Anne Whitworth

Semantic memory is impaired in both dementia with Lewy bodies and dementia of Alzheimer's type: a comparative neuropsychological study and literature review

OBJECTIVE To test the hypothesis that semantic impairment is present in both patients with dementia with Lewy bodies (DLB) and those with dementia of Alzheimers type (DAT). METHODS A comprehensive battery of neuropsychological tasks designed to assess semantic memory, visuoperceptual function, verbal fluency, and recognition memory was given to groups of patients with DLB (n=10), DAT (n=10) matched pairwise for age and mini mental state examination (MMSE), and age matched normal controls (n=15). RESULTS Both DLB and DAT groups exhibited impaired performance across the range of tasks designed to assess semantic memory. Whereas patients with DAT showed equivalent comprehension of written words and picture stimuli, patients with DLB demonstrated more severe semantic deficits for pictures than words. As in previous studies, patients with DLB but not those with DAT were found to have impaired visuoperceptual functioning. Letter and category fluency were equally reduced for the patients with DLB whereas performance on letter fluency was significantly better in the DAT group. Recognition memory for faces and words was impaired in both groups. CONCLUSIONS Semantic impairment is not limited to patients with DAT. Patients with DLB exhibit particular problems when required to access meaning from pictures that is most likely to arise from a combination of semantic and visuoperceptual impairments.

Conversing in dementia: A conversation analytic approach

Abstract Pragmatic impairment is a major source of disruption to communication between people with dementia and their caregivers. Speech and language therapists have an important role to play in providing education and advice to caregivers that will facilitate more effective communication. This aspect of therapy has become central to the management of communication difficulties in dementia and comprehensive lists of general strategies can be found in the literature. Currently, however, there are no procedures available to guide clinicians in individually targeting advice that take into account both the range of communication problems that can arise and the unique interaction that occurs between two individuals. Furthermore, suggested communication strategies have been clinician-driven rather than led by the patient or caregiver, thereby failing to incorporate the knowledge and skill that the caregiver has already developed. Finally, there are limited empirical data about the effects of modifying linguistic variables in communication with people with dementia. A review of existing research in this area is provided and the potential contribution of conversation analysis to the assessment and management of pragmatic disorders in dementia targeted at an individual level is explored. Using a conversation analytic framework, a methodology will be described that 1. (a) identifies the interactional difficulties from the perspective of the individual patient and caregiver, 2. (b) obtains information on the strategies currently being used at home and 3. (c) determines the degree of their success. Data are presented and the implications for individually targeted education and advice to caregivers are discussed.

Conversational partner training programmes in aphasia: A review of key themes and participants' roles

Background: Conversational training programmes are increasingly being reported for partners of people with aphasia. While these all aim to increase communicative effectiveness between people with aphasia and their communication partners, and all report measurable success, the programmes vary in terms of selection criteria for participants, the methods used, and the way in which they have been evaluated. This paper critically reviews a group of studies that have carried out conversation partner training (CPT) programmes for both familiar partners of people with aphasia (spouse or relative of a person with aphasia) and volunteers. We wish to acknowledge Janet Webster for her comments on earlier drafts.SCA is a registered trademark. Aims: The purpose of the review is (1) to identify the type of people CPT might benefit, i.e., whether particular characteristics of the participants have been considered influential to the outcome of interventions and (2) to consider the outcomes of such training programmes more generally, i.e., whether they have been effective, whether the effectiveness of the programmes is dependent on the format of the training and, to some extent, the measures that have been used to evaluate their effectiveness. Main Contribution: The review highlighted the positive outcomes reported by the studies, irrespective of whether the usual conversation partner or a volunteer was involved, in relation to the evaluation measures used. A paucity of information was found for the conversation partner participants compared to the person with aphasia, along with a limited analysis of the impact of the partner on the effectiveness of the intervention. Criteria underpinning selection for training programmes was related primarily to availability rather than behavioural or conversational characteristics. Longer‐term follow‐up of interventions was also limited. Conclusion: That CPT interventions can be effective is not disputed here. However, the measurement of such effectiveness needs scrutiny and for whom these interventions work remains largely unknown. This review highlights the need for more information on both participants, with particular regard to the partner of the person with aphasia, to be both established and documented when reporting the impact of this type of intervention. This will permit an examination of the extent to which particular variables or partner profiles are influential and potentially predictive when determining suitable candidates for CPT. Equally, systematic follow‐up of all those participating in training will enable a clearer picture to emerge of the effectiveness of such interventions.

Treating verbs in aphasia: exploring the impact of therapy at the single word and sentence levels

BACKGROUND In recent years there has been significant interest in the differential processing of nouns and verbs in people with aphasia, but more limited consideration about whether the differences have implications for therapy. It remains unclear whether verbs can be treated in a similar way to nouns or should be treated using approaches that recognize the relationship between verb retrieval and sentence production. AIMS This paper reviews studies focusing on therapy for spoken verb retrieval, considering the impact of therapy on treated and untreated verbs, sentence production and connected speech. It explores whether there are differential gains across therapy paradigms and whether verbs respond to therapy in the same way as nouns. METHOD & PROCEDURES Studies were identified using a systematic search. A total of 26 studies were reviewed and classified under four headings: (1) studies that treated verbs in a single-word context, (2) studies that compared treatment for nouns and verbs, (3) studies that treated verbs in a sentence context, and (4) studies that treated verb retrieval and argument structure. MAIN CONTRIBUTION Findings from the review demonstrate that verb therapy, irrespective of whether verbs are treated within a single-word or sentence context, is effective in improving the retrieval of treated verbs, but with limited generalization to untreated verbs. Verbs respond very similarly to nouns when treated using the same techniques, but improving verb retrieval may be harder to achieve than improving noun retrieval. The impact on sentence production is more varied. The gains in sentence production are discussed in relation to the different therapy types, the rationale for therapy and the presence of co-occurring sentence difficulties. CONCLUSIONS The review highlights the need for more systematic evaluation of different types of verb therapy, measuring the impact of therapy on verb retrieval, sentence production and connected speech. Only through the judicious assessment and monitoring of change across different contexts will an understanding of how verbs respond to therapy be developed and what generalization patterns can be predicted. This will lead to increased confidence in the selection of therapy approaches for people with verb difficulties in aphasia.

Is it time to stop “fishing”? A review of generalisation following aphasia intervention

Background: The study of generalisation is integral to both demonstrating and maximising therapy effectiveness. With aphasia therapy aiming to promote change in everyday communication, there is a temptation to “fish” for any evidence of improvement; multiple tasks, elicitation methods, and measures may be used to identify any change that might then be attributed to therapy. Examining the evidence about generalisation will allow us to develop our theoretical understanding of change following aphasia intervention and strengthen our ability to form robust predictions for generalisation that can be tested. Aims: We explore what is meant by generalisation, considering it within the broader context of impact of intervention. We propose a framework focusing on linguistic generalisation at the levels of word, sentence, and connected speech. The discussion draws on the therapy literature for spoken production, exploring single-word therapies for nouns and verbs, sentence production therapies, and discourse therapies. Main Contribution: This article introduces a framework to conceptualise and describe generalisation within level, i.e., change to untreated stimuli within the same linguistic level as the focus of treatment, and across level, i.e., change at a different linguistic level to the focus of treatment. The existing evidence base for spoken production is reviewed using the framework, considering our current knowledge, the predictions we are able to make, and areas for future focus. Conclusions: There is an urgent need for further research in this area. While within-level generalisation has often been addressed systematically, there have been more limited attempts to systematically define, predict, and measure generalisation across linguistic levels. This has resulted in a limited evidence base from which to make decisions regarding when and how to best facilitate generalisation and where and how to best measure generalisation. We propose it is time to stop fishing for change in an opportunistic way and to develop a greater understanding of the relationship between change at the different linguistic levels of words, sentences, and connected speech. We need to use theory and evidence to predict change (selecting the right “pond” within which to fish) and identify valid and reliable ways to measure both targeted and generalised therapy effects (selecting the right “bait”).

Enhancing research capacity across healthcare and higher education sectors: Development and evaluation of an integrated model

BackgroundWith current policy in healthcare research, in the United Kingdom and internationally, focused on development of research excellence in individuals and teams, building capacity for implementation and translation of research is paramount among the professionals who use that research in daily practice. The judicious use of research outcomes and evaluation of best evidence and practice in healthcare is integrally linked to the research capacity and capabilities of the workforce. In addition to promoting high quality research, mechanisms for actively enhancing research capacity more generally must be in place to address the complexities that both undermine and facilitate this activity.MethodsA comprehensive collaborative model for building research capacity in one health professional group, speech and language therapy, was developed in a region within the UK and is presented here. The North East of England and the strong research ethos of this profession in addressing complex interventions offered a fertile context for developing and implementing a model which integrated the healthcare and university sectors. Two key frameworks underpin this model. The first addresses the individual participants’ potential trajectory from research consciousness to research participative to research active. The second embeds a model developed for general practitioners into a broader framework of practice-academic partnership and knowledge and skills exchange, and considers external drivers and impacts on practice and patient outcomes as key elements.Results and discussionThe integration of practice and academia has been successful in building a culture of research activity within one healthcare profession in a region in the UK and has resulted, to date, in a series of research related outcomes. Understanding the key components of this partnership and the explicit strategies used has driven the implementation of the model and are discussed here.ConclusionsA strong, equitable collaboration between clinical and academic partners working towards a common outcome can enhance the use of research within the healthcare workforce and contribute actively to the research process. A set of propositions are specified to facilitate both transferability of this partnership model to other professional groups and clinical teams and evaluation of the model components.

Using Narrative as a Bridge: Linking Language Processing Models with Real-Life Communication

In chronic aphasia, maximizing generalization of improved language abilities from clinical tasks to everyday communication can require the same systematic planning process as the early stages of therapy, often drawing on additional areas of knowledge and successes from other clinical populations. The use of narrative structure is shown here to be a useful framework for building on the developments within sentence processing impairments in aphasia and creating a bridge to more real-life language tasks. An intervention based on narrative structure is described with two people with different language profiles and at different stages of the chronic aphasia spectrum. The insights gained in assessing language ability, underpinning intervention, and capturing therapeutic changes are demonstrated.

Profiling conversation in Parkinson's disease with cognitive impairment

The impact of cognitive impairment on the interaction between people with Parkinsons disease (PD) and their carers was examined. A conversation analytic approach was taken to profile the nature of the communication difficulties of 12 people with PD with cognitive impairment in addition to the articulatory and prosodic disturbances typically associated with PD. Using a methodology that combined carer reports and analysis of conversational data, the complex relationship between impaired communicative behaviour, carers perceptions and the influence of changes from premorbid conversational styles and contexts was examined. The interactional consequences of altered communication behaviour were explored by analysing the types of strategies that were spontaneously used by carers when difficulties arose in conversation. The study further compared the conversational profiles of people with PD diagnosed with two putatively different pathologies in an attempt to determine whether analysis of interaction could discr...

Beyond narrative: Is there an implicit structure to the way in which adults organise their discourse?

Abstract Understanding the structure of discourse in healthy adults is fundamental to the assessment and diagnosis of discourse level impairments in clinical populations and the development of effective treatment regimes. Exploring discourse genre in healthy speakers that extend beyond the traditional narrative is equally paramount in facilitating maximum impact of clinical interventions in everyday speaking contexts. This study aimed to characterise the discourse of 30 healthy adult speakers across three age groups (20–39, 40–59 and 60+ years) and four discourse genres (recount, procedural, exposition and narrative), drawing on discourse frameworks used in classroom teaching. A clinically useful discourse protocol and analytic procedure using SALT was developed that profiled the macrostructure and key aspects of linguistic microstructure of the different genres, exploring coherence and cohesion within and across genre in a systematic manner. Analyses considered whether there were differences in coherence and cohesion among the different age groups, different genres and specific topics. Results showed that, while individual variability was present, healthy adults structured their discourse consistently, adhering to the frameworks described in the developmental literature, across all four genres. Significant age differences were only seen in the amount of information contained in the body of the discourse (i.e. events, steps or statements offered) with older participants offering less information. This dataset will enable comparisons to be drawn with clinical populations to determine the utility and the feasibility of the use of this framework for diagnosis and intervention.

NARNIA: a new twist to an old tale. A pilot RCT to evaluate a multilevel approach to improving discourse in aphasia

Background: Developing effective interventions for people with aphasia, which both ameliorate impaired language and directly impact on real-life communication, is a key focus of aphasia research. While single-word and sentence-level models of language processing have informed effective interventions, there is limited evidence of intervention approaches that extend the principles from these models to discourse. Aims: This pilot randomised controlled trial (RCT) aimed to compare a novel multilevel intervention, a Novel Approach to Real-life communication: Narrative Intervention in Aphasia (NARNIA), with usual care (UC), with a view to assess the feasibility and acceptability of the approach and estimate effect sizes to design and power a definitive trial. Methods & Procedures: In a prospective, single-blind, RCT, 14 people with mild to moderate aphasia, between 2 and 165 months following stroke, were randomised to the two interventions. Both therapy conditions were delivered four times weekly over 5 weeks. The NARNIA intervention specifically combined word retrieval, sentence production, and discourse macrostructure across a range of everyday discourse (ED) genres. UC comprised any speech-language therapy routinely used in clinical practice, individually tailored to meet the assessed needs of the participant. The Curtin University Discourse Protocol (CUDP) was used to measure verb access, sentence production, and discourse structure. Outcomes & Results: Eight participants were assigned to the NARNIA intervention and six participants to UC. No significant differences were present in baseline prognostic factors between the two groups prior to intervention. Following intervention, orientation aspects of macrostructure were significantly greater in the NARNIA group on ED measures than in the UC group, with no other between-group differences found. Significant changes were, however, seen within groups across ED genres. The NARNIA group made significant gains across all language levels, while the UC made isolated gains in sentence production. Few changes were seen in narrative discourse for either group. While single-word processing was not significantly different between groups, significant within-group differences were seen. While both groups significantly improved in retrieving nouns in isolation, only the NARNIA group made significant improvement in verb processing. No change was seen in constrained sentence production for either group. Conclusions: These findings are highly promising in demonstrating the use of macrostructure to scaffold production of words and sentences and improve discourse organisation. The significantly greater within-group gains for the NARNIA participants will provide a platform to power a larger trial to evaluate the effectiveness of this integrated multilevel intervention for aphasia.