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Narrative Language Abilities in Adults with Parkinson disease

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Narrative language requires sophisticated discourse planning. This may be compromised in adults ... New York: Puffin Books. McNamara, P. & Durso, R. (2003) ... – PowerPoint PPT presentation

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Title: Narrative Language Abilities in Adults with Parkinson disease


1
Narrative Language Abilities in Adults with
Parkinson disease Biji A. Philip, Amrita Nambiar,
Lynne E. Hewitt, Alexander Goberman Department of
Communication Disorders Bowling Green State
University
Abstract Narrative language requires
sophisticated discourse planning. This may be
compromised in adults with Parkinsons disease
(PD) secondary to deficits in abstract cognitive
and higher level linguistic abilities. In this
pilot study, we collected narrative language
samples from 12 adults with PD (63 to 89 years),
using a wordless picture book. Formal test
results indicated difficulty in identifying and
explaining ambiguities, and making inferences.
Narratives were characteristic of embedded
episodes and involved detailed descriptions of
episodes. However, the narratives lacked
contiguity appropriate prosodic inflections
failure to use a child-directed register
referential inadequacy, and difficulty in making
appropriate inferences about story ending.
Preliminary results support feasibility of
protocol.
  • Results (Microstructure Narrative Analyses)
  • Use of ambiguous or incorrect referents (4
    participants had 15 or greater incomplete ties).
  • High percentage of pauses and reformulations.
  • Lack of appropriate cohesive markers to indicate
    transitions from one episode to another.
  • Persistent use of the simple conjunctive
    cohesive marker and.
  • Lack of semantically rich conjunctions.
  • P0017 used a variety of conjunctions which
    rendered a higher quality to the narrative.

Table 1 Demographic characteristics of
participants with PD
Comparative Case Study
  • Introduction
  • Research findings indicate that abstract
    cognitive and higher level language abilities are
    compromised in individuals with Parkinsons
    disease (PD).
  • Investigations have revealed that subtle
    language deficits may exist even in non-demented
    individuals with PD (Berg et al., 2003 Grossman
    et al., 2002 Gurd, 2000 Kemmerer, 1999 Lewis
    et al., 1998 Hough, 2004)
  • Most studies focus on semantic and grammatical
    deficits.
  • Semantic deficits
  • Generative naming deficits (Hough, 2004).
  • Verbal fluency deficits (Gurd, 2000).
  • Morpho-syntactic deficits
  • Difficulty understanding ambiguous sentences
    (Lewis et al., 1998) and passive sentences
    (Grossmann et al., 2002 Kemmerer, 1999).
  • High-level language deficits (Berg et al., 2003
    Lewis et al., 1998)
  • Making inferences.
  • Understanding metaphors.
  • Only one study up to date that focuses on
    conversational pragmatics (McNamara Durso,
    2003).
  • Results indicated that participants with PD had
    difficulties in conversational appropriateness,
    stylistics, speech acts, gestures, prosodic
    inflections, and facial expressions.

Figure 1 Narrative abilities of PD participant
compared to age, gender, and education-matched
control

Table 2 Results of formal language and cognitive
testing
Table 2 Results of Formal Language and Cognitive
Testing
  • Rationale
  • Limited research on pragmatic language abilities
    in adults with PD.
  • Narrative language requires sophisticated
    discourse planning.
  • May be compromised in adults with PD, secondary
    to deficits in abstract cognitive and higher
    level language abilities.
  • Conversations and personal narratives are
    inherent to everyday life.
  • Results may provide useful insights for
    intervention.
  • Potential impact on quality of life for
    individuals with PD.
  • Macrostructure Narrative Analyses
  • Both provided a title and named the three main
    characters in the story.
  • Fewer references to the internal responses of
    the characters in the narrative of the
    participant with PD.
  • Participant with PD did not use child-directed
    register used complex vocabulary.
  • The control participant asked several questions
    directed to the child also defined certain
    complex words.
  • Participant with PD did not provide an adequate
    resolution to the problem in the story.
  • Lack of prosodic inflections or humor in the
    narrative of the participant with PD when
    compared to control.
  • Microstructure Narrative Analyses
  • Ambiguous referents and lexical errors present
    in the narrative of the PD participant.
  • Higher percentage of pauses and reformulations
    in PD participants narrative.
  • Research Questions
  • What are the narrative language abilities of
    adults with PD?
  • Are there differences between the narrative
    abilities of adults with PD and age, gender, and
    education-matched controls?

  • Discussion
  • Formal language test results
  • Deficits in identifying resolving ambiguities
    making appropriate inferences.
  • Better performance on pragmatic sub-test on
    CASL.
  • Possibly attributable to ease of task leading to
    ceiling effects.
  • Results of cognitive testing
  • 7 participants scored in below average to
    average range. Individual differences seen
    higher performance on narrative task formal
    language testing not always seen in the more
    able individuals.
  • Suggests that language deficits may exist in
    some non-demented individuals with PD.
  • Narrative language samples indicate deficits in
    - orienting the speaker to the story providing
    unambiguous information referencing the internal
    responses of the characters and in making
    appropriate inferences.
  • Deficits may be secondary to abstract cognitive
    and higher language ability deficits.
  • Higher percentage of pauses and reformulations,
    and lack of prosodic inflections attributable to
    motoric deficits.
  • Pragmatic effects of speech deficits include
    communicative breakdowns leading to deficits in
    functional communicative competence of speakers
    with PD.
  • Future directions
  • Pilot work supports further investigation of
    narrative and other pragmatic language abilities
    in adults with PD.
  • Recruitment of age, gender and education-matched
    controls needed.
  • Expanding analysis from narrative to other
    contexts, including conversations.
  • Development of language assessment protocol for
    assessing adults with PD may assist in
    identifying pragmatic deficits that affect
    quality of life.

Table 3 Percentage of pauses, mazes, and
narrative cohesion
  • Method
  • Participants
  • 12 adults with PD, aged 63-89 years, 4 females
    and 8 males.
  • 10 lived in the community 2 lived in a nursing
    home.
  • Duration of disease ranged from 3-12 years.
  • Number of years of education ranged from 13-22
    years.
  • Procedure
  • Participants were initially administered the
    following cognitive and language tests.
  • Dementia Rating Scale, 2nd Ed. (DRS-2 Jurica,
    Leitten, Mattis, 2001).
  • Peabody Picture Vocabulary Test (PPVT-III B
    Dunn Dunn, 1997).
  • Three sub-tests assessing pragmatic language
    abilities from the Comprehensive Assessment of
    Spoken Language (CASL Carrow-Woolfolk, 1999).
  • Participants were then asked to familiarize
    themselves with the story from a wordless picture
    book Frog, where are you? (Mayer, 1969). They
    were then instructed to narrate the story as if
    they were telling it to a child.
  • The narrative samples were audio and video
    recorded.
  • Data analysis
  • The narratives were transcribed using the
    Systematic Analysis of Language Transcripts
    (SALT Miller Chapman, 2000).
  • The first author then analyzed the narrative
    samples based on the existing coding systems in
    the literature.
  • Results (Macrostructure Narrative Analyses)
  • 50 of narratives were characteristic of
    embedded episodes.
  • Detailed descriptions of the events in the
    story. However, lack of contiguity between
    episodes.
  • 3 participants provided a title.
  • 4 participants named the characters in the
    story.
  • Limited references to the internal responses of
    the characters.
  • 5 participants made the appropriate inference of
    the story ending.
  • 3 participants did not provide an adequate
    resolution to the problem. One participant did
    not even identify the problem.
  • Only 3 participants used a child-directed
    register.
  • Lack of prosodic inflections to indicate novel
    events or absurdities.
  • References
  • Berg, E., Bjornram, C., Hartelius, L., Laakso,
    K., Johnels, B., (2003). High level language
    difficulties in Parkinsons disease. Clinical
    linguistics phonetics,17, 63-80.
  • Carrow-Woolfolk, E. (1999). Comprehensive
    Assessment of Spoken Language. Circle Pines, MN
    American Guidance Service.
  • Dunn, T., Dunn, L. (1997). Peabody Picture
    Vocabulary Test-III. Circle Pines, MN American
    Guidance Service.
  • Grossman, M., Lee, C., Morris, J., Stern, M. B.,
    Hurtig, H. I. (2002). Assessing Resource
    Demands during Sentence Processing in Parkinsons
    Disease. Brain and Language, 80, 603-616.
  • Gurd, J. M. (2000). Verbal fluency deficits in
    Parkinsons disease individual differences in
    underlying cognitive mechanisms. Journal of
    Neurolinguistics, 13, 47-55.
  • Hough, M. S. (2004). Generative word fluency
    skills in adults with Parkinsons disease.
    Aphasiology, 18, 581-588.
  • Hughes, D., McGillivray, L., Schmidek, M.
    (1997). Guide to narrative language. Eau Claire,
    WI Thinking Publications.
  • Jurica, P. J., Leitten, C. L., Mattis, S.
    (2001). Dementia Rating Scale-2. Lutz, FL
    Psychological Assessment Resources.
  • Kemmerer, D. (1999). Impaired comprehension of
    raising-to-subject constructions in Parkinsons
    disease. Brain and Language, 66, 311-328.
  • Lewis, F. M., Lapointe, L. L., Murdoch,, B. E.,
    Chenery, H. J. (1997). Language impairment in
    Parkinsons disease. Aphasiology, 12, 193-206.
  • Liles, B., Coelho, C., Duffy, R., and Zalagens,
    M. Effects of elicitation procedures on the
    narratives of normal and closed head-injured
    adults. Journal of Speech and Hearing Disorders,
    54, 356-365.
  • Mayer, M. (1969). Frog, where are you? New York
    Puffin Books.
  • McNamara, P. Durso, R. (2003). Pragmatic
    communication skills in patients with Parkinsons
    disease. Brain and Language, 84, 414-423.
  • Miller, J. Chapman, R. (2000). Systematic
    Analysis of Language Transcripts. Madison, WI
    University of Wisconsin Language Analysis Lab.
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