Discourse intervention strategies in Alzheimer's disease: Eye-tracking and the effect of visual cues in conversation

Brandão, Lenisa; Monção, Ana Maria; Andersson, Richard; Holmqvist, Kenneth

doi:10.1590/S1980-57642014DN83000012

Abstracts

OBJECTIVE:

The goal of this study was to investigate whether on-topic visual cues can serve as aids for the maintenance of discourse coherence and informativeness in autobiographical narratives of persons with Alzheimer's disease (AD).

METHODS:

The experiment consisted of three randomized conversation conditions: one without prompts, showing a blank computer screen; an on-topic condition, showing a picture and a sentence about the conversation; and an off-topic condition, showing a picture and a sentence which were unrelated to the conversation. Speech was recorded while visual attention was examined using eye tracking to measure how long participants looked at cues and the face of the listener.

RESULTS:

Results suggest that interventions using visual cues in the form of images and written information are useful to improve discourse informativeness in AD.

CONCLUSION:

This study demonstrated the potential of using images and short written messages as means of compensating for the cognitive deficits which underlie uninformative discourse in AD. Future studies should further investigate the efficacy of language interventions based in the use of these compensation strategies for AD patients and their family members and friends.

Alzheimer's disease; discourse; attention; visual cues

OBJETIVO:

O objetivo deste estudo foi o de investigar se pistas visuais sobre o tópico discursivo podem servir como auxiliares para a manutenção da coerência e da informatividade em narrativas autobiográficas de pessoas com doença de Alzheimer (DA).

MÉTODOS:

O experimento apresentou três condições: uma conversa tendo à vista uma tela de computador em branco; uma condição de conversação com pista dentro do tópico, em que a tela do computador mostrava uma foto e uma frase sobre o evento tema; e uma condição fora de tópico, em que a tela mostrava uma foto e uma frase que não apresentavam relação com o tema da conversa. O discurso foi gravado enquanto a atenção visual foi examinada através de rastreamento ocular para medir a atenção dos participantes para as pistas apresentadas na tela e para o rosto do ouvinte.

RESULTADOS:

Os resultados sugerem que as intervenções por meio de pistas visuais na forma de imagens e informações escritas são úteis para melhorar a informatividade discursiva na AD.

CONCLUSÃO:

Este estudo demonstrou o potencial do uso de imagens e mensagens escritas curtas como meios de compensação para aumentar a informatividade do discurso em pacientes com DA. Estudos futuros devem investigar a eficácia de intervenções de linguagem baseadas no uso dessas estratégias de compensação para a comunicação de pacientes com DA com seus familiares e amigos.

doença de Alzheimer; discurso; atenção; pistas visuais

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REFERENCES

¹
Bourgeois, MS. Evaluating memory wallets in conversations with persons with dementia. J Speech Hear Res 1992;35:1344-1357.
²
McPherson A, Furniss FG, Sdogati C, Cesaroni F, Tartaglini B, Lindesay J. Effects of individualized memory aids on the conversation of persons with severe dementia: a pilot study. Aging Ment Health 2001;5:289-294.
³
Bourgeois MS, Camp C, Rose M, et al. A comparison of training strategies to enhance use of external aids by persons with dementia. J Commun Disord 2003; 36:361-378.
⁴
Dijkstra K, Bourgeois M, Youmans G, Hancock A. Implications of an advice-giving and teacher role on language production in adults with dementia. Gerontologist 2006;46:357-366.
⁵
Holsanova J, Johansson R, Holmqvist K. To tell and to show: the interplay of language and visualisations in communication. In: Gärdenfors P, Wallin A (Editors). A smorgasbord of cognitive science. Nora, Sweden: Nya Doxa; 2008:215-229.
⁶
Tales A, Haworth J, Nelson S, Snowden RJ, Wilcock G. Abnormal visual search in mild cognitive impairment and Alzheimer's disease. Neurocase 2005;11:80-84.
⁷
Fernandez-Duque D, Black S. Attentional Networks in normal aging and Alzheimer's disease. Neuropsychology 2006;20:133-143.
⁸
LaBar K, Mesulam M, Gitelman DR, Weintraub S. Emotional curiosity: modulation of visuospatial attention by arousal is preserved in aging and early-stage Alzheimer's disease. Neuropsychologia 2000;38:1734-1740.
⁹
Rhys C, Schmidt-Renfree N. Facework, social politeness and the Alzheimer's patient. Clin Linguist Phon 2000;14:533-543.
¹⁰
Langton SRH, Watt RJ, Bruce V. Do the eyes have it? Cues to the direction of social attention. Trends Cogn Sci 2000;4:50-59.
¹¹
Ogrocki PK, Hills AC, Strauss ME. Visual exploration of facial emotion by healthy older adults and patients with Alzheimer disease. Neuropsychiatry Neuropsychol Behav Neurol 2000;13:271-278.
¹²
Astell AJ, Ellis MP. The social function of imitation in severe dementia. Inf Child Dev 2006;15:311-319.
¹³
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.
¹⁴
Folstein MF, Folstein SE, Mchugh PR. "Mini-mental state": a practical method for grading the cognitive status of patients for the clinician. J Psychiatr Res 1975;12:189-198.
¹⁵
Guerreiro M, Silva AP, Botelho MA, Leitão O, Castro-Caldas A, Garcia C. Adaptação à população portuguesa na tradução do "Mini Mental State Examination" (MMSE). Rev Portug Neurol 1994;1:9-10.
¹⁶
Reisberg B, Ferris SH, De Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatr 1982; 139:1136-1139.
¹⁷
Rubin DC, Schulkind MD. Distribution of important and word-cued autobiographical memories in 20-, 35-, and 70-year-old adults. Psychol Aging 1997;12:524-535.
¹⁸
Schneider W, Eschman A, Zuccolotto A. E-Prime User's Guide. Pittsburgh: Psychology Software Tools, Inc; 2002.
¹⁹
Holmqvist K, Nyström M, Andersson R, Dewhurst R, Jarodzka H, van de Weijer J. Eye tracking: A comprehensive guide to methods and measures. Oxford University Press; 2011.
²⁰
Macwhinney B. The CHILDS Project: Tools for Analyzing Talk. 3rd ed. Mahwah, NJ: Lawrence Erlbaum Associates; 2000.
²¹
Laine M, Laakso M, Vuorinen E, Rinne J. Coherence and informativeness of discourse in two dementia types. J Neurolinguistics 1998;11:79-87.
²²
Linell P, Gustavsson L, Juvonen P. Interactional dominance in dyadic communication: a presentation of initiative-response analysis. Linguistics 1988; 26:415-442.
²³
Carletta J. Assessing agreement on classification tasks: the kappa statistic. Computational Linguistics 1996;22:249-254.
²⁴
Statistical Package for the Social Sciences (SPSS). Version 18.0 [Computer program]. Chicago: USA. 2009.
²⁵
Crawford JR, Howell DC. Comparing an individual's test score against norms derived from small samples. Clin Neuropsychol 1998;12:482-486.
²⁶
Dobbins IG, Hans S. Cue-versus probe-dependent prefrontal cortex activity during contextual remembering. J Cogn Neurosci 2006;18:1439-1452.
²⁷
Argyle M, Cook M. Gaze and mutual gaze. London: Cambridge University Press;1976.
²⁸
Brandão, L., Parente, M.A.M.P. & Pena-Casanova, J. Estratégias comunicativas de pessoas com doença de Alzheimer. Psicol Reflex Crit 2010;23:308-316.
²⁹
Mahendra N, Bayles K. Effect of presentation modality on immediate and delayed recall in individuals with Alzheimer's disease. Am J Speech Lang Pathol 2005;14:144-155.

Publication Dates

Publication in this collection
Sept 2014

History

Received
09 May 2014
Accepted
10 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
Bourgeois, MS. Evaluating memory wallets in conversations with persons with dementia. J Speech Hear Res 1992;35:1344-1357.

[2] ²
McPherson A, Furniss FG, Sdogati C, Cesaroni F, Tartaglini B, Lindesay J. Effects of individualized memory aids on the conversation of persons with severe dementia: a pilot study. Aging Ment Health 2001;5:289-294.

[3] ³
Bourgeois MS, Camp C, Rose M, et al. A comparison of training strategies to enhance use of external aids by persons with dementia. J Commun Disord 2003; 36:361-378.

[4] ⁴
Dijkstra K, Bourgeois M, Youmans G, Hancock A. Implications of an advice-giving and teacher role on language production in adults with dementia. Gerontologist 2006;46:357-366.

[5] ⁵
Holsanova J, Johansson R, Holmqvist K. To tell and to show: the interplay of language and visualisations in communication. In: Gärdenfors P, Wallin A (Editors). A smorgasbord of cognitive science. Nora, Sweden: Nya Doxa; 2008:215-229.

[6] ⁶
Tales A, Haworth J, Nelson S, Snowden RJ, Wilcock G. Abnormal visual search in mild cognitive impairment and Alzheimer's disease. Neurocase 2005;11:80-84.

[7] ⁷
Fernandez-Duque D, Black S. Attentional Networks in normal aging and Alzheimer's disease. Neuropsychology 2006;20:133-143.

[8] ⁸
LaBar K, Mesulam M, Gitelman DR, Weintraub S. Emotional curiosity: modulation of visuospatial attention by arousal is preserved in aging and early-stage Alzheimer's disease. Neuropsychologia 2000;38:1734-1740.

[9] ⁹
Rhys C, Schmidt-Renfree N. Facework, social politeness and the Alzheimer's patient. Clin Linguist Phon 2000;14:533-543.

[10] ¹⁰
Langton SRH, Watt RJ, Bruce V. Do the eyes have it? Cues to the direction of social attention. Trends Cogn Sci 2000;4:50-59.

[11] ¹¹
Ogrocki PK, Hills AC, Strauss ME. Visual exploration of facial emotion by healthy older adults and patients with Alzheimer disease. Neuropsychiatry Neuropsychol Behav Neurol 2000;13:271-278.

[12] ¹²
Astell AJ, Ellis MP. The social function of imitation in severe dementia. Inf Child Dev 2006;15:311-319.

[13] ¹³
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.

[14] ¹⁴
Folstein MF, Folstein SE, Mchugh PR. "Mini-mental state": a practical method for grading the cognitive status of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[15] ¹⁵
Guerreiro M, Silva AP, Botelho MA, Leitão O, Castro-Caldas A, Garcia C. Adaptação à população portuguesa na tradução do "Mini Mental State Examination" (MMSE). Rev Portug Neurol 1994;1:9-10.

[16] ¹⁶
Reisberg B, Ferris SH, De Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatr 1982; 139:1136-1139.

[17] ¹⁷
Rubin DC, Schulkind MD. Distribution of important and word-cued autobiographical memories in 20-, 35-, and 70-year-old adults. Psychol Aging 1997;12:524-535.

[18] ¹⁸
Schneider W, Eschman A, Zuccolotto A. E-Prime User's Guide. Pittsburgh: Psychology Software Tools, Inc; 2002.

[19] ¹⁹
Holmqvist K, Nyström M, Andersson R, Dewhurst R, Jarodzka H, van de Weijer J. Eye tracking: A comprehensive guide to methods and measures. Oxford University Press; 2011.

[20] ²⁰
Macwhinney B. The CHILDS Project: Tools for Analyzing Talk. 3rd ed. Mahwah, NJ: Lawrence Erlbaum Associates; 2000.

[21] ²¹
Laine M, Laakso M, Vuorinen E, Rinne J. Coherence and informativeness of discourse in two dementia types. J Neurolinguistics 1998;11:79-87.

[22] ²²
Linell P, Gustavsson L, Juvonen P. Interactional dominance in dyadic communication: a presentation of initiative-response analysis. Linguistics 1988; 26:415-442.

[23] ²³
Carletta J. Assessing agreement on classification tasks: the kappa statistic. Computational Linguistics 1996;22:249-254.

[24] ²⁴
Statistical Package for the Social Sciences (SPSS). Version 18.0 [Computer program]. Chicago: USA. 2009.

[25] ²⁵
Crawford JR, Howell DC. Comparing an individual's test score against norms derived from small samples. Clin Neuropsychol 1998;12:482-486.

[26] ²⁶
Dobbins IG, Hans S. Cue-versus probe-dependent prefrontal cortex activity during contextual remembering. J Cogn Neurosci 2006;18:1439-1452.

[27] ²⁷
Argyle M, Cook M. Gaze and mutual gaze. London: Cambridge University Press;1976.

[28] ²⁸
Brandão, L., Parente, M.A.M.P. & Pena-Casanova, J. Estratégias comunicativas de pessoas com doença de Alzheimer. Psicol Reflex Crit 2010;23:308-316.

[29] ²⁹
Mahendra N, Bayles K. Effect of presentation modality on immediate and delayed recall in individuals with Alzheimer's disease. Am J Speech Lang Pathol 2005;14:144-155.

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