• people with AD were significantly less coherent than normal speakers
• global coherence (topical relation between and the general topic ) was worse than local coherence (topical relation between and the immediate preceding utterance)
• on syntactic and phonological measures they did not differ to normals

Question 28

What did muller and Wilson (2008) say about coherence in PWD?

Answer 28

• noted problems with referential cohesion (i.e gender errors) and omission of noun/ pronoun to mark who is being talked about.

Question 29

Who talks about cohesion in dementia?

Answer 29

• Muller and Wilson (2008)
• Ellis et al (2016)
• Glosser and deser (1990)

Question 30

What did Hamilton 1994 do in trying to understand interaction in demntia?

Answer 30

• extended, longdutudinal case study of interviews between a women with AD and the researcher (interactional sociolinguistic approach)
• analysed how questions and responses changed over time

Question 31

What did Hamilton (1994) find?

Answer 31

• The interviewer (without AD) adapts to Elise’s decreasing cognitive abilities
• There were some notible question-answer responses from person with AD:
  
  • no repsonse
  • question-type mismatch (not answering question properly)
  • vague responses
• Patterns of decline in person with AD

Question 32

What were the patterns of decline noted in Hamilton (1994)

Answer 32

1. Stage 1 (active , confused and aware) -
   
   • PWD displays word finding but can often circumlocute (rather than using neologisms or empty words)
   • PWD is active in conversation (asks Wh- and yes/no questions)
   • when response is not appropriate is is more often vague than no response
   • seems aware (e.g. topicalises and apologises for memory lapses)
2. Stage 2 (active, confused and unaware) -
   
   • Still active in conversation but less active in asking questions
   • Increasingly unaware of her difficulties; no references to them or apologies
   • No longer producing circumlocutions (now displaying neologisms or empty words)
   • Still asking wh- and yes-no questions
   • Responses now more inappropriate, not so much just vague
   • Still showing positive politeness
3. Stage 3 (Less active, confused, unaware)
   
   • Participation in conversations now markedly reduced
   • Questions only refer to the present; now no longer using tag questions
   • Now producing more ‘no responses’
   • Showing perseverations and repeats (of self and others)
   • Still sometimes using repair (eg asking for clarification)
   • Now virtually no positive politeness
4. Stage 4 (Passive)
   
   • No lexical items; utterances confined to non-lexical items ‘uhuh’, ‘mm’, ‘mmhm’ etc
   • So, sometimes responses might be ‘appropriate’, but often they are ‘no responses’ or ‘question-type mismatch’
   • But, still able to: take turns, request repetition (‘hmm?’); indicate that she recognizes personally important topics (difference between ‘mm’ and ‘mmhm)