Functional approaches in Dementia

Question 1

3 types of functional approach

Answer 1

Discourse analysis approach

Conversational analysis approach

Psychosocial approach

Question 2

2 types of DA

Answer 2

interactional sociolinguistics

systemic functional linguistics

Question 3

who researched interactional sociolinguistics

Answer 3

Hamilton, 1994

Question 4

what does interactional sociolinguistics draw on?

Answer 4

draws on sociolinguistic - mix of linguistic and social approaches

Question 5

what does interactional sociolinguistics (Hamilton, 1994) do?

Answer 5

uses quantitative evidence of change in speaker with DAT over 4 years to outline 4 broad stages of decline

Question 6

stage 1 of interactional sociolinguistics (Hamilton, 1994)

Answer 6

Stage 1: Active, confused and aware

Displays WFD but can often circumlocute

Is active in conversation, asks yes/no questions

When response is not appropriate, it is often more vague than a no response

Seems aware - topicalises, apologises for memory lapses

Has positive politeness strategies - compliments others, uses endearments, shows appreciation etc.

Question 7

stage 2 of interactional sociolinguistics (Hamilton, 1994)

Answer 7

Stage 2: Active, confused and unaware

Still active in conversation but less active in asking questions

Increasingly unaware of her difficulties - no apologies or references to them

No longer producing circumlocutions, now displaying neologisms or empty words

Still asking wh- questions and yes/no questions

Responses are now inappropriate not just vague

Still showing positive politeness

Question 8

stage 3 of interactional sociolinguistics (Hamilton, 1994)

Answer 8

Stage 3: Less active, confused and unaware

Participation in conversation now markedly reduced

Questions only refer to the present, no longer using tag questions

Now producing more ‘no responses’

Showing perseverations and repeats (of self and others)

Still sometimes uses repair (e.g. asking for clarification)

Now virtually no positive politeness

Question 9

stage 4 of interactional sociolinguistics (Hamilton, 1994)

Answer 9

Stage 4: Passive

No lexical items - utterances confines to non-lexical items ‘uhuh’, ‘mm’, ‘mmhm’ etc.

Sometimes responses may be appropriate but often they are ‘no responses’ or ‘question-type mismatch’

Still able to:

Take turns

Request repetition

Recognize personally important topics

Question 10

what is SFL often used for?

Answer 10

SFL work often used to create a distinction between cohesion and coherence in discourse

Question 11

original researchers involved in SFL work

Answer 11

(Halliday & Hasan, 1976)

Question 12

what is cohesion

Answer 12

surface indication of relations within and between sentences. Occurs when the interpretation of an element of the discourse is dependent on another element

Question 13

how is cohesion shown?

Answer 13

References:

• Anaphoric pronouns (e.g. he, she)
• Demonstratives (e.g. this, that)

Ellipsis

Conjunctions

Question 14

what is coherence?

Answer 14

the result of appropriate topic maintenance

Question 15

2 types of coherence

Answer 15

local

global

Question 16

what is local coherence

Answer 16

topical relation between an utterance and the immediately preceding utterance

Question 17

what is global coherence

Answer 17

topical relation between an utterance and the general topic

Question 18

which researchers used SFL to investigate dementia

Answer 18

Ellis et. al., 2016

Glosser & Deser (1990)

Muller & Wilson (2008)

Question 19

summary and findings of Ellis et. al., 2016

Answer 19

Lit review of global coherence in adult populations

Global coherence worse in DAT, FTD and VD than in normal speakers

Question 20

summary and findings of Glosser & Deser (1990)

Answer 20

Investigated coherence and cohesion in interview discourse in people with DAT

People with DAT were significantly less coherent than normal speakers

Global coherence worse than local coherence

Question 21

summary and findings of Muller & Wilson (2008)

Answer 21

Applying SFL to person with dementia, specifically focusing on cohesion

Noted gender errors and vague/ambiguous references

Question 22

how do people with cognitive impairments show atypical talk + reference

Answer 22

not so much in the form of repair but in the atypical use of actions (i.e. the form of the utterance in often relatively good or normal but there is something pragmatically odd about the action (e.g. the speaker has already asked this question or what the speaker is saying is clearly not true) (Wilkinson, 2019)

Question 23

what is a Q&A sequence?

Answer 23

Typically, constitute a common type of adjacency pair sequence in conversation (two types of turn or action that go together in a sequence).

Question 24

what does a Q&A sequence show?

Answer 24

Display an epistemic imbalance between speakers (questioner = less informed than speaker who will answer).

As part of this, the questioner often responds with third turn to show they have now become informed

Question 25

reference for Q&A sequences in DAT

Answer 25

Jones, 2015

Question 26

finidings from Jones, 2015 - Q&A sequences in DAT

Answer 26

Episodic memory impairments associated with DAT result in difficulties answering what seem like simple, routine questions. (answering a question requires knowledge which relies on memory) If turns put PwDAT on the spot this can highlight their difficulties = causes distress PwDAT sometimes able to work herself to an answer, particularly with collaboration for co-participant. PwDAT uses remaining knowledge to ‘guess’ what answer should be and know what an appropriate type of response should be - aiming to pass as competent. This can backfire if PwDAT guesses wrongly and so their lack of knowledge is ‘caught out’ - can cause interactional difficulty and embarrassment.

Question 27

who researched how Q&A sequences are impacted by FTD?

Answer 27

Mikesell, 2009; 2010

Question 28

findings of Mikesell, 2009; 2010 - Q&A sequences in FTD

Answer 28

Listeners find it frustrating to talk with them People with FTD regularly perceived as lazy Can produce turns although usually minimal responses Does not typically initiate sequences Regularly does not seem to understand/deal with the larger activity their turn is produced within Some turns appear normal (remaining abilities are enough to produce normal-looking responses) but over time limitations of individual, out of context responses become apparent

Question 29

what are two turns investigated by Mikesell?

Answer 29

i don't know repetition of some or all of previous utterance

Question 30

why is idk often used as a response

Answer 30

Very versatile - can be used to answer a wide range of questions

Question 31

limitation of idk as a response

Answer 31

Not always appropriate - draws attention to what they cannot do

Question 32

how much more are modified repeats used by speakers with dementia

Answer 32

Used modified repeats 40x more than speakers w/o dementia

Question 33

when are modified repeats used?

Answer 33

often in repsonse to directives

Question 34

why are modified repeats useful?

Answer 34

words are already there in prior turn so allows speaker to claim understanding without having to show it

Question 35

who researched co-participant talk in FTD

Answer 35

Joaquin, 2010)

Question 36

findings of Joaquin, 2010

Answer 36

co-participants in conversation talk to people with FTD similar to the way in which adults talk to children e.g. they use directives (i.e. they tell the FTD person what to do) Makes PwFTD appear even more child-like - this way of talking can further reduce their autonomy and agency even more than they already are.

Question 37

4 aspects of atypical topic talk seen in dementia

Answer 37

topic initiation topic maintenance topic perserverance confabulations

Question 38

who researched topic initiation in dementia

Answer 38

Perkins et. al., 1998

Question 39

Perkins et. al., 1998 findings

Answer 39

PWD may produce turns which appear topically incoherent or are perhaps attempting to start a new topic, but very abruptly ie too disjunctive a topic change for the co-participant to follow.

Question 40

who researched topic maintenance in dementia

Answer 40

Perkins et. al., 1998

Question 41

Perkins et. al., 1998 findings (topic maintenance)

Answer 41

Topics may be unequally shared. It may fall to the conversation partner to carry the topic. This may be because the PWD talks in a certain way which puts the conversational burden onto the CP eg by asking questions

Question 42

which types of dementia is topic perseveration noted in and by who?

Answer 42

Reported in people with DAT (Muller & Guendouzi, 2005) Reported in people with Lewy Body dementia (Perkins et al., 1998)

Question 43

what does to confabulate mean?

Answer 43

present statements about facts in the world where those statements are evidently incorrect

Question 44

how is confabualtions different to lying

Answer 44

Common in PWD although they are unaware of their incorrectness so it is different to lying (Lindholm, 2015)

Question 45

how are confabulations brought about?

Answer 45

Confabulations can be brought about by a number of psychological causes  E.g. delusions or hallucinations althouhg this is widely debated

Question 46

difficulties encountered if confabulation becomes topic of talk

Answer 46

Present conversational dilemma for the PWD’s CPs - should they agree with what the other person has said, even though here what the PWD has said seems nonsensical?

Question 47

common CP response if confabulation becomes topic of talk

Answer 47

minimal response

Question 48

why are minimal responses if confabulation becomes topic of talk

Answer 48

Retain ambiguity - can be heard as agreement or acknowledgement Non-committal - avoids CP having to display an understanding. They can just go along with it.

Question 49

who researched retained abilites

Answer 49

Kitzinger & Jones (2007) Kindell et. al., 2013

Question 51

Kitzinger & Jones (2007) findings

Answer 51

Woman with DAT Can typically carry out call openings relatively normally  Has enough intact cognitive ability to deal with this structured and routinized conversational task

Question 52

Kindell et. al., 2013 findings

Answer 52

In FTD (semantic dementia) Compensatory strategies: Uses enactment to show rather than describe Direct reported speech (often consists of semantically vague language) Pointing Drawing on retained visuo-spatial skills Lack of repair shows that PwFTD can talk fluently albeit quite vaguely using NV communication

Question 53

what is investigated in psychosocial approach?

Answer 53

QoL life story work impact on self

Question 54

who investigated the impact of dementia on QoL

Answer 54

Smith et. al., 2006

Question 55

who investigated the impact of dementia on self

Answer 55

Sabat & Collins, 1999 Tappen et. al., 1999

Question 56

who investigated the importance of using life story work in managing dementia

Answer 56

Kindell et. al., 2014