Compensatory strategies in picture description across severity levels in Alzheimer's disease: A longitudinal study

Abstract

Communication changes over time were studied in 55-persons with Alzheimer's disease (AD) who completed a picture description task at entry, six, and 12-months. Differences at three levels of AD severity (early, middle, late) were investigated using six discourse measures (total utterances, length of utterance, words, abandoned utterances, information units, and conciseness), and six pragmatic measures (questions, turns, unsure statements, judgments, egocentric comments, and giving names). Across all three groups, subjects were less concise over time, made shorter utterances, asked more questions, and provided fewer information units. Increasing percentages of subjects made unsure statements with time. However, performance varied by severity group, with increasing unsureness occurring only at early AD, and all other observed changes occurring at late AD. Persons with AD appear to strive for communication competence as language declines by increasing certain compensatory pragmatic aspects (questions and unsure statements) at different severity levels of the disorder. This suggests that compensatory pragmatic devices are used with flexibility, and that the desire to communicate is maintained throughout the course of AD.