Analysis of word number and content in discourse of patients with mild to moderate Alzheimer's disease

Lira, Juliana Onofre de; Minett, Thaís Soares Cianciarullo; Bertolucci, Paulo Henrique Ferreira; Ortiz, Karin Zazo

doi:10.1590/S1980-57642014DN83000010

Abstracts

Alzheimer's disease (AD) is characterized by impairments in memory and other cognitive functions such as language, which can be affected in all aspects including discourse. A picture description task is considered an effective way of obtaining a discourse sample whose key feature is the ability to retrieve appropriate lexical items. There is no consensus on findings showing that performance in content processing of spoken discourse deteriorates from the mildest phase of AD.

OBJECTIVE:

To compare the quantity and quality of discourse among patients with mild to moderate AD and controls.

METHODS:

A cross-sectional study was designed. Subjects aged 50 years and older of both sexes, with one year or more of education, were divided into three groups: control (CG), mild AD (ADG1) and moderate AD (ADG2). Participants were asked to describe the "cookie theft" picture. The total number of complete words spoken and information units (IU) were included in the analysis.

RESULTS

There was no significant difference among groups in terms of age, schooling and sex. For number of words spoken, the CG performed significantly better than both the ADG 1 and ADG2, but no difference between the two latter groups was found. CG produced almost twice as many information units as the ADG1 and more than double that of the ADG2. Moreover, ADG2 patients had worse performance on IUs compared to the ADG1.

CONCLUSION

Decreased performance in quantity and content of discourse was evident in patients with AD from the mildest phase, but only content (IU) continued to worsen with disease progression.

Alzheimer's disease; dementia; language

Doença de Alzheimer (DA) é caracterizada por prejuízo na memória e em outras funções cognitivas, como a linguagem, que pode ser afetada em todos os aspectos, incluindo o discurso. Tarefa de descrição de figura é considerada uma forma eficaz de obter amostra de discurso cuja característica fundamental é a capacidade de recuperar itens lexicais adequados. Não há consenso nos achados sobre deterioração no desempenho do conteúdo do discurso na fase leve da DA.

OBJETIVO:

Comparar a quantidade e a qualidade do conteúdo do discurso em pacientes com DA leve, moderada e controles.

MÉTODOS:

Foi feito um estudo transversal cuja amostra foi composta por indivíduos a partir de 50 anos, de ambos os sexos, com um ou mais anos de escolaridade. Foram divididos em três grupos: controle (GC), DA leve (ADG1) e DA moderada (ADG2) e a eles foi solicitado descrever a "prancha do roubo dos biscoitos". Considerados na análise o número total de palavras completas faladas e o de unidades de informação (UI).

RESULTADOS:

Não houve diferença significativa entre os grupos. Para o número de palavras, o CG apresentou desempenho significativamente melhor que AD1 e AD2, não houve diferença entre os dois últimos grupos. O GC produziu quase o dobro de unidades de informação em relação ao ADG1 e mais que o dobro do que ADG2. Além disso, o ADG2 apresentou pior desempenho nas UI em comparação ao ADG1.

CONCLUSÃO:

Foi observado um evidente prejuízo no desempenho quanto à quantidade e ao conteúdo do discurso em pacientes com DA a partir da fase leve. Entretanto apenas o conteúdo continuou a se agravar com a progressão da doença.

doença de Alzheimer; demência; linguagem

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References

¹
Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement 2013;9:63-75. e2.
²
McKhann GM, Knopman DS, Chertkow H, et al. 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. Alzheimers Dement 2011;7:263-269.
³
St-Pierre M-C, Ska B, Béland R. Lack of coherence in the narrative discourse of patients with dementia of the Alzheimer's type. J Multil Commun Disord 2005;3:211-215.
⁴
Keller J, Rech T. Towards a modular description of the deficits in spontaneous speech in dementia. J Pragmatics. 1998;29(3):313-32.
⁵
Giles E, Patterson K, Hodges JR. Performance on the Boston Cookie Theft picture description task in patients with early dementia of the Alzheimer's type: missing information. Aphasiology 1996;10:395-408.
⁶
Mackenzie C. Adult spoken discourse: The influences of age and education. International J Lang Commun Disord 2000;35:269-285.
⁷
Duong A, Ska B. Production of narratives: Picture sequence facilitates organizational but not conceptual processing in less educated subjects. Brain Cogn 2001;46:121-124.
⁸
Goodglass H, Kaplan E. Boston diagnostic aphasia examination booklet: Lea & Febiger; 1983.
⁹
Nicholas LE, Brookshire RH. A system for quantifying the informativeness and efficiency of the connected speech of adults with aphasia. J Speech Lang Hearing Res 1993;36:338-350.
¹⁰
Nicholas M, Obler LK, Albert ML, Helm-Estabrooks N. Empty speech in Alzheimer's disease and fluent aphasia. Journal of Speech, Lang Hearing Res 1985;28:405-410.
¹¹
Croisile B, Ska B, Brabant M-J, et al. Comparative study of oral and written picture description in patients with Alzheimer's disease. Brain Lang 1996;53:1-19.
¹²
Kave G, Levy Y. Morphology in picture descriptions provided by persons with Alzheimer's disease. J Speech Lang Hearing Res 2003;46:341-352.
¹³
Hier DB, Hagenlocker K, Shindler AG. Language disintegration in dementia: Effects of etiology and severity. Brain Lang 1985;25:117-133.
¹⁴
Bschor T, Kuhl K-P, Reischies FM. Spontaneous speech of patients with dementia of the Alzheimer type and mild cognitive impairment. Int Psychogeriatr 2001;13:289-298.
¹⁵
Groves-Wright K, Neils-Strunjas J, Burnett R, O'Neill MJ. A comparison of verbal and written language in Alzheimer's disease. J Commun Disord 2004;37:109-130.
¹⁶
Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
¹⁷
Pfeffer R, Kurosaki T, Harrah C, Chance J, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
¹⁸
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease Report of the NINCDS-ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984;34:939-944.
¹⁹
Goodglass H, Kaplan E. The assessment of aphasia and related disorders: Lea & Febiger; 1972.
²⁰
Feyereisen P, Berrewaerts J, Hupet M. Pragmatic skills in the early stages of Alzheimer's disease: an analysis by means of a referential communication task. Int J Lang Commun Disord 2007;42:1-17.
²¹
Carlomagno S, Santoro A, Menditti A, Pandolfi M, Marini A. Referential communication in Alzheimer's type dementia. Cortex 2005;41:520-534.
²²
Ahmed S, de Jager CA, Haigh A-M, Garrard P. Semantic processing in connected speech at a uniformly early stage of autopsy-confirmed Alzheimer's disease. Neuropsychology 2013;27:79-85.
²³
Chertkow H, Bub D. Semantic memory loss in dementia of Alzheimer's type what do various measures measure? Brain 1990;113:397-417.
²⁴
Hodges JR, Salmon DP, Butters N. Semantic memory impairment in Alzheimer's disease: Failure of access or degraded knowledge? Neuropsychologia 1992;30:301-314.
²⁵
Nebes RD. Semantic memory in Alzheimer's disease. Psychol Bull. 1989;106:377-394.
²⁶
Moreaud O, David D, Charnallet A, Pellat J. Are semantic errors actually semantic?: evidence from Alzheimer's disease. Brain Lang 2001; 77:176-186.
²⁷
Laatu S, Revonsuo A, Jäykkä H, Portin R, Rinne J. Visual object recognition in early Alzheimer's disease: deficits in semantic processing. Acta Neurol Scand 2003;108:82-89.
²⁸
Harnish SM, Neils-Strunjas J, Eliassen J, et al. Visual discrimination predicts naming and semantic association accuracy in Alzheimer's disease. Cogn Behav Neurol 2010;23:231-239.
²⁹
Glosser G, Deser T. Patterns of discourse production among neurological patients with fluent language disorders. Brain Lang 1991;40:67-88.
³⁰
Almor A, Kempler D, MacDonald MC, Andersen ES, Tyler LK. Why do Alzheimer patients have difficulty with pronouns? Working memory, semantics, and reference in comprehension and production in Alzheimer's disease. Brain Lang 1999;67:202-227.
³¹
Perry RJ, Hodges JR. Attention and executive deficits in Alzheimer's disease A critical review. Brain 1999;122:383-404.
³²
Vuorinen E, Laine M, Rinne J. Common pattern of language impairment in vascular dementia and in Alzheimer disease. Alzheimer Dis Assoc Disord 2000;14:81-86.
³³
Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lance 2006;366(9503):2112-2117.

Publication Dates

Publication in this collection
Sept 2014

History

Received
15 May 2014
Accepted
22 July 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement 2013;9:63-75. e2.

[2] ²
McKhann GM, Knopman DS, Chertkow H, et al. 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. Alzheimers Dement 2011;7:263-269.

[3] ³
St-Pierre M-C, Ska B, Béland R. Lack of coherence in the narrative discourse of patients with dementia of the Alzheimer's type. J Multil Commun Disord 2005;3:211-215.

[4] ⁴
Keller J, Rech T. Towards a modular description of the deficits in spontaneous speech in dementia. J Pragmatics. 1998;29(3):313-32.

[5] ⁵
Giles E, Patterson K, Hodges JR. Performance on the Boston Cookie Theft picture description task in patients with early dementia of the Alzheimer's type: missing information. Aphasiology 1996;10:395-408.

[6] ⁶
Mackenzie C. Adult spoken discourse: The influences of age and education. International J Lang Commun Disord 2000;35:269-285.

[7] ⁷
Duong A, Ska B. Production of narratives: Picture sequence facilitates organizational but not conceptual processing in less educated subjects. Brain Cogn 2001;46:121-124.

[8] ⁸
Goodglass H, Kaplan E. Boston diagnostic aphasia examination booklet: Lea & Febiger; 1983.

[9] ⁹
Nicholas LE, Brookshire RH. A system for quantifying the informativeness and efficiency of the connected speech of adults with aphasia. J Speech Lang Hearing Res 1993;36:338-350.

[10] ¹⁰
Nicholas M, Obler LK, Albert ML, Helm-Estabrooks N. Empty speech in Alzheimer's disease and fluent aphasia. Journal of Speech, Lang Hearing Res 1985;28:405-410.

[11] ¹¹
Croisile B, Ska B, Brabant M-J, et al. Comparative study of oral and written picture description in patients with Alzheimer's disease. Brain Lang 1996;53:1-19.

[12] ¹²
Kave G, Levy Y. Morphology in picture descriptions provided by persons with Alzheimer's disease. J Speech Lang Hearing Res 2003;46:341-352.

[13] ¹³
Hier DB, Hagenlocker K, Shindler AG. Language disintegration in dementia: Effects of etiology and severity. Brain Lang 1985;25:117-133.

[14] ¹⁴
Bschor T, Kuhl K-P, Reischies FM. Spontaneous speech of patients with dementia of the Alzheimer type and mild cognitive impairment. Int Psychogeriatr 2001;13:289-298.

[15] ¹⁵
Groves-Wright K, Neils-Strunjas J, Burnett R, O'Neill MJ. A comparison of verbal and written language in Alzheimer's disease. J Commun Disord 2004;37:109-130.

[16] ¹⁶
Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[17] ¹⁷
Pfeffer R, Kurosaki T, Harrah C, Chance J, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[18] ¹⁸
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease Report of the NINCDS-ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984;34:939-944.

[19] ¹⁹
Goodglass H, Kaplan E. The assessment of aphasia and related disorders: Lea & Febiger; 1972.

[20] ²⁰
Feyereisen P, Berrewaerts J, Hupet M. Pragmatic skills in the early stages of Alzheimer's disease: an analysis by means of a referential communication task. Int J Lang Commun Disord 2007;42:1-17.

[21] ²¹
Carlomagno S, Santoro A, Menditti A, Pandolfi M, Marini A. Referential communication in Alzheimer's type dementia. Cortex 2005;41:520-534.

[22] ²²
Ahmed S, de Jager CA, Haigh A-M, Garrard P. Semantic processing in connected speech at a uniformly early stage of autopsy-confirmed Alzheimer's disease. Neuropsychology 2013;27:79-85.

[23] ²³
Chertkow H, Bub D. Semantic memory loss in dementia of Alzheimer's type what do various measures measure? Brain 1990;113:397-417.

[24] ²⁴
Hodges JR, Salmon DP, Butters N. Semantic memory impairment in Alzheimer's disease: Failure of access or degraded knowledge? Neuropsychologia 1992;30:301-314.

[25] ²⁵
Nebes RD. Semantic memory in Alzheimer's disease. Psychol Bull. 1989;106:377-394.

[26] ²⁶
Moreaud O, David D, Charnallet A, Pellat J. Are semantic errors actually semantic?: evidence from Alzheimer's disease. Brain Lang 2001; 77:176-186.

[27] ²⁷
Laatu S, Revonsuo A, Jäykkä H, Portin R, Rinne J. Visual object recognition in early Alzheimer's disease: deficits in semantic processing. Acta Neurol Scand 2003;108:82-89.

[28] ²⁸
Harnish SM, Neils-Strunjas J, Eliassen J, et al. Visual discrimination predicts naming and semantic association accuracy in Alzheimer's disease. Cogn Behav Neurol 2010;23:231-239.

[29] ²⁹
Glosser G, Deser T. Patterns of discourse production among neurological patients with fluent language disorders. Brain Lang 1991;40:67-88.

[30] ³⁰
Almor A, Kempler D, MacDonald MC, Andersen ES, Tyler LK. Why do Alzheimer patients have difficulty with pronouns? Working memory, semantics, and reference in comprehension and production in Alzheimer's disease. Brain Lang 1999;67:202-227.

[31] ³¹
Perry RJ, Hodges JR. Attention and executive deficits in Alzheimer's disease A critical review. Brain 1999;122:383-404.

[32] ³²
Vuorinen E, Laine M, Rinne J. Common pattern of language impairment in vascular dementia and in Alzheimer disease. Alzheimer Dis Assoc Disord 2000;14:81-86.

[33] ³³
Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lance 2006;366(9503):2112-2117.

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