WIDEN FRONTIERS

Alzheimer's disease (AD) has become the most common form of dementia in the world. Nowadays, it does not raise only a scientific, human and healthy challenge, but also a social and family one. AD is a progressive, degenerative disease that destroys vital brain cells. AD affects memory systems as well as cognitive and executive functions; that is, AD damages the ability to think, to remember, to speak and to make decisions. In addiction to affecting a person’s mental abilities, the disease can also lead to other problems such as emotional and behavioural changes, confusion and disorientation in time and space.

In the early stage of the disease, apart from memory systems, language becomes one of the affected cognitive functions. Until now, the greater part of linguistic research in AD accounts for semantic dificulties at a lexical level and their neural correlates (Imamura 1998; Venneria et al., 2008; Costa et al., 2008; Apostolova et al., 2008). These discoveries are relevant because they do not contribute only to the study of the conceptual organization of the information in the brain, but also of the anatomical ground of semantic degradation.

However, if we consider aging as a complex process, given its multi-directionality and the great internal and external variables that take part in the process, we should think about aging from a global and multidisciplinary perspective in order to comprehend the nature of aging. Also, we should keep in mind that scientists are neither exactly sure why cells fail in AD, nor have they yet identified any single cause. Because of this, one might expect that this disease has a multifactorial reason, with the greatest risk factor being increasing age. As aging, AD entails a complex process and it is not enough to think that language problems in AD are mainly characterised by a shrinking vocabulary and decreased word fluency; we must study, therefore, language within these processes from a wide perspective, beyond the lexical level.

To my knowledge, I consider Discourse Studies as the most suitable discipline for research in the communicative and linguistic dimensions in AD. It is the richest area in Neurolinguistics dealing with the complex interaction among language, cognition and brain. Thus, Discourse Studies could generate a multidisciplinary study framework around language research in AD. According to the literature, studies on the interplay between discourse processing and memory systems (Kintsch et al., 1999; Caspari, I., y Parkinson, Stanley R., 2000) as well as on discourse processes and its neural correlations have been published (Nieuwland, M. S. & van Berkum, Jos J. A. 2006; Troiani et al., 2006; Baggio et al., 2008; van Berkum et al., 2008; Martín-Loeches et al., 2008). Despite these studies, research into Alzheimer Discourse, in this particular field, hardly exists (Ash et al., 2006).

Previous research into Discourse Studies and Alzheimer’s Disease has focused, essentially, on discourse semantic level (Ulatowska, H. K. & Chapman, S. B. 1991; Vuorinen et al., 2000; Dijkstra et al., 2003; Ash et al., 2004; Ash et al., 2007). Additionally, there exist studies covering the pragmatic and sociolinguistics aspects of Alzheimer Discourse (Ramanathan 1995; Ramanathan 1997; Perkins et al., 1998; Keller, J., y Rech, T., 1998; Hamilton 1994; Hamilton 2008) as well as relatively new studies on research in artificial intelligenge (AI) for which the general motivation is to construct testable computational models that will enhance understanding of the effects of AD on communication and, specifically, to develop a computer program for training caregivers in use of assistive techniques for social conversation with persons in their care affected by AD (Green 2002; Green & Davis 2003; Green 2004).

All these different perspectives on Alzheimer Discourse research allow us to achieve an integral comprehension of how the real communication of persons living with AD is. In spite of these studies (among others), there are still not many researchers doing this kind of work; thus, more investigation in all dimensions of Alzheimer Discourse (such as pragmatic, semantic, sociolinguistic, neurologic, cognitive, technological (AI) and so on) is needed. I would like highlight the importance of crossing disciplinary boundaries in order to obtain a complete understanding about discourse and Alzheimer. That is, Discourse Studies will permit us 1) to comprehend how language is used by patients with this disease in many contexts, both experimental and natural; 2) to find out how discourse processing is carried out at a neural level and how discourse interplays with memory systems and cognitive aspects as well.

All these reflections make up part of my PhD project, which has also a therapeutic motivation: setting up new more natural and contextualized therapies in order to stimulate communicative skills of people suffering of Alzheimer. Some of these therapies could be thought through Yoga practice, which could improve in a creative way their mental (cognitive) and body balance.

ART THERAPY FOR ALZHEIMER'S

Museums across USA are reaching out to people with Alzheimer's in order to bring the soothing power of art into the minds of those tackling dementia. The Museum of Modern Art in New York recently received a major, two-year grant from the MetLife Foundation to expand its "Meet Me At MoMA" program, which offers small group sessions and workshops for people in the early to mid stages of Alzheimer's. Other museums, including the Museum of Fine Arts in Boston and the Virginia Museum of Fine Arts in Richmond, offer similar programs.

The museum is also conducting a study, in conjunction with the New York University School of Medicine, to assess the effects of art therapy on those with Alzheimer's disease. The "Meet Me at MoMA" program guides people with Alzheimer's through lively discussions of works by modern masters like Henri Matisse, Jackson Pollock and Andy Warhol. MoMA, like other museums, offers weekly or monthly tours for people in the early to middle stages of Alzheimer's disease. Individuals are encouraged to discuss the works and to express whatever thoughts and emotions come to mind. Seeing art and talking about it, like creating art, is thought to release trapped emotions and engage parts of the brain that keep the mind active and the memory intact. In fact, art may prove a vital creative outlet for many with the disease who can no longer read or have trouble speaking or understanding words. Art, like music, seems to touch areas deep in the brain that are vital for well-being and emotional health, regardless of age or mental capacities. That's why both art and music therapy are increasingly being used for people with Alzheimer's disease.

As a researcher interested in new natural treatments for persons with Alzheimer's Disease, I would like to take this news item to highlight the innovative project of Dr. Heidi Hamilton on “Talk in Response to Paintings: A Pilot Study of the Intersection of Art, Dementia, and Discourse" (in collaboration with Dr. John Zeisel, President, of Hearthstone Alzheimer Care Ltd., Massachusetts, founder of the “Artists for Alzheimer’s” program, and Dr. Mike Bird, Senior Clinical Psychologist, Greater Southern Area Health Service, Queanbeyan, New South Wales), August 2007-present. This study focuses on linguistic analysis in order to provide powerful evidence of the cognitive and social effects of such programs on participants. According to Dr. Hamilton, the findings of this study will illuminate contextual features of the complex relationship between language and Alzheimer’s disease while simultaneously providing an important step toward improving the everyday lives of people living with this disease.

Picture: By Robert Deutsch, USA TODAY

ALZHEIMER'S RSS SPEECH THERAPY

Web site related to new articles on language and AD

Click here: Alzheimer's Speech Therapy

MANAGEMENT OF KNOWLEGDE IN ALZHEIMER'S DISEASE

A new study published in Neuropsychology suggests that patients with AD seem to have trouble determining which pieces of information are more important than others. The researchers, led by Alan D. Castel of the University of California, Los Angeles, based their conclusions on a study of 109 people with an average age of 75. Some were in early stages of Alzheimer's, while others were cognitively healthy. Selecting what is important to remember, attending to this information, and then later recalling it can be thought of in terms of the strategic control of attention and the efficient use of memory. To examine whether aging and Alzheimer’s disease (AD) influenced this ability, the present study used a selectivity task, where the volunteers were asked to memorize a series of words, each of which had a point value associated with it. The higher the value of the word, they were told, the more important it was to remember it. The researchers said it might be that in early Alzheimer's the brain was already becoming less efficient at learning and memorizing. They added that it might be possible to train patients to improve their memory strategies.

New evidence suggests that in Alzheimer's Disease part of the initial impairment lies in attentional control (see Balota & Faust, 2001, and Perry & Hodges, 1999) and it can lead to impairments in:

(1) Enconding and maintaining relevant information in Working Memory
(2) Inhibitory control
(3) Retrieval and response control

According to this study, the ability to selectively encode information is likely dependent on several possibly interrelated abilities, including inhibitory control, working memory capacity, monitoring, and metacognitive control related to using performance on previous trials to update resource allocation strategies. Although previous research has widely documented impairments in memory in old age and AD, the present study shows that AD is also associated with a specific deficit in being selective and strategic about encoding operations, which likely contributes to their poorer memory efficiency.

Personally, I think that the results of this study are very interesting to gain an insight also into the nature of communication impairments in Alzheimer. Both, memory-attention and communication deficits are interconnected, so that, I am focusing my thesis project on how persons with AD manage knowledge in talk. I consider that, at the same time, it should be appropriated to carry out new studies on that issue but beyond the word-level and well-controlled experimental environments. That is, research with ecological validity into how persons with AD communicate and interact with their interlocutors in real world-settings are needed in order to comprehend how these strategies for knowledge management are set and which their real deficits in communication, memory and attention are.

Journal reference:

Alan D. Castel, David A. Balota, and David P. McCabe. Memory Efficiency and the Strategic Control of Attention at Encoding: Impairments of Value-Directed Remembering in Alzheimer's Disease. Neuropsychology, Vol. 23, No. 3

LINGUISTIC STUDY OF AGATHA CHRISTIE'S BOOKS CLAIMS SHE HAD ALZHEIMER

An in-depth analysis of Agatha Christie's novels has suggested that she was suffering from Alzheimer's disease. Academics at the University of Toronto studied a selection of Christie's novels written between the ages of 28 and 82, counting the numbers of different words, indefinite nouns and phrases used in each. They found that the vocabulary size decreased sharply, while repetition of phrases and indefinite word usage (something, thing, anything) in her novels increased significantly. "These language effects are recognised as symptoms of memory difficulties associated with Alzheimer's disease" said Dr Ian Lancashire from the English department and computer scientist Dr Graeme Hirst.

Although Christie, whose books have sold over two billion copies worldwide, was never diagnosed with dementia, the authors of the study conclude that the changes in her writing are consistent not with normal ageing, but with Alzheimer's disease. The Canadian study supports a 2004 comparison of two early works by Iris Murdoch with her last novel, Jackson's Dilemma, which concluded that textual analysis could be used to detect the onset of dementia before anyone [has] the remotest suspicion of any untoward intellectual decline".Jackson's Dilemma was published in 1995 to a poor critical reception, and Murdoch was found to have Alzheimer's the following year. Scientists from the Institute of Cognitive Neuroscience at University College London compared it to earlier works Under the Net and The Sea, The Sea, and found that her vocabulary had worsened in the final work, which contained fewer words and clauses per sentence on average.
Lancashire and Hirst are now continuing and extending their study, looking into changes in Christie's use of passive verbs and the decline in her syntactic complexity. They also want to compare her writing with the work of a contemporary for whom dementia is not suspected.

Source: guardian.co.uk at 13.53 BST on Friday 3 April 2009

SOCIAL INTERACTIONS AND MENTAL FUNCTIONING

Spending just 10 minutes talking to another person can help improve your memory and your performance on tests, according to a University of Michigan study."In our study, socializing was just as effective as more traditional kinds of mental exercise in boosting memory and intellectual performance," said Oscar Ybarra, a psychologist at the U-M Institute for Social Research (ISR) and a lead author of the study with ISR psychologist Eugene Burnstein and psychologist Piotr Winkielman from the University of California, San Diego.
This experiment shows that social interaction directly affects memory and mental performance in a positive way and it suggests that social isolation may have a negative effect on intellectual abilities as well as emotional well-being.

About the research

COMMUNICATION AND KNOWLEDGE

Discourse processing certainly represents an aspect of verbal communication that will allow bridge between more classically language-related aspects of cognition and other aspects of cognition that are not exclusive to language but nonetheless allow optimal interpersonal communication abilities. Studying discourse together with other disciplines could help us to understand different aspects which take part in communication processes and could be impaired in Alzheimer communication: how we perceive the world, remember things, comprehend social and linguistic events, and act effectively to satisfy one's needs.

Studies in discourse impairments in brain-damaged individuals should systematically incorporate an appreciation of all cognitive abilities that are necessary in order to achieve normal interpersonal communication (working memory, semantic memory, attention, inferential abilities, visual skills...) Also these studies should propose approaches that enable capturing inter and intra subject variability.

The major issue between persons living with AD and the people who interact with them is communication. We need to really listen, to make sure that we understand and are understood.

How people acquire and represent knowledge about their world, how they organize and use that knowledge, how they use language in speaking. This is a complex cognitive skill. So that, the management of knowledge is a complex cognitive skill and I suggest to focus the study of Alzheimer discourse on that issue: Which is the rol of knowledge in dicourse production and comprehension?